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The Clinical Significance of Abnormal Renal Uptake Seen in Tc-99m MDP Scintigraphy
Tc-99m MDP閃爍攝影所見腎臟局部活性異常之臨床意義
摘要
Tc-99m MDP (technetium-99m methylene diphosphonate)是目前最常被使用作為骨骼閃爍攝影之一種放射性製劑。此一製劑經靜脈注射後，除被骨骼攝取外；其餘多經由腎臟排出。其排出量，依據不同文獻之報告，在注射後3小時佔初劑量之 1/3至1/2。因此利用此一特性，我們可在患者接受骨骼攝影之同時，配合新型掃描儀之使用，看到清晰之腎臟影像和液體在泌尿系統中之動力變化。由於申請接受骨骼攝影之患者，多具選擇性；以罹患癌症之老年人居多，其存在或併發泌尿道異常之現象，不但比例上高於常人，且多無症狀。在過去數年間，我們常可在患者接受骨骼攝影之同時，意外地發現異常之腎臟影像，然而，此種現象是否具有臨床意義，即為本文所要探討之重點。本院在過去一年中，共搜集了118位病例，包括50位腎臟造影正常者和68位接受骨骷攝影同時出現腎臟局部活性異常者，後者，依其活性之增減分為(1)部活性增加和(2)局部活性減少兩類；分別為52例和16例。此118位患者均接受腎盂腎盞攝影和／或腎臟超音波檢查。結果顯示，利用骨骸閃爍攝影，對於腎臟局部活動性異常之偵測，在第一類患者，有較高之靈敏度；腎盂積水和／或輸尿管積水是造成此類異常最常見的原因；臨床上，其診斷又以子宮頸癌患者為最；對第二類思者，則有較高之專一性；以單純性囊腫最多，其發生原因由資料顯示，與患者罹患癌症與否及類別無直接關係。本文結論是：患者接受骨骼攝影時，其所呈現之局部腎臟活性異常變化，由檢查之預測值得知，頗具臨床意義。不但可評估患者骨骼本身之病變，亦可對可能導致患者不可逆變化卻又無明顯症狀之泌尿道異常作早期偵測，以期達到早期預防或冶療之目的。
關鍵字
無資料並列摘要
Tc-99m MDP (technetium-99m methylene diphosphonate) is currently the most common radiopharmaceutical for skeletal imaging. In ordinary condition, certain amount of the tracer is excreted through the urinary system. Thus, we can also see the kidneys clearly while the patients receive bone scintigraphy. From Feburary 1984 to January 1985, 118 cases including 50 cases of normal renal image as control group were selected for this study. All of them had a renal radiographic study within 15 days of the bone study. Patients with abnormal renal uptake were devided into two groups: (1) Focal increased radioactivity (52 cases) and (2) Focal decreased radioactivity (16 cases). By using the decision matrix method based on Bayes' theorem, we calculate the sensitivity, specificity, and the probability of the presence of renal abnormality in each category to evaluate its validity and yield. Our study reveals that, in addition to detecting skeletal abnormality, bone scintigraphy can provide useful data of renal function and show a significant correlation on the incidence of renal abnormalities.