胸导管出口梗阻在^(99)T^(cm)-右旋糖酐淋巴显像中的影像特征  

Imaging features of^(99)T^(cm)-dextran lymphoscitigraphy in thoracic duct exports obstruction

作　　者：郑朋腾 童冠圣 Zheng Pengteng;Tong Guansheng(Department of Nuclear Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院核医学科,北京100038

出　　处：《中华核医学与分子影像杂志》2022年第5期274-278,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的通过^(99)T^(cm)-右旋糖酐(DX)淋巴显像与直接淋巴管造影(DLG)的比较,探讨^(99)T^(cm)-DX淋巴显像在胸导管出口(TDE)梗阻患者中的影像特征及价值。方法回顾性分析北京世纪坛医院2017年1月1日至2019年1月1日经胸导管末端手术探查证实的304例TDE梗阻患者(男140例,女164例,中位年龄32岁);根据TDE的不同显影特点将^(99)T^(cm)-DX淋巴显像结果分为Ⅰ~Ⅴ型(Ⅰ型:未显影;Ⅱ型:一过性显影;Ⅲ型:持续或增宽显影;Ⅳ型:显像剂异常反流;Ⅴ型:双侧静脉角显影),其中Ⅰ、Ⅱ型视为TDE异常显影阴性,Ⅲ~Ⅴ型视为TDE异常显影阳性,并分析^(99)T^(cm)-DX淋巴显像不同阳性类型与DLG检查的一致性。对数据行McNemar检验和Kappa检验分析。结果在TDE异常检测方面,^(99)T^(cm)-DX淋巴显像阳性率为70.1%(213/304),DLG阳性率为97.4%(296/304),^(99)T^(cm)-DX淋巴显像不及DLG(χ^(2)=4.16,P<0.001)。^(99)T^(cm)-DX淋巴显像阳性患者中,Ⅲ型占比最高,达54.9%(167/304),与DLG一致性低(Kappa=0.08,P=0.005);而在Ⅳ型及Ⅴ型患者中,^(99)T^(cm)-DX淋巴显像与DLG一致性Kappa值分别为0.48和0.86(均P<0.001)。在TDE梗阻所引起临床表现方面,^(99)T^(cm)-DX淋巴显像对下肢淋巴水肿及乳糜性积液的诊断与临床诊断的符合率分别高达96.1%(98/102)、83.6%(127/152)。结论TDE梗阻的^(99)T^(cm)-DX淋巴显像表现以Ⅲ型居多,在Ⅳ型及Ⅴ型患者中显像与DLG一致性较好。^(99)T^(cm)-DX淋巴显像可作为TDE梗阻的筛查手段,在诊断由TDE梗阻引起的下肢淋巴水肿、乳糜性积液方面具有重要的临床意义。Objective To compare the^(99)T^(cm)-dextran(DX)lymphoscitigraphy and direct lymphography(DLG),in order to investigate the imaging features and clinical significance of^(99)T^(cm)-DX lymphoscitigraphy in patients with thoracic duct exports(TDE)obstruction.Methods A total of 304 patients(140 males,164 females,median age:32 years)with TDE obstruction confirmed by thoracic duct exploration between 2017-01-01 and 2019-01-01 in Beijing Shijitan Hospital were retrospectively analyzed.Based on the different imaging characteristics of TDE,the reluts of^(99)T^(cm)-DX lymphoscitigraphy were divided into five groups(Ⅰ:no TDE presenting;Ⅱ:TDE presenting temporarily;Ⅲ:TDE presenting constantly or extensively;Ⅳ:abnormal reflux of imaging agents;Ⅴ:bilateral venous angle presenting).Ⅰ/Ⅱgroups were regarded as negative andⅢ-Ⅴgroups as positive.The consistency of^(99)T^(cm)-DX lymphoscitigraphy with DLG was evaluated with Kappa test,and the positive rates of the two methods were compared by McNemar test.Results In the detection of TDE,the positive rate of^(99)T^(cm)-DX lymphoscintigraphy was 70.1%(213/304),which was significantly lower than that of DLG(97.4%,296/304;χ^(2)=4.16,P<0.001).The groupⅢhas the largest number of cases(54.9%,167/304),and there was a low consistency with DLG(Kappa=0.08,P=0.005).However,there was a higher consistency between^(99)T^(cm)-DX lymphoscintigraphy results and the corresponding DLG results in the groupsⅣ/Ⅴ(Kappa values:0.48,0.86,both P<0.001).Furthermore,the diagnostic accordance rates of lower extremity lymphedema and chylous effusion were 96.1%(98/102)and 83.6%(127/152),respectively,compared with the clinical diagnosis.Conclusions TDE obstruction of^(99)T^(cm)-DX lymphoscitigraphy presents in the majority withⅢtype.^(99)T^(cm)-DX lymphoscitigraphy results in patients with typeⅣandⅤhave a better consistency with those of DLG.^(99)T^(cm)-DX lymphoscitigraphy can be used as a screening tool of TDE obstruction,and play a role in the diagnosis of lower limb lymphedema and

关 键 词：导管阻塞 胸导管 放射性核素显像 右旋糖酐类 锝 淋巴造影术 

分 类 号：R817.4[医药卫生—影像医学与核医学]