| 文哲,童冠圣,刘勇,刘璐,陈道桢,孙晋,沈文彬.对比99Tcm-DX与99Tcm-HAS显像诊断小肠淋巴管扩张症[J].中国医学影像技术,2014,30(5):772~775 |
| 对比99Tcm-DX与99Tcm-HAS显像诊断小肠淋巴管扩张症 |
| Diagnosis of intestinal lymphangiectasia： Comparison of 99Tcm-DX and 99Tcm-HAS scintigraphy |
| 投稿时间：2013-12-03 修订日期：2014-03-20 |
| DOI： |
| 中文关键词: 小肠淋巴管扩张症 放射性核素显像 诊断显像 |
| 英文关键词:Intestinal lymphangiectasia Radionuclide imaging Diagnostic imaging |
| 基金项目:国家自然科学基金（81372480、81202032）。 |
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| 中文摘要: |
| 目的 比较99Tcm-DX与99Tcm-HSA显像对小肠淋巴管扩张症的诊断效能。方法 收集56例低蛋白血症患者，均在7天内接受99Tcm-DX与99Tcm-HSA显像；以病理检查、胶囊肠镜或临床最终诊断作为“金标准”，评价2种检查方法的诊断效能，应用Kappa检验分析这两种方法的一致性。结果 38例（38/56，67.86%）最终诊断为IL，其中原发性IL34例，继发性IL4例；余18例中，10例诊断为乳糜性单或多浆膜腔积液，1例为肾病综合征，2例为不明原因失蛋白性肠病，5例为不明原因低蛋白血症。99Tcm-DX与99Tcm-HSA显像诊断IL的灵敏度分别60.53%（23/38）、94.73%（36/38），特异度为88.89%（16/18）、61.11%（11/18），准确率为69.64%（39/56）、83.93%（47/56），阳性预测值为92.00%（23/25）、83.72%（36/43），阴性预测值为51.61%（16/31）、84.62%（11/13）；两者诊断符合率为67.85%（38/56，Kappa=0.392，P<0.05）。结论 99Tcm-HSA显像诊断IL的灵敏度较高，而99Tcm-DX显像的特异度较高，两者结合可能有助于提高诊断IL的准确性。 |
| 英文摘要: |
| Objective To compare the diagnostic efficacy of 99Tcm-DX and 99Tcm-HSA scintigraphy for intestinal lymphangiectasia (IL). Methods A total of 56 patients of hypoalbuminemia suspected of IL were enrolled. All patients underwent 99Tcm-DX and 99Tcm-HSA scintigraphy within 7 days of clinical presentation. Pathological findings, capsule endoscopy or the final clinical diagnosis were considered as the golden standards. Kappa test was used to analyze the concordance between the two image modalities. Results Thirty-eight patients (38/56, 67.86%) were finally diagnosed as IL, including 34 of primary intestinal lymphangiectasia and 4 of secondary intestinal lymphangiectasia. The other 18 patients were respectively diagnosed with single or multiplechylous cavity effusion (n=10), nephrotic syndrome (n=1), unexplained protein losing enteropathy (n=2) or unexplained hypoalbuminemia (n=5). The sensitivity, specificity and accuracy of 99Tcm-DX and 99Tcm-HSA scintigraphy were 60.53% (23/38) and 94.73% (36/38), 88.89% (16/18) and 61.11% (11/18), 69.64% (39/56) and 83.93% (47/56), respectively. The positive predictive value and negative predictive value of 99Tcm-DX and 99Tcm-HSA scintigraphy was 92.00% (23/25) and 83.72% (36/43), 51.61% (16/31) and 84.62% (11/13), respectively. Diagnostic consistency of 99Tcm-DX and 99Tcm-HSA scintigraphy was 67.85% (38/56, Kappa=0.392, P<0.05). Conclusion 99Tcm- HSA scintigraphy has high sensitivity in diagnosis of IL, while 99Tcm-DX scintigraphy has high specificity. Combining 99Tcm-DX and 99Tcm-HSA scintigraphy may improve diagnostic accuracy of IL. |
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