346例上尿路结石患者99Tcm-DTPA肾动态显像结果分析

目的 探讨99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)肾动态显像在上尿路结石患者肾功能评价中的临床价值.方法 回顾性分析了346例上尿路结石患者的核素肾动态显像、静脉肾盂造影(IVP)和血尿素氮(BUN)、血清肌酐(SCr)值,并依据总肾肾小球滤过率(GFR)将BUN和SCr结果分成4组进行分析.结果 ①346例肾动态显像患者,总肾GFR与BUN、SCr水平呈明显负相关(r=-0.458,P=0.000;r=-0.542,P=0.000).②4组之间比较,BUN和SCr均存在统计学差异(F=49.23,P=0.000;F=80.66,P=0.000);经最小显著差别法分析,组1与组2之间比较,BUN和SCr均无统计学差异(P=0.119和P=0.088);而其余各组之间比较,BUN和SCr均存在统计学差异(P均＜0.05).③IVP不显影的43只患肾中,经99Tcm-DTPA肾动态显像提示有18只(41.9%)有残余肾功能(GFR≥10 ml/min),平均GFR为(21.89±12.81)ml/min.结论 99Tcm-DTPA肾动态显像能早期评价肾功能,特别是对IVP不显影的患肾功能的评价具有重要临床价值.     

单侧单发肾癌患者术前分肾GFR的测定与分析

目的 分析核素肾动态显像Gate's法测定的单侧单发肾癌患者总肾、患肾及健肾肾小球滤过率（GFR）的特点。 方法 收集2018年1月至2019年12月于天津医科大学第二医院就诊的50例单侧单发肾癌患者（肾癌组）[其中男性32例、女性18例,年龄43~65（54.2±9.7）岁]的术前临床资料,并以中国肾癌高发年龄段（47~68岁）的60名健康受试者[其中男性36名、女性24名,年龄（56.1±8.6）岁]为对照组进行回顾性研究。肾癌组患者术前与对照组同期均行99Tcm-二亚乙基三胺五乙酸（DTPA）肾动态显像,比较2组受试者的临床指标、总肾及单肾GFR。肾癌组总肾GFR与对照组总肾GFR,肾癌组患肾、健肾GFR与对照组单肾GFR的比较均采用独立样本t检验。观察肾癌组患者中非对称肾功能的发生情况和健肾代偿情况,比较慢性肾脏病学流行病学合作研究公式和Gate's法计算肾癌组总肾GFR的差异,并采用Pearson相关性分析进行分析。 结果 肾癌组与对照组的性别比、年龄、吸烟情况、体重指数、血压、空腹血糖、动脉粥样硬化指数、血红蛋白、血清肌酐、尿素和尿酸等各项临床指标的差异均无统计学意义（χ2=0.185、0.021,t=0.656~1.980,均P>0.05）。肾癌组患者总肾GFR[（103.9±15.9） mL/min]与对照组[（103.2±10.6） mL/min]相比,差异无统计学意义（t=0.116,P=0.908）。与对照组单肾GFR[（51.2±5.9 ） mL/min]相比,肾癌组患肾GFR[（47.4±13.0） mL/min]明显降低,健肾GFR[（56.1±10.9） mL/min]明显升高,且差异均有统计学意义（t=?2.248、2.837,均 P <0.05）。50例肾癌患者中,21例患者患肾与健肾GFR占总肾GFR的百分比之差的绝对值>10%;16例患者健肾GFR高于同年龄段健康人群单肾GFR参考值范围的上限。慢性肾脏病学流行病学合作研究公式和Gate's法分别计算肾癌组总肾GFR的差异有统计学意义[（120.1±26.1） mL/(min·1.73 m2）vs. （108.7±13.4） mL/(min·1.73 m2）,t=3.765,P<0.05]且二者具有相关性(r=0.54,P<0.05)。 结论 核素肾动态显像Gate's法可获得患肾和健肾GFR变化的准确信息,为肾癌患者治疗方案的确定提供依据。     

