^(99m)Tc-RBC胃肠道显像对消化道出血的诊断价值

Diagnosis of hemorrhage in the digestive tract using ^(99m)Tc-RBC gastrointestinal imaging

目的探讨９９ｍＴｃ－ＲＢＣ显像对消化道出血的诊断价值。方法对拟诊消化道出血的１１５例患者进行９９ｍＴｃ－ＲＢＣ胃肠 道显像，以首次发现腹部异常放射性浓聚区、浓聚影沿肠道下移且随时间逐渐增浓者诊断为出血。结果发现出血８３ 例，其中６例因麦克尔憩室、右肾上极积水及腹腔血管畸形而误诊阳性。３２例阴性中，１８例经其他检查明确了出血部 位。检查灵敏度为８１．１％（７７／９５），特异性为７０％（１４／２０）。对急性出血患者，该法阳性率为７５．０％（１２／１６），特异性为７５．０ （９／１２）；对慢性出血患者，阳性率为８２．３％（６５／７９），特异性为６２．５％（５／８）。８３例阳性者中，显像发现的出血部位与病变 部位相符合者７３例，定位准确率为８７．９％（７３／８３）。结论９９ｍＴｃ－ＲＢＣ显像可明确出血部位和范围，为临床治疗提供有用 的信息。

Objective: To investigate the accuracy of 99mTc-RBC gastrointestinal imaging in the diagnosis of hemorrhage in the digestive tract. Methods A total of 115 cases suspected of gastrointestinal bleeding underwent conventional gastrointestinal scintigraphy with 99mTc-RBC The diagnostic criteria of bleeding was that abnormal radioactive accumulation in the abdomen was observed, which extended along the gastrointestinal traet and thickened with the passage of time. Results Gastrointestinal bleeding was found in 83 cases by the imaging examination, among whom 6 were misdiagnosed due to Meckel's diverticulum, hydronephrosis at the upper pole of the right kidney or deformity of the blood vessels in the abdominal cavity. In the 32 cases of negative hemorrhagic imaging findings, 18 were found with bleeding by other diagnostic measures. The diagnostic sensitivity of99mTc-RBC imaging, decided on the basis of the above results, was 81 .l% (77/95) with specificity of 70% (14/20), which were respectively 75.0% (12/16) and 75.0% in cases of acute gastrointestinal bleeding, and 82.3% (65/79) and 62.5% (5/8) in cases of chronic bleeding. In 73 out of the 83 positive cases, bleeding sites found by 99mTc-RBC imaging corresponded with those pathologically located, suggesting a diagnostic accuracy of 87.9% (73/83). Conclusions 99mTc-RBC gastrointestinal imaging is effective in the diagnosis of digestive tract hemorrage, which helps locate the bleeding sites and provide useful information for clinical management.