Hepatobiliary scintigraphy with 99Tcm-HIDA in patients with jaundice.

In order to assess the clinical value of 99Tcm-HIDA for hepatobiliary scintigraphy 23 patients with hepatocellular disease and 44 patients with obstructive biliary tract disease were examined. Positive information was obtained in 14 and 23 patients, respectively. False results mainly depended on inadequate imaging of the liver in the case of severely impaired function, whatever the cause. Spontaneously ameliorated obstruction leaving an impaired hepatocellular function may give misleading results. A malignant tumour widely involving the liver and impressing the bile ducts may also create the appearance of obstruction. If HIDA scintigraphy be limited to patients with serum bilirubin levels between 40 and 250 mumol/l the diagnostic specificity and sensitivity of 90 per cent and 78 per cent, respectively, is reached in demonstrating obstruction, when the prevalence is 0.58.     

内乳前哨淋巴结^99Tc^m-硫胶体显像影响因素分析

目的探讨内乳前哨淋巴结^99Tc^m-硫胶体（SC）显像的影响因素,为提高显像效果提供依据。方法分析263例T1或T2期乳腺癌患者的内乳前哨淋巴结”^99Tc^m-显像资料,选取患者年龄、肿块所在乳腺（左或右）、肿块所在象限、病灶性质、瘤周注射钟点位置、注射显像剂体积、显像剂放射性活度及显像延时时限共8个影响因素,用SPSS 11.5软件进行单因素和多因素分析,P〈0．05为差异有统计学意义。结果左乳较右乳（Wald值为27．71,P〈0．05）、内半乳腺较外半乳腺（Wald值为6．46,P=0．011）易出现内乳淋巴引流;瘤周3点注射法优于4点注射法（Wald值为11．57,P=0．001）;每点0．5×10^-3L^99Tc^m-SC注射能取得较好的显像效果;在活度一体积组合中,活度不是关键性因素。年龄（Wald值为3．20,P=0．074）、病灶性质（Wald值为0．05,P=0．82）及显像延时时限（Wald值为0．69,P=0．41）对内乳前哨淋巴结显像无明显影响。结论在选取的8个因素中,肿块所在乳腺（左或右）、肿块所在象限、瘤周注射钟点位置、注射显像剂体积为影响内乳淋巴结显影的独立因素,年龄、病灶性质及延时时限与内乳前哨淋巴结显像无关。     

Peritoneo-scrotal communication: demonstration by 99mtechnetium sulphur colloid scintigraphy

Continuous ambulatory peritoneal dialysis is a widely used and convenient alternative to haemodialysis in patients with renal failure. Occasionally, a scrotal swelling may develop during this procedure because of fluid passing through a patent processus vaginalis. We present a case report to illustrate the diagnostic use of radionuclide scintigraphy in this group of patients.     

Intra-arterial and intraportal infusion liver scintigraphy using 99mTc-labeled colloid]

Intra-arterial infusion liver scintigraphy was performed in 11 patients with primary or metastatic liver tumor, and intraportal infusion liver scintigraphy was performed in 6 patients for prophylaxis of liver metastasis from colorectal cancer. 99mTc-Sn colloid or 99mTc-phytate was administered through the catheter of which tip was placed in the portal vein or the hepatic artery, and then liver image was obtained. When 99mTc-phytate was infused intra-arterially, significant amount of the infused tracer passed through the liver and we could not get sufficient information to assess the distribution of drug administered through the catheter. On the other hand, intraportal infusion liver scintigraphy using 99mTc-Sn colloid or 99mTc-phytate and intra-arterial infusion liver scintigraphy using 99mTc-Sn colloid revealed heterogeneity of liver uptake, tracer uptake in spleen, low uptake area corresponding to the liver tumor and high uptake area around it. The findings will be clinically useful, and these methods are thought to be helpful to confirm the satisfactory drug distribution.     

Rim sign in Tc-99m sulfur colloid hepatic scintigraphy

A case of pericholecystic hyperperfusion on Tc-99m sulfur colloid (SC) flow images with a pericholecystic rim of increased activity (PCHA) on delayed planar and single-photon emission computed tomography images of the liver was seen in a patient with a history of multiple renal transplants admitted with cramping right lower quadrant abdominal pain. Laparotomy performed 5 days after the scan revealed an acutely perforated gangrenous gallbladder and occluded cystic duct. The secondary findings of gallbladder hyperperfusion and PCHA or "rim sign" have been frequently reported with Tc-99m IDA hepatobiliary imaging. These secondary findings in conjunction with a nonvisualized gallbladder on an IDA scan suggest a complicated or advanced stage of acute cholecystitis and usually require urgent surgical intervention. The rim sign on Tc-99m SC scintigraphy also likely indicates the same grave diagnosis.     

