Tc-99m-RBC显像定位诊断胃肠道出血的价值

目的:回顾性分析Tc-99m-RBC显像定位诊断胃肠道出血,总结定位诊断不准确的原因．方法:收集我科2000-2005年Tc-99m-RBC显像病例42例,通过手术、内镜最终明确诊断出血部位和出血病因者17例．分析Tc-99m-RBC显像报告与最终诊断的符合情况及原因．结果:Tc-99m-RBC显像诊断与最终诊断符合4例,基本符合6例,不符合7例．符合率为10／17．不符合的诊断主要是对出血灶的肠段定位偏低、对出血肠段判断错误、不明原因的异常放射性浓聚、假阳性和假阴性诊断．肠段判断错误的病例,报告对出血点的腹部分区正确．结论:正确掌握肠管的解剖走行,谨慎报告左上腹模糊的放射性浓聚是提高Tc-99m-RBC显像定位诊断胃肠道出血的关键．

Value of Tc-99m-labeled red blood cells scintigraphy in diagnosis of gastrointestinal bleeding

AIM: To retrospectively study the value of technetium-99m-labeled red blood cell scinti-graphy in the localization of gastrointestinal bleeding. METHODS: A total of 42 patients received Tc-99m RBC scintigraphy for the localization of gastrointestinal bleeding from January 2000 to December 2005, of which 17 cases were confirmed by surgical and endoscopic findings. The data obtained by Tc-99m RBC scintigraphy and the final results were comparatively analyzed. RESULTS: Of the 17 cases confirmed by operation and endoscopy, 4 were found with perfect matches with the data of Tc-99m RBC scintigraphy, 6 with general matches and 7 without matches. The overall match ratio was 58.8% (10/17). The mismatches between Tc-99m RBC scintigraphic and endoscopic/surgical findings included 4 aspects: inaccurate localization of gastrointestinal bleeding, unknown abdominal radioactivity, false-positive and false-negative diagnosis. CONCLUSION: Two steps are keys to avoid the diagnostic pitfall in the localization of gastrointestinal bleeding: to know the intestine anatomy; to view the obscure radioactivity in left upper adomen carefully.