^(99)Tc^m-二乙基乙酰替苯胺亚氨二醋酸显像在婴儿持续性黄疸鉴别诊断中的意义  

Significance of Differential Diagnosis of Technetium-99m-2,6-Diethylphenylcarbamoyl-Methyl-Diacetic Acid Imaging in Infants with Persistent Jaundice

作　　者：陈维安[1] 李春亿[1] 梁宏[1] 胡平[1] 张祥松[1] 

机构地区：[1]中山大学附属第一医院影像医学部核医学科,广州510080

出　　处：《实用儿科临床杂志》2007年第7期502-503,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨99Tcm-二乙基乙酰替苯胺亚氨二醋酸(99Tcm-EHIDA)肝胆显像对婴儿期持续性黄疸鉴别诊断的意义。方法369例持续性黄疸患儿进行99Tcm-EHIDA肝胆显像,动态观察肝胆系及肠道放射性核素排泄情况,分别获取5、30min,1h或延迟的影像,其中348例参照临床最终诊断进行评价。结果348例患儿中肠道显影90例,其中证实为婴儿肝炎综合征(IHS)70例,巨细胞病毒性肝炎13例,胆汁黏稠综合征5例,先天性胆管狭窄2例。肠道未显影258例,其中经手术、病理及临床转归确诊胆道闭锁(EHBA)208例,IHS17例,先天性肝内胆管扩张11例,胆总管囊肿6例,胆汁黏稠综合征8例,β-珠蛋白生成障碍贫血8例。99Tcm-EHIDA显像诊断EHBA灵敏度为100%,特异度为64.3%,准确度为85.6%;对IHS诊断的灵敏度为80.5%,特异度为92.3%,准确度为89.4%。结论99Tcm-EHIDA肝胆显像能无创、安全、较准确地鉴别EHBA与IHS,对于婴儿持续性黄疸治疗的选择有重要意义。Objective To evaluate differential diagnosis value of infants with persistent jaundice by technetium - 99m - 2,6 - diethylphe- nylcarbamoylmethyl -diacetic acid（ ^99 Tc^m - EHIDA） hepatobiliary scintigraphy. Methods There were 369 infants with persistent jaundice performed by ^99Tc^m -EHIDA hepatobiliary scintigraphy. It could display dynamic function imaging at 5 min ,30 min, 1 h or delay phase by ob- serving radioactivity excretion of hepatobiliary tract and intestine. Of them ,348 cases were appraised according to clinical diagnostic results. Resuits Of 348 infants,90 cases were showed radioactivity in intestine ;70 of 90 cases were proved infantile hepatitis symptoms（IHS） by follow - up;others including 13 cases cytomegalovirus hepatitis ,5 cases of cholestatic syndromes and 2 cases of congenital bile duct stricture. Of 3d8 infants ,258 cases were showed non -radioactivity in intestine..Among them ,208 cases were confirmed extrahepatic biliary atresia （EHBA） by postoperative histopathology, 17 cases were infantile hepatitis symptoms by clinical follow - up results ; others including 11 cases of congenital intrahepatic bile ducts dilatation ,6 cases of choledochal cysts ,8 cases of cholestatic syndromes, and 8 cases of β -thalassemia. The sensitivity of ^99Tc^m - EHIDA imaging in the diagnosis of EHBA was 100% ,and the specificity and accuracy were 64.3% and 85.6%. The sensitivity of imaging was 80.5% in the diagnosis of IHS, and the specificity and accuracy were 92.3% and 89.4%. Conclusions ^99Tc^m - EHIDA hepatobiliary scintigraphy can differentiate EHBA and IHS ,which is noninvasive, safe and reliable. It has definitely clinical value to the choice of therapy in infants with persistent jaundice.

关 键 词：黄疸 胆道 放射性核素显像 婴儿 

分 类 号：R725.7[医药卫生—儿科]