联合应用CT淋巴管成像与^(99m)Tc-DX淋巴显像在原发性乳糜性心包积液中的诊断价值  

The Value of CT Lymphangiography Combined with^(99m)Tc⁃DX Lymphoscintigraphy in Diagnosing Primary Chylopericardium

作　　者：张怡梦 文哲 李兴鹏 刘梦珂 张晓杰 童冠圣 王仁贵[1] ZHANG Yimeng;WEN Zhe;LI Xingpeng(Department of Radiology,Capital Medical University,Beijing Shijitan Hospital,Beijing 100038,P.R.China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射科,北京100038 [2]首都医科大学附属北京世纪坛医院核医学科,北京100038

出　　处：《临床放射学杂志》2024年第4期549-554,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金资助项目(编号:61876216)。

摘　　要：目的探讨^(99m)Tc-DX淋巴显像和CT淋巴管成像(CTL)联合应用在原发性乳糜性心包积液中的诊断价值。方法回顾性分析经临床确诊的48例原发性乳糜性心包积液患者,所有患者均行^(99m)Tc-DX淋巴显像和CTL。根据^(99m)Tc-DX淋巴显像表现进行分型:Ⅰ型为异常浓聚型,表现为左颈静脉角处异常放射性浓聚,Ⅱ型为异位引流型,表现为右颈静脉角区对比剂持续性浓聚,伴或不伴有左颈静脉角放射性浓聚,Ⅲ型为未显影或一过性显影型,表现为左颈静脉角未显影或在检查过程中一过性显影。CTL的评价指标包括:(1)颈部、锁骨下区、胸导管末端、右淋巴导管末端及腋窝对比剂异常分布及反流;(2)胸部对比剂异常分布,包括胸深部(前纵隔、主肺动脉窗、气管及支气管周、隆突下、后纵隔、肺门、支气管血管束周围、心包等)对比剂异常分布,胸浅部(肋间、胸膜、横膈上)对比剂异常分布;(3)胸导管扩张是指胸导管最宽径>3 mm为扩张;(4)横膈下、同侧髂组、腰干对比剂异常分布,对侧髂组、对侧腰干反流,腹膜后对比剂异常分布。并将各组CTL表现进行统计学分析,P<0.05为差异有统计学意义。结果48例患者^(99m)Tc-DX淋巴显像Ⅰ型12例,Ⅱ型14例,Ⅲ型22例,原发性乳糜性心包积液的各组CTL评价指标中,后纵隔对比剂异常分布的发生率,Ⅰ型大于Ⅲ型,差异有统计学意义(P=0.003),心包及主肺动脉窗对比剂异常分布的发生率,^(99m)Tc-DX淋巴显像Ⅰ型大于Ⅲ型,差异有统计学意义(P=0.008),双颈部或锁骨下区对比剂异常分布的发生率,^(99m)Tc-DX淋巴显像Ⅱ型大于Ⅲ型(P=0.002),差异有统计学意义。结论^(99m)Tc-DX分型反映了原发性乳糜性心包积液患者的胸导管病变及心包积液性质,CTL显示全身淋巴管是否异常及淋巴管外病变,两种方法联合应用,对于原发性乳糜性心包积液的定位和定性诊断、判断病变程度和累及范围�Objective To investigate the diagnostic value of combined^(99m)Tc⁃DX lymphoscintigraphy and CT lymphangi⁃ography(CTL)in primary chylopericardium.Methods Forty⁃eight patients diagnosed with primary chylopericardium clinically were retrospectively analyzed,and^(99m)Tc⁃DX lymphoscintigraphy and CT lymphangiography(CTL)were performed in all patients.According to the^(99m)Tc⁃DX lymphoscintigraphy results,primary chylopericardium was classified into three types:type I(abnormal concentration pattern,abnormal radioactive concentration at the angle of the left jugular vein),type II(ectopic drainage pattern,persistent concentration of contrast in the right jugular angle with or without radiographic con⁃centration in the left jugular angle),and typeⅢ(without image or transient image pattern,no visualization of the left jugular vein angle or a transient visualization during the examination).The evaluation indexes of CTL include:(1)abnormal distri⁃bution of contrast and reflux in the neck,subclavian region,end of thoracic duct,end of right lymphatic duct and axilla;(2)abnormal distribution of contrast in the chest,including abnormal distribution of contrast in the deep thorax(anterior medi⁃astinum,aortopulmonary window,peri⁃tracheal and bronchial,inferior bulge,posterior mediastinum,hilum,peri⁃bronchial vascular bundle,pericardium,etc.),abnormal distribution of contrast in the superficial thorax(intercostal,pleura);(3)di⁃lated thoracic duct was defined as dilated when the widest diameter of thoracic duct was>3 mm;(4)abnormal distribution of contrast agent in sub⁃diaphragm,ipsilateral iliac group,lumbar trunk,abnormal distribution of contrast agent in contralat⁃eral iliac group,contralateral lumbar trunk,abnormal distribution of retroperitoneal contrast agent.CTL characteristics were analyzed between different groups,and P<0.05 was considered a statistically significant difference.Results Primary chylopericardiumin 48 patients showed 12 cases of^(99m)Tc⁃DX lymphoscintigraphy imaging typeⅠ,14 pat

关 键 词：原发性乳糜性心包积液 淋巴管成像 ^(99m)Tc-DX淋巴显像 体层摄影术 X线计算机 胸导管 

分 类 号：R542.12[医药卫生—心血管疾病] R816.2[医药卫生—内科学]