联合应用直接淋巴管造影后CT与^(99)Tc^(m)-DX淋巴显像在诊断乳糜性胸腔积液中的价值探讨

Exploration of the Value of Combined Application of Direct Lymphangiography Followed by CT and^(99)Tc^(m)-DX Lymphography in the Diagnosis of Chylothorax

目的通过联合应用直接淋巴管造影(DLG)后CT与^(99)Tc^(m)-右旋糖酐(DX)淋巴显像两种检查方法,探讨在诊断乳糜性胸腔积液中的价值。方法回顾性分析经临床确诊为乳糜性胸腔积液的51例患者的资料,所有患者均行DLG后CT和^(99)Tc^(m)-DX淋巴显像两种检查,观察其DLG后CT碘油分布的异常,以及^(99)Tc^(m)-DX淋巴显像后双下肢引流、胸导管和颈静脉角区放射性分布的异常。结果DLG后CT可显示大量颈部、胸部、腹部和盆部碘油的异常分布,^(99)Tc^(m)-DX淋巴显像显示静脉角区显影、持续和/或增宽显影,显示乳糜性胸腔积液、乳糜性腹腔积液和乳糜性心包积液,以及双下肢淋巴回流缓慢,双下肢淋巴肿。结论DLG后CT可清晰显示不同解剖部位的淋巴管异常,而^(99)Tc^(m)-DX淋巴显像从功能上反映乳糜性胸腔积液漏出的情况,联合应用二者可为该病的诊断及鉴别诊断提供有价值的影像学信息。

Objective To investigate the value of direct lymphangiography followed by CT and^(99)Tc^(m)-DX lymphography in the diagnosis of chylothorax.Methods We retrospectively analyzed the data of 51 patients who were clinically and/or pathologically diagnosed with chylothorax,and all of them underwent direct lymphangiography followed by CT and^(99)Tc^(m)-DX lymphography to observe the abnormal distribution of iodine oil after direct lymphangiography,as well as abnormal distribution of bilateral lower extremity drainage,thoracic duct,and jugular venous angulation area after^(99)Tc^(m)-DX lymphography.Abnormalities of radiologic distribution.Results CT after direct lymphangiography showed abnormal distribution of large amounts of iodine oil in the neck,chest,abdomen and pelvis,and^(99)Tc^(m)-DX lymphatic imaging showed venous angular regions showing,persistent and/or widened appearances showing chylothorax,chylous abdomen and celiac pericardial effusion,and bilaterally lower extremity slow lymphatic reflux and bilateral lower extremity lymphomas.Conclusion Direct lymphangiography followed by CT can clearly show lymphatic vessel abnormalities in different anatomical sites,whereas^(99)Tc^(m)-DX lymphatic imaging functionally reacts to the leakage of chylothorax,and the combined application of the two can provide valuable imaging information for the diagnosis and differential diagnosis of this disease.