摘要
目的探讨99Tcm-二乙基乙酰苯胺亚氨二醋酸(99Tcm-EHIDA)肝胆断层显像和γ-谷胺酰转肽酶(γ-GT)对婴儿持续性黄疸的鉴别诊断价值。方法肝胆动态平面显像1h内未见明确肠道放射性出现的127例持续性黄疸患儿,6～8h进行肝胆断层显像及滤波反投射三维重建,排除体表及其他脏器放射性干扰的基础上,重点观察有无肠道放射性出现和功能性胆囊显影,所有患儿进一步接受24h肝胆平面延迟显像和显像前血清γ-GT测定,参照临床最终诊断评价其诊断效能和联合应用价值。结果99Tcm-EHIDA肝胆平面显像诊断先天性胆道闭锁(BA)和婴儿肝炎综合征(IHS)的灵敏度、特异性、准确性、阳性预测价值、阴性预测价值分别为85.7%、59.8%、71.7%、49.2%、91.7%和59.8%、85.7%、71.7%、91.7%、49.2%;联合6～8h肝胆断层显像,诊断BA和IHS的灵敏度、特异性、准确性、阳性预测价值、阴性预,测价值分别提高至97.1%、73.9%、80.3%、58.6%、98.6%和73.9%、97.1%、80.3%、98.6%、58.6%。对日龄<60d组,以γ-GT≥300U/L作为BA的诊断标准,诊断BA和IHS的灵敏度、特异性、准确性分别为60.9%、87.7%、80.0%和87.7%、60.9%、80.0%。对日龄<60d,肝胆显像(平面加断层,以下简称肝胆联合显像)持续未见功能性胆囊影和(或)肠道放射性的37例患儿,联合检测血清γ-GT,对BA的诊断特异性和对IHS的诊断灵敏度均提高至91.2%。结论99Tcm-EHIDA肝胆断层显像对BA和IHS的诊断效能明显高于24h延迟平面显像,对日龄<60d者,肝胆联合显像和血清γ-GT具有较好的联合应用价值。
Objective To evaluate the differential diagnosis value of technetium - 99m - diethvl - iminodiaeelie acid （^99Tc^m - EHIDA ） hepatohiliary section imaging and gamma - glutamyltraasferase （ γ- GT） in diagnosis of persistent infantile jaundice. Methods One hundred and twenty - seven persistent jaundice infants who showed no definite radioactivity in the intestine on the hepatobiliary dynamie planar imaging during the first hour after the administration of ^99Tc^m - EHIDA underwent hepatobiliary section imaging and following filtration backup projection three - dimensional reconstruction. The focus of interest was the visualization of radioactivity in the intestine and the appearance of the functional gallbladder. All infants accepted the 24 h delayed planar imaging and serum γ - GT examination in advance, The diagnostie value and combined application of hepatobiliary imaging and serum γ - CT were evaluated according to their final diagnosis. Results The sensitivity,specifieity, accuracy, positive predictive value and negative pasitive predictive of 24 h delayed hepatnbiliary planar imaging in the diagnosis of biliary atresisa （ BA ） and infantile hepatitis symdrome （IHS） were 85.7% ,59.8% ,71.7% ,49.2% ,91.7% and 59.8% ,85.7% , 71.7% ,91. 7% ,49.2% ,respeetiveiy. The respective value for combined with hepatobiliary imaging （planar and section） were improved to 97.1% ,73.9% ,80.3% ,58.6% ,98.6% and 73.9% , 97.1% , 80.3% ,98.6% , 58.6%. The diagnostic sensitivity, specificity, accuraey to BA and IHS were 60.9% ,87.7% ,80.0% and 87.7% ,60.9% ,80.0% when γ - GT higher than 300 U/L was served as the criterion to the patient younger than 60 d. The diagnostic sensitivity to BA anti specificity to IHS had reached up to 91.2% when the γ - GT was considered to the patients with nonvisualization of radioactivity in gallbladder and（or） intestine. Conclusions The diagnoslie value of hepatobifiary section imaging in diagnosis of BA and IHS is higher than that of 24 h delayed planar imaging. ^99Tc^m - EHIDA hepatobiliary combined with imaging and serum γ- GT fan he united with better complementation to the differential diagnosis of jaundiced patients younger than 60 d.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第19期1510-1512,共3页
Journal of Applied Clinical Pediatrics
关键词
肝胆显像
断层显像
γ-谷胺酰转肽酶
胆道闭锁
婴儿肝炎综合征
hepatobiliary imaging
section imaging
γ - glutamyltransferase
biliary alresia
infantile hepatitis syndrome