骨髓增殖性疾病全身骨髓分布变化的研究

目的 探讨用^99Tc^m-硫胶体显像观察骨髓增殖性疾病（MPD）全身骨髓分布改变及特点的临床意义。方法 患者85例，包括原发性骨髓纤维化（IMF）40例，真性红细胞增多症（PV）15例，原发性血小板增多症（ET）5例，慢性粒细胞性白血病（CGL）25例。^99Tc^m-硫胶体使用剂量370－550MBq(2-5mL)。结果 全身骨髓分布异常占88．2％，可见骨髓显像呈增强型、抑制型及抑制伴扩张型异常表现。中心性骨髓（CBM）抑制率及外周性骨髓（PBM）扩张率分别为61．2％及56．5％。IMF骨髓抑制型较增强型外周血象降低程度差异有显著性（P＜0．05）。CGL患者CBM抑制及PBM扩张程度均随病情缓解而减轻。各疾病间PBM扩张形态有一定差异。结论 胶体骨髓显像的不同类型与MPD外周血象、临床病程及病情缓解状态有关；骨髓显像有助于MPD的鉴别诊断，了解MPD患者临床状态及预后。     

Hepatobiliary scintigraphy with SPECT in infancy

Hepatobiliary scintigraphy (HBS) is an important investigation for the diagnosis of biliary atresia (BA) and its differentiation from causes of conjugated hyperbilirubinemia that do not require surgical intervention. Delayed imaging at 24 hours and phenobarbitone augmentation for 5 days has been required to achieve high sensitivity and specificity with current techniques. This study explores whether adding single photon emission computed tomography (SPECT) performs as well as existing methods without requiring delayed 24-hour imaging and whether the phenobarbitone premedication is necessary in all cases. METHODS: A retrospective analysis of 105 HBS studies on 94 patients was performed. HBS included SPECT at 4 to 6 hours postinjection when no tracer was seen in the gastrointestinal tract in the first 60 minutes. This was done in 80 patients. RESULTS: Gastrointestinal activity was seen in 14 patients within 60 minutes. For 4- to 6-hour studies, standard HBS and HBS with SPECT data showed a sensitivity of 100% for the diagnosis of BA. The specificity, accuracy, and positive likelihood ratios (PLR) were 67%, 75%, and 3 (confidence interval [CI]=2.03-4.16) for planar imaging at 4 to 6 hours and 90%, 93%, and 10 (CI=4.42-19) for 4- to 6-hour planar and SPECT imaging. When the 11 patients who had phenobarbitone stimulation were included, the results improved to 97%, 98%, and 30 (CI=7.06-80). CONCLUSION: The addition of SPECT 4 to 6 hours postinjection of tracer significantly improves the diagnostic accuracy of hepatobiliary scintigraphy compared with planar imaging alone. This accuracy is as good as HBS performed after phenobarbitone stimulation. The combined technique of HBS with SPECT and phenobarbitone has the highest accuracy. Delayed imaging at 24 hours is usually not necessary.     

99Tcm-HMPAO-labelled leucocytes for bone marrow scintigraphy and evaluation of skeletal lesions. Comparison with 99Tcm-HSA colloid results

Bone marrow scintigrams obtained 2-6 h and/or 20-24 h after injection of 99Tcm-HMPAO-labelled leucocytes (LeuSc) in 16 patients (seven males, nine females, average age 57 years, either with benign or malignant haemopathy, or with benign or metastatic skeletal diseases) have been compared to corresponding pictures obtained 20 min after injection of 99Tcm-labelled human serum albumin nanosized colloids (NanSc, performed within a week thereafter). Overall distribution of the colloids and of the labelled leukocytes at the level of the bone marrow appeared to be the same. Fresh vertebral fractures as well as metastatic lesions of the axial skeleton appeared as cold defects in both investigations. Fractures of the ribs as well as one metastatic lesion involving one trochanter could not be identified. Although all seven lesions involving Th9 to L4 could be clearly investigated with LeuSc, only three could be recognized with NanSc. It is concluded that, in patients with cancerous diseases, LeuSc is better than NanSc in demonstrating lesions in the case of dubious conventional osseous scintigrams as well as in the case of neurological or skeletal symptoms at the level of the lumbar and/or low thoracic regions.