SPECT肾动态显像评价肾功能与静脉肾盂造影的对比研究

目的比较单光子发射计算机化体层显像术(SPECT)和静脉肾盂造影(IVP)评价肾功能的价值。方法回顾性分析53例经临床症状、体征、B超、CT及生化检查等确诊为肾脏疾病患者的99mTc-DTPA肾动态显像和IVP检查资料。结果 53例受检者中核素显像显示有功能者92.1%,无功能者7.9%;IVP检查显示有功能者39.2%,无功能者67.8%。可见核素显像有功能明显高于IVP检查(P<0.01),IVP不显影的患肾99mTc-DTPA动态显像主要表现为2～3级,即放射性摄取中度以上减少82.1%GFR均值23.1 ml/min,肾实质不显影占17.9%。结论99mTc-DTPA肾动态显像是评价肾功能的理想方法,优于IVP,IVP患肾不显影时应进一步行99mTc-DTPA肾动态显像。     

肾动态显像评价肾积水患者肾功能的应用价值

目的 探讨肾动态显像Gates法测定肾小球滤过率（GFR）（gGFR）在肾积水和非肾积水肾病中的应用价值。 方法 选取2015年1月至2017年1月同时接受双血浆法测定GFR（rGFR）和gGFR的肾积水患者和非肾积水肾病患者,肾积水患者191例,其中男性97例、女性94例,年龄（43.35±15.91）岁;非肾积水肾病患者133例,其中男性82例、女性51例,年龄（55.31±13.54）岁。参照美国慢性肾脏病及透析的临床实践指南,将肾积水患者和非肾积水肾病患者分别分为肾功能正常组和轻、中、重度慢性肾衰竭组,对每组gGFR和rGFR进行分析比较,并计算两种方法的差值（ΔGFR）。不同肾功能组的比较采用单因素方差分析（ANOVA）,若差异有统计学意义,则行LSD-t检验法进行两两比较。gGFR和rGFR的比较采用配对t检验;相关性采用Pearson相关分析;一致性分析用Bland-Altman检验。 结果 肾积水和非肾积水肾病患者的gGFR比rGFR高,且前者的差异有统计学意义[（70.60±22.58） mL/（1.73 m2·min） vs. （58.67±20.49） mL/（1.73 m2·min）,t=9.335,P=0.000];与非肾积水肾病患者比较,肾积水患者gGFR和rGFR的相关性（r=0.692,P=0.000）较低。在肾积水患者中,轻、中、重度慢性肾衰竭组的gGFR均明显高于rGFR[（81.01±18.40） mL/（1.73 m2·min） vs. （71.03±7.74） mL/（1.73 m2·min）、（60.98±18.28） mL/（1.73 m2·min） vs. （45.85±7.60） mL/（1.73 m2·min）、（42.88±16.14） mL/（1.73 m2·min） vs. （23.65±4.04） mL/（1.73 m2·min）],差异均有统计学意义（t=4.559、8.398、4.480,均P<0.05）;中度慢性肾衰竭组gGFR和rGFR的相关性（r=0.461,P=0.000）最高;肾功能正常组和轻、中、重度慢性肾衰竭组患者的ΔGFR逐渐增高,分别为（?1.61±14.05）、（9.99±18.81）、（15.14±16.54）、（19.23±15.48）mL/（1.73 m2·min）,差异有统计学意义（F=5.595,P=0.001）; 有5.76%（11/191,>5%）的点在一致性界限（L_OA）之外,gGFR和rGFR的一致性较差。在非肾积水肾病患者中,轻度慢性肾衰竭组的gGFR明显低于rGFR[（66.08±8.97） mL/（1.73 m2·min） vs. （70.59±8.08） mL/（1.73 m2·min）],差异有统计学意义（t=?3.472,P<0.05）,中、重度慢性肾衰竭组的gGFR高于rGFR[（45.99±9.76） mL/（1.73 m2·min） vs. （43.83±8.29） mL/（1.73 m2·min）、（26.25±8.57） mL/（1.73 m2·min）vs.（20.19±5.72） mL/（1.73 m2·min）],差异均有统计学意义（t=2.095、4.907,均P<0.05）;轻度慢性肾衰竭组gGFR和rGFR的相关性（r=0.737,P=0.000）最高;肾功能正常组和轻、中、重度慢性肾衰竭组患者的ΔGFR逐渐增高,分别为（?5.64±16.64）、（?4.51±6.23）、（2.16±7.71）、（6.06±6.87）mL/（1.73 m2·min）,差异有统计学意义（F=9.446,P=0.000）;有3.01%（4/133,<5%）的点在L_OA之外,gGFR和rGFR的一致性较好。 结论 肾动态显像Gates法评估肾积水患者的GFR价值有限,应参考双血浆法的定量结果和其他检查结果进行综合分析判断。     

