Clinical study for the evaluation of hemodynamic effects of varicocele on scrotal scintigraphy and infrared-thermography

摘要

精索静脈瘤の血行動態と陰嚢部の皮膚温度との関連性を陰嚢シンチグラフィと赤外線サーモグラフィを用いて検討した。対象は男子不妊を主訴とし臨床的に精索静脈瘤と診断された患者93例である。シンチグラフィ動態像では陰嚢部における時間-放射能曲線 (TAC) を作成し, TACの形状より早期に急上昇するもの (Type 1) と緩徐に上昇するもの (Type 2) に分類し, 内精静脈からの逆流血液量の評価とした。静態像では陰嚢部における異常集積の程度により重症度分類を行い, 蔓状静脈叢における血液プール量の評価とした。サーモグラフィでは陰嚢部の高温域の皮膚温度を測定するとともに, 高温域の広がりの程度より重症度分類を行なった。画像において, 血液プール像と高温域の広がりとはよく一致し, 両検査における重症度には良好な相関が認められた。サーモグラフィによる重症度と高温域の皮膚温度との間には統計学的に相関が認められた。同様にシンチグラフィによる重症度と皮膚温度との間にも相関が認められた。以上より, 精索静脈瘤患者における高温域の皮膚温度は血液プール量を反映すると考えられた。TACにおけるタイプ分類と皮膚温度にも有意の相関がみられ, さらに血液プールが同程度の症例でみると, 逆流血液の多い Type 1群では Type 2 群より皮膚温度は高かった。このことより, 逆流血液の増加は皮膚温度をさらに上昇させる要因と考えられた。 / To evaluate the effects of venous reflux of internal spermatic vein and blood pool of pampiniform plexus on scrotal temperature, scrotal scintigraphy and infrared-thermography were performed in 93 infertile males with clinical varicocele. On scintigraphy, dynamic images and static images were taken. Time-activity curves (TACs) generated from dynamic images on left scrotal region were divided broadly into two types ; the curve increases rapidly from the first pass and soon keeps equilibrium (Type 1), and it rises gradually (Type 2). Scintigraphies were graded by the degree of blood pool ; normal (P.0), minimal (P.1), moderate (P.2), and severe (P.3) . On thermogaphy, the average temperature of scrotal hyperthermia was taken, and according to the extent of hyperthermia, thermographic grading was made as follows ; normal (TG.0), minimal (TG.1), moderate (TG.2), and whole hemiscrotum (TG.3). Varicoceles were detected in 86 cases (92%) by scintigraphy and in 91 cases (98%) by thermography. Twenty-nine showed Type 1 on TAC, and they presented strong venous reflux on dynamic images and large blood pool on static images. There were good correlations between the type of TAC and scintigraphic grade. Size and location of hyperthermia on thermography corresponded well to those of blood pool on scintigraphy, and grades of both examinations were significantly correlated. The average temperature of hyperthermia was higher than 32℃ (mean 33.8±1.0℃). The mean temperature of hyperthermia differed significantly between the grades of thermography. Also it differed significantly between the grades of scintigraphy. When grades of blood pool were same (in case of P.2), the mean temperature of type 1 was significantly higher (1.0℃) than type 2. In conclusion, the extent of hyperthermia corresponded to blood pool of varicocele. Temperature of hyperthermia was correlated to the degree of blood pool, and increased blood refux from internal spermatic vein may be other factor to rise the temperature of varicocele more.