淋巴显像诊断小肠淋巴管扩张症的腹部影像分型及价值

摘要

Objective To investigate the image classification and diagnostic value of 99Tcm-DX lymphoscintigraphy in intestinal lymphangiectasia (IL).Methods A total of 68 patients (the study group) with clinical suspicion of IL from June 2007 to September 2012 were retrospectively analyzed.Using a stratified sampling method,60 patients with lower limb lymphedema or chylous ascites (the control group) were selected by age-and gender-matched with the study group.All patients underwent 99Tcm-DX lymphoscintigraphy.The lymphoscintigraphic findings were classified according to the imaging characteristics in abdomen.The intestinal tract could be shown on the images of 99Tcm-DX lymphoscintigraphy was the diagnostic standard of IL.Results According to the histopathology results,60 cases of the study group were finally diagnosed as IL and 8 cases were excluded.Five patterns of 99Tcm-DX images in abdomen were classified as following:pattern Ⅰ,consecutive visualization of intestine; pattern Ⅱ,delayed visualization of intestine; pattern Ⅲ,accumulation in ascites ; pattern Ⅳ,hybrid; pattern Ⅴ,negative results.The cases of Ⅰ,Ⅱ,Ⅲ,ⅣandⅤin the study group and control group were 19 vs 0,17 vs 4,11 vs 13,6 vs 0 and 7 vs 43,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 99Tc m-DX lymphoscintigraphy in diagnosing IL were 70.0％ (42/60),94.1％ (64/68),82.8 ％ (106/128),91.3％(42/46) and 78.0％(64/82),respectively.Conclusions 99Tcm-DX lymphoscintigraphy may be an important diagnostic method for IL,and the visualization of intestine is an important evidence for the diagnosis of IL.%目的 探讨小肠淋巴管扩张症(IL)患者99Tcm-DX淋巴显像的腹部影像分型及其诊断价值.方法 选择2007年6月至2012年9月临床疑诊IL的68例患者作为研究组,通过分层随机方法选取同期年龄、性别与研究组相匹配的60例下肢淋巴水肿或乳糜腹腔积液的患者作为对照组.2组患者均行99Tcm-DX淋巴显像,对患者的腹部影像特征进行分型.以肠道显影作为IL阳性诊断标准,根据病理检查或胶囊肠镜的最终诊断评价99Tcm-DX淋巴显像的诊断效能.结果 68例患者中有60例患者确诊为IL.99Tcm-DX腹部影像可分为5型:Ⅰ型,肠道动态显影型;Ⅱ型,肠道延迟显影型;Ⅲ型,腹腔积液显影型;Ⅳ型,混合型;Ⅴ型,腹部显影阴性型.研究组和对照组符合Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ型表现的病例数分别为19和0、17和4、11和13、6和0以及7和43.在全部128例受试者中,99Tcm-DX淋巴显像诊断IL的灵敏度为70.0％ (42/60),特异性为94.1％(64/68),阳性预测值为91.3％(42/46),阴性预测值为78.0％ (64/82),准确性为82.8％ (106/128).结论 99Tcm-DX显像可以作为临床诊断IL的重要手段,肠道显影是其重要的诊断依据.