不同肾小球滤过率检测方法在多囊肾肾功能评价中的临床价值

目的探讨99Tcm-二亚乙基三胺五乙酸（99Tcm-DTPA）肾动态显像Gate's法及血肌酐估测法在多囊肾各时期肾小球滤过率（GFR）检测中的应用价值。方法选择2006年1月至2018年9月未行透析治疗的多囊肾患者59例。参考美国慢性肾脏病及透析的临床实践指南,依据慢性肾病（CKD）分期（1~5期）,以双血浆法测定GFR为参考标准,将多囊肾患者分为3组。A组:GFR ≥ 60 mL/（min·1.73m2）,CKD分期为1~2期,共19例;B组:60 mL/（min·1.73 m2）>GFR ≥ 30 mL/（min·1.73 m2）,CKD分期为3期,共23例;C组:GFR < 30 mL/（min·1.73 m2）,CKD分期为4~5期,共17例。将Gate's法、血肌酐估测法测定的GFR分别与双血浆法测定的结果进行配对t检验和Pearson相关分析。结果（1）血肌酐估测法测得的A、B、C 3组的GFR分别为（85.43±19.77）、（46.56±15.48）、（20.96±11.3）mL/（min·1.73 m2）,双血浆法测得的GFR分别为（80.58±16.2）、（42.66±7.63）、（18.61±7.21）mL/（min·1.73 m2）,两者间的差异均无统计学意义（t=-1.462、-1.592、-1.791,均P>0.05）,且均有很好的相关性（r=0.69、0.68、0.92,均P < 0.05）。（2）Gate's法测得的A、B、C 3组的GFR分别为（75.39±20.75）、（42.86±18.95）、（25.85±14.91）mL/（min·1.73 m2）,与双血浆法测定的GFR比较,两者在A、B组中的差异均无统计学意义（t=1.255、-0.061,均P>0.05）,且均有很好的相关性（r=0.55、0.62,均P < 0.05）;但是,两者在C组中的差异有统计学意义（t=-2.132,P < 0.05）,且无明显相关性（r=0.36,P>0.05）。结论Gate's法可很好地评估多囊肾CKD分期为1~3期的患者的肾功能GFR,但对CKD分期为4~5期的患者不适合。血肌酐估测法可有效评价多囊肾CKD各时期的肾功能GFR。     

Gates法测定2型糖尿病肾病患者肾小球滤过率

目的 探讨2型糖尿病肾病患者99Tcm-DTPA GFR测定的时间影响及GFR对2型糖尿病肾功能异常早期诊断的临床意义.方法 招募健康志愿者11名,其中男6名,女5名,年龄47～79(61.45±7.90)岁;社区2型糖尿病肾病患者56例,其中男31例,女25例,年龄45～75(60.98±6.96)岁,均应用99Tcm-DTPA肾动态显像测定GFR.分别取注药后第2分钟和第3分钟图像勾画ROI,根据Gates分析方法,计算总肾及分肾GFR.利用SPSS 15.0软件对数据进行Pearson相关分析和两样本t检验.结果 2型糖尿病肾病患者的GFR与SCr[(84.90±14.38) μnol/L]呈负相关:注射99Tcm-DTPA后第2分钟双肾、左肾和右肾GFR均与SCr呈负相关(r=-0.599、-0.553和-0.529,均P＜0.001);第3分钟双肾、左肾和右肾GFR也均与SCr呈负相关(r=-0.652、-0.636和-0.470,均P≤0.001).2型糖尿病肾病患者双肾、左肾和右肾第3分钟GFR分别为(69.77±11.00)、(33.12±5.74)和(37.34±9.81) ml/min,低于健康对照组[(97.89±5.98)、(46.60±4.91)和(51.28±4.20) ml/min;t=-8.212、-7.233和-4.069,均P＜0.001].结论 建议对2型糖尿病肾病患者选择注射99Tcm-DTPA后第3分钟的放射性计数测定GFR;GFR测定对糖尿病肾病患者肾功能异常早期诊断具有重要意义.     

