核素胃肠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 :探讨利用核素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10 2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为出血。结果 :发现出血 76例 ,其中因 4例右肾上极积水及麦克尔憩室而误诊为阳性。 2 6例阴性中 ,16例经其他检查明确了出血部位。检查灵敏度为 81 8% (72 / 88) ,特异性为 71 4 % (10 / 14)。对急性出血患者 ,该法灵敏度为 87 5 % (14/ 16 ) ,特异性为 77 7% (7/ 9) ;对慢性出血患者 ,灵敏度为 80 5 % (5 8/72 ) ,特异性为 6 0 0 % (3/ 5 )。 72例阳性中 ,显像发现的出血部位与病变部位相符合者 6 1例 ,定位准确率为84 7% (6 1/ 72 )。结论 :99mTc -RBC显像可明确消化道出血部位和范围 。

Objective:To investigate the accuracy of 99m Tc-RBC gastrointestinal imaging in the diagnosis of hemorrhage in the digestive tract.Method:A total of 102 cases suspected of gastrointestinal bleeding underwent conventional gastrointestinal scintigraphy with 99m Tc-RBC.The diagnostic criteria of bleeding was that abnormal radioactive accumulation in the abdomen observed,which extended along the gastrointestinal tract and thickened with the passage of time.Result:Gastrointestinal bleeding was found in 76 cases by the imaging examination,among them 4 were misdiagnosed due to Meckels diverticulum,hydronephrosis at the upper pole of the right kidney.In the 26 cases of negative hemorrhagic imaging findings,16 were found with bleeding by other diagnostic measures.The diagnostic sensitivity of 99m Tc-RBC imaging,decided on the basis of the above results,was 81.8% and the specificity was 71.4%.In 61 out of the 72 positive cases,bleeding sites found by 99m Tc-RBC imaging corresponded with those pathologically located,suggesting a diagnostic accuracy of 84.7%.Conclusion: 99m Tc-RBC gastrointestinal imaging is effective in the diagnosis of digestive tract hemorrhage,which helps to locate the bleeding sites and provide useful information for clinical management.