^(99m)Tc-二乙基乙酰苯胺亚氨二醋酸肝胆断层显像在先天性胆道闭锁鉴别诊断中的价值

The value of99mTc-EHIDA hepatobiliary section imaging in the differential diagnosis of extrahepatic biliary atresia

目的评价99mTc-二乙基乙酰苯胺亚氨二醋酸(99mTc-EHIDA)肝胆断层显像在先天性胆道闭锁(EHBA)鉴别诊断中的价值。方法回顾性分析2000年8月至2011年9月自山东大学齐鲁医院小儿内、外科138例持续性黄疸患儿资料。比较患儿行单纯99mTc-EHIDA肝胆动态显像(平面显像)及99mTc-EHIDA肝胆动态显像(平面显像)加做99mTc-EHIDA肝胆断层显像(断层显像)两种显像结果的差异。结果肝胆平面显像诊断EHBA结果为:真阳性32例,假阳性40例、真阴性59例,假阴性7例;诊断EHBA的灵敏度为82%(32/39)、特异性为60%(59/99)、准确性为66%(91/138)、阳性预测值为44%(32/72)、阴性预测值为89%(59/66)。平面显像加作肝胆断层显像对EHBA诊断结果为:真阳性39例,假阳性24例、真阴性75例,假阴性0例;诊断EHBA的灵敏度为100%(39/39)、特异性为76%(75/99)、准确性为83%(114/138)、阳性预测值为62%(39/63)、阴性预测值为100%(75/75)。两种显像方法比较,在诊断EHBA的灵敏度、特异性、准确性、阳性预测值、阴性预测值方面差异均有统计学意义(P<0.05或0.01)。结论99mTc-EHIDA肝胆平面显像加作断层显像能降低诊断EHBA的假阳性及假阴性,提高对EHBA的鉴别诊断效能。

Objective To evaluate the value of^99mTc-diethyl iminodiacetic acid（EHIDA）hepatobiliary section imaging（section imaging）in the differential diagnosis of extrahepatic biliary atresia（EHBA）. Methods Retrospective data were collected from 138 infants with persistent jaundice. Two results were gained by^99mTc-EHIDA hepatobiliary dynamic imaging（surface imaging）and surface imaging combining section imaging,respectively. The difference of two results were compared by χ^2- test of four-fold table. Results In surface imaging,the diagnosis results of EHBA were true positive in 32,false positive in 40,true negative 59,false negative 7. The diagnostic evaluation index was saitivity 82%（32/39）,specificity 60%（59/99）,accuracy 66%（91/138）,positive predictive value 44%（32/72）and negative predictive value 89%（59/66）. In surface combining section imaging,the diagnosis results of EHBA were true positive in 39,false positive 24,true negative 75,false negative 0;the diagnostic evaluation index was saitivity 100%（39/39）,specificity 76%（75/99）,accuracy 83%（114/138）,positive predictive value 62%（39/63）and negative predictive value 100%（75/75）. Comparing the results of the two methods,there was statistical significance（P0.05 or 0.01）in saitivity,specificity,accuracy,positive predictive value and negative predictive value for EHBA. Conclusion For EHBA,the surface imaging combining section imaging can depress the false positive rate and the false negative rate,thus improving differential diagnosis efficacy.