静脉肾盂造影单侧肾不显影53例分析

静脉肾孟造影（IVP）在临床上经常会遇到单例肾或双肾不显影的问题。本文收集我院1981～1991年有明确病案记载的53例进行讨论。一、临床资料本组男性37例，女性16例。其中1～40岁9例，40～65岁30例，65～80岁14例。平均年龄44岁。男女之比2．3：1。临床表现：10例出现肿块；42例间歇性胀痛、绞痛；15例尿频、尿急、尿痛；27例肉眼血尿（9例伴有血凝块）；8例脓尿。IVP左肾不显影ZI例，右肾不显影用例，技术因素造成2例不显影。用76％泛影葡胺2ml／kg体重行大剂量IVP，皮质显影者34例。延长造影至35～60min，4例出现肾门区云雾状改变，1…     

蛋白质负荷肾显像观察2型糖尿病早期肾病的肾储备功能

目的 用蛋白质负荷肾动态显像评价2型糖尿病（DM）早期肾病患者的肾储备功能（RFR）.方法 研究对象共50例：健康对照组（G1组）14例,2型DM正常白蛋白尿组（G2组）15例,2型DM早期肾病组（G3组）21例.1周内分别行静息及蛋白质负荷99Tcm-DTPA肾动态显像.肾储备值为负荷前后肾小球滤过率（GFR）、高峰时间、半排时间、20 min残留率的差值.采用单因素方差分析和t检验,对3组各参数进行比较.结果 GFR所得肾储备值在3组间差异均有统计学意义（t=14.884,32.180,16.042,P均＜0.01）,蛋白质负荷后,G1组GFR平均增加了20.1ml·min-·1.73 m-2,G2组平均增加了10.9 ml·min-1·1.73 m-2,G3组仅增加了2.2 ml·min-1·1.73 m-2 半排时间所得肾储备值在G2组和G1组间差异有统计学意义（t=5.505,P＜0.05）,而G3组和G1组间的差异有明显统计学意义（t=8.914,P＜0.01） 高峰时间所得肾储备值在G3组和G1组间差异也有统计学意义（t=5.690,P＜0.01） 20 min残留率所得肾储备值在G3组和G1组间差异有统计学意义（t=4.376,P＜0.05）.结论 蛋白质负荷肾动态显像是测定RFR的有效方法,RFR是评价DM早期肾损害的有效指标.     

99Tcm-DTPA肾动态显像评价儿童重复肾功能

目的 探讨99Tcm-DTPA肾动态显像在评价儿童重复肾功能中的应用价值.方法 选择经B超或MR尿路成像(MRU)示有重复肾的患儿25例,男9例,女16例,年龄2～ 72 (23.80±20.97)个月.选择同期且年龄匹配、B超或MRU结果正常、为探查泌尿系统感染病因行肾动态显像的婴幼儿20名作为对照组,其中男9名,女11名,年龄2 ～72(32.95±23.58)个月.2组均按照年龄分亚组:组Ⅰ,年龄0～24个月;组Ⅱ,年龄25～72个月.受检者99Tcm-DTPA肾动态显像经医院伦理委员会批准并经监护人知情同意.显像后勾画双肾ROI(包括重复肾)获得肾图,计算肾GFR及患肾上、下半肾摄取率.多组间均数两两比较采用Dunnett-t检验.结果25例患儿共26个重复肾(1例左、右双侧重复肾),其中左侧重复肾16个,右侧重复肾10个.26个重复肾中,肾图正常6个、持续上升型9个、高水平延长线型4个、抛物线型2个、低水平延长线型5个.患儿组组Ⅰ患肾19个,组Ⅱ患肾7个;对照组2组均为20个肾.患儿组中正常肾图者GFR为(78.81±15.97) ml/min(组Ⅰ)及(64.68±11.15) ml/min(组Ⅱ),持续上升型肾图者GFR为(72.11±22.76) ml/min(组Ⅰ)及(63.41±16.42) ml/min(组Ⅱ),高水平延长线型肾图者GFR为(68.74±16.17) ml/min(组Ⅰ),抛物线型肾图者GFR为(65.26±15.27) ml/min(组Ⅰ),以上各组GFR与对照组GFR[组Ⅰ:(79.35±13.31) ml/min;组Ⅱ:(76.46±9.69) ml/min]相比,差异均无统计学意义(均P＞0.05);而5个肾图呈低水平延长线型患肾的GFR为(45.83±10.17) ml/min(组Ⅰ)及(45.53±10.42) ml/min(组Ⅱ),均低于对照组(均P ＜0.05).26个患肾中,23个可清晰分辨上、下半肾,占88.46％.相对于整个患肾而言,3个重复肾摄取率＞30％,5个重复肾摄取率为10％ ～30％,15个重复肾摄取率＜10％.结论 99Tcm-DTPA肾动态显像可定量评价重复肾功能,对临床重复肾患儿治疗方式的选择有一定的参考价值.     

SPECT/CT直接测量肾脏深度在肾小球滤过率测定中的应用

目的 探讨在以SPECT/CT测定GFR时用CT直接测量肾脏深度代替传统的Tonnesen公式法的必要性和可行性.方法 49例患者在接受肾动态显像的同时进行腹部CT平扫,测量两侧肾的深度.将所测值与传统的Tonnesen公式值和SPECT侧位平面图像测量值进行比较,然后将CT和SPECT测得的肾脏深度数据代入到Gates法GFR测量软件中,观察肾脏深度改变对GFR测定值的影响.采用配对t检验对Tonnesen公式法和SPECT测量法测得的肾脏深度值及各自深度值对应的GFR与CT法测得的相关数据间差异进行比较,对Tonnesen公式误差、SPECT测量误差与肾脏深度的关系采用直线相关分析.结果 CT测得的肾脏深度分别为右肾(7.04±1.15) cm,左肾(7.18±1.15) cm.与CT测量值相比,Tonnesen公式法低估了肾脏深度[右肾:(5.77±0.90) cm,t=- 11.50,P＜0.01;左肾:(5.74±0.88) cm,t=12.20,P＜0.01],而SPECT测量值则高估了肾脏深度[右肾:(7.40±1.15) cm,t=5.19,P＜0.01;左肾:(7.49±1.19) cm,=5.14,P＜0.01].Tonnesen公式法误差与肾脏深度呈正相关(右肾:r =0.62,P＜0.01;左肾:r=0.73,P＜0.01),而SPECT测量误差与肾脏深度不相关(右肾r =0.26,P＞0.05;左肾r=0.38,P＜0.01).Tonnesen公式法得到的两侧肾脏深度差为0.03 ～0.05 cm,而SPECT和CT得到两侧肾脏深度差分别为0.54±0.33(0.01～1.28) cm和0.62±0.45(0.01～1.60) cm.Gates法采用Tonnesen公式肾脏深度低估了GFR,与CT所测肾脏深度对应的GFR相比,误差百分比分别为右肾(-20.92±11.28)％(t=-6.99,P＜0.01),左肾(-23.71±7.71)％(t=-8.73,P＜0.01);采用SPECT测量则高估了GFR,对应误差百分比为右肾(5.23±9.64)％(t=2.72,P＜0.01),左肾(8.93±9.29)％(=5.21,P＜0.01).结论 采用SPECT/CT的CT功能精确测量两侧肾脏深度,有助于提高Gates法GFR测定的准确性.     

Refinement of the positive predictive value of gallbladder nonvisualization after morphine administration for acute cholecystitis based on the temporal pattern of common bile duct activity

The authors previously reported two major patterns in the time-activity curve of the common hepatic bile duct (BD) after morphine administration in patients with gallbladder nonvisualization. The first pattern consists of a gradual increase in BD activity (of variable duration) occurring during a simultaneous decrease in liver parenchymal activity (BD increase), representing the physiologic effects of morphine administration. The second pattern consists of a continuous decrease in BD activity that parallels the activity in the liver parenchyma (BD decrease), representing lower or no physiologic effects of morphine administration. The authors hypothesize that gallbladder nonvisualization associated with a continuous decrease in BD activity after morphine administration will have a lower positive predictive value (PPV) for acute cholecystitis than gallbladder nonvisualization associated with an increase in BD activity. METHODS: Thirty-six patients who had morphine-augmented cholescintigraphy were divided into two groups: 19 with BD increase after morphine administration and 17 with BD decrease. RESULTS: Of the 36 patients, 22 had acute cholecystitis. The positive predictive value (PPV) of gallbladder nonvisualization was 61%. All of the remaining 14 had chronic cholecystitis. Of 19 patients with BD increase, 15 had acute cholecystitis (PPV = 79%), whereas only 7 of 17 patients with BD increase (PPV = 41 %) had acute cholecystitis (P = 0.023 by the one-tailed and 0.038 by the two-tailed Fisher exact tests). CONCLUSIONS: Gallbladder nonvisualization after morphine administration with the pattern of BD decrease is not as reliable (intermediate probability in this series) for the diagnosis of acute cholecystitis as is nonvisualization of the gallbladder in patients with a pattern of BD increase (high probability).     

Pericholecystic hepatic activity in cholescintigraphy

Gallbladder nonvisualization in cholescintigraphy has been shown to be a reliable finding in acute cholecystitis. In some cholescintigrams, we have observed faintly increased pericholecystic hepatic activity in conjunction with gallbladder nonvisualization. To determine the frequency and significance of the pericholecystic hepatic activity finding, we evaluated 334 consecutive adult patients who had cholescintigrams with technetium-99m diisopropylphenylcarboamoyl iminodiacetic acid. Pericholecystic hepatic activity was seen in 21% of the abnormal scans demonstrating gallbladder nonvisualization but in none of the other scans. Thirteen of these patients underwent surgery; 11 (85%) were found to have acute cholecystitis, and two (15%) had chronic cholecystitis. Four patients (31%) had acute gangrenous cholecystitis, and five (39%) had cholecystitis complicated by gallbladder perforation. The pericholecystic hepatic activity sign is not specific for gangrenous cholecystitis or gallbladder perforation but does reliably indicate inflammatory gallbladder disease and is associated with a relatively high incidence of cholecystitis complicated by perforation.     

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

ObjectiveWe compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization.Materials and MethodsA total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups.ResultsIn the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively (p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable.ConclusionThe use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.     

Variable bile retention on cholescintigraphy after morphine administration

Intravenous morphine sulfate has been used in conjunction with cholescintigraphy. We studied the variations in the degree and duration of the effects of 2 mg morphine on biliary kinetics in patients with gallbladder nonvisualization and undertook a comparison with biliary kinetics in patients not given morphine. Of 24 morphine-augmented cholescintigrams that were obtained without additional injection of technetium-99m diisopropyl-iminodiacetic acid (DISIDA), 19 showed continued gallbladder nonvisualization. Time-activity curves (TACs) of the liver parenchyma and common bile/hepatic duct (CD) of the entire study (before and after morphine) were obtained. In two patients, the CD was not sufficiently visualized to define a region of interest. In 17 patients, the peak CD activity was observed between 14 and 47 min after injection of^99mTc-DISIDA. In these 17, the TAC of the CD was declining essentially in parallel with the TAC of the liver parenchyma at the end of the first hour before morphine. After morphine injection, CD activity slowly increased for a variable duration in nine patients, while it continued to decrease in eight. CD activity between 1 h and 2 h showed a continuously decreasing pattern in another group of 20 patients who did not receive morphine despite gallbladder nonvisualization at 1 h. In summary, no significant effect of 2 mg of intravenous morphine on biliary kinetics was detected scintigraphically in a considerable proportion of patients. Also, there was considerable variation in the duration of the effect of morphine, when such an effect was present. This observation may have significant clinical implications for morphine-augmented cholescintigraphy.     

A false-positive hepatobiliary scan in a patient with cystic fibrosis

A case of nonvisualization of the gallbladder in an adult patient with cystic fibrosis in the absence of acute cholecystitis is reported. Delayed images to 20 hours showed persistent nonvisualization. Review of the literature on cystic fibrosis suggests that nonvisualization of the gallbladder may be secondary to inspissated mucus rather than acute cholecystitis, and therefore a positive hepatobiliary scan in these patients should be interpreted with caution.     

Scintigraphic findings in acute gangrenous cholecystitis

Nine patients who had surgically proven acute gangrenous cholecystitis and Tc-99m DISIDA scintigrams were reviewed retrospectively. Three types of scintigraphic findings were presented: 1) nonvisualization of the gallbladder, three cases; 2) nonvisualization of the gallbladder plus a rim sign, two cases; and 3) nonvisualization of the gallbladder plus an enlarged photon deficient area corresponding to the gallbladder fossa, four cases. A rim sign or an enlarged gallbladder fossa reflect the direct spread of inflammation from the gallbladder into the liver, causing impaired hepatocyte function. An enlarged gallbladder fossa may represent a later stage of a rim sign. Presumably tracer excretion by hepatocytes is affected initially by the inflammatory process, followed by impairment of tracer concentrating ability. Since the gallbladder may be suspended occasionally by a mesentery and not in contact with the liver, the secondary signs may be absent in acute gangrenous cholecystitis.     

Cholescintigraphic abnormality in a case of Kawasaki syndrome

A 26-month-old girl with Kawasaki syndrome (mucocutaneous lymph node syndrome) is presented. Liver function studies were abnormal and sonographic examination revealed hydrops of the gallbladder. The Tc-99m DISIDA cholescintigraphy demonstrated both early and delayed nonvisualization of the gallbladder. A photopenic area was noted in and below the gallbladder fossa and there was medial and upward displacement of the common bile duct. It appears that Kawasaki syndrome may result in nonvisualization of the gallbladder by cholescintigraphy. Accordingly, this diagnosis should be added to the list of conditions associated with nonvisualization of the gallbladder by biliary scintigraphy.     

Contracted gallbladder: a cause of false-positive hepatobiliary scan in patients with cystic fibrosis

Gallbladder nonvisualization on hepatobiliary scintigraphy in cystic fibrosis is generally secondary to cystic duct obstruction from inspissated bile, mucus, or gallstones. We report gallbladder nonvisualization on hepatobiliary imaging in two patients with cystic fibrosis who had contracted gallbladders on ultrasonography. Repeat ultrasonography at 6 months revealed persistent gallbladder contraction. A contracted gallbladder therefore is a potential cause of a false-positive hepatobiliary scan which can be treated with conservative management.     

Lymphoscintigraphy in patients with lymphedema. A new approach using intradermal injections of technetium-99m human serum albumin

Forty cases were examined by a new lymphoscintigraphic approach using intradermal injections of Tc-99m human serum albumin (HSA). Thirty-three patients had lymphedema due to the metastases of a malignant tumor and/or the dissection of lymph nodes. The others were control patients without lymphedema. With the assistance of a computer, sequential images and time-activity curves of tracer activity in the lymph nodes and the soft tissue were obtained at 30 minutes after injection. An image of the axillary or inguinal lymph nodes was identified 2-6 minutes after injection in control cases. Four main abnormal findings, the delayed appearance of radioactivity and interruption of the lymphatic system, the collateral pathways, and the retrograde lymphatic flow were observed clearly, as was the nonvisualization of the lymph nodes. These abnormalities were observed in a high percentage of patients with moderate lymphedema, as compared with a low percentage of patients with slight lymphedema. The collateral pathways could not be observed in patients with severe lymphedema. Imaging with Tc-99m HSA was considered to be more useful than other techniques, including radiocolloid lymphoscintigraphy, for examining patients with lymphedema.     

The rim sign: association with acute cholecystitis

In a retrospective analysis of 218 hepatobiliary studies in patients clinically suspected of acute cholecystitis, a rim of increased hepatic activity adjacent to the gallbladder fossa (the "rim sign") has been evaluated as a scintigraphic predictor of confirmed acute cholecystitis. Of 28 cases with pathologic confirmation of acute cholecystitis in this series, 17 (60%) demonstrated this sign. When associated with nonvisualization of the gallbladder at 1 hr, the positive predictive value of this photon-intense rim for acute cholecystitis was 94%. When the rim sign was absent, the positive predictive value of nonvisualization of the gallbladder at 1 hr for acute cholecystitis was only 36%. As this sign was always seen during the first hour postinjection, it can, when associated with nonvisualization, reduce the time required for completion of an hepatobiliary examination in suspected acute cholecystitis.