肝脾閃爍攝影術中血液貯留像對於原發性肝細胞癌症的診斷

VALUE OF BLOOD POOL PHASE RADIONUCLIDE IMAGING IN DIAGNOSIS OF HEPATOCELLULAR CARCINOMA

謝明裕(Ming-Yuh Hsieh) ； 吳重慶(Chung-Chieng Wu) ； 何耀輝(Yau-Hui Ho) ； 王良彥(Liang-Yen Wang) ； 陳章義(Chang-Yi Cheng)

《中華放射線醫學雜誌》 7卷4期 (1982/12) Pp. 303-308

摘要

於民國70年11月至71年6月間，在例常的肝、脾閃爍攝影術中，加照1分鐘的血中貯留相影像，對84例後來被證實的佔位性病灶患者檢査，以觀察此佔位性病灶之血管性。56例原發性肝細胞癌症患者中，30例被發現爲血流灌注良好，11例爲無法判定，15例爲灌注不良；28例非細胞癌症之佔位性病灶患者中，僅1例爲灌注良好，5例爲無法判定，其它爲灌注不良。以血流灌注良好爲診斷肝細胞癌症的依據，則其敏感性爲54%(30/56)，特異性爲79%(22/28)，而準確性爲62%(52/84)。就肝細胞癌症者中經病理切片檢査發現之25例加以分析，其中10例α-胎蛋白呈陽性反應(RIA法＞320ng/ml，RPHA法≥400ng/ml) (4096之敏感性)，14例爲血中貯留相閃爍影像呈灌注良好之病灶(56%之敏感性);若以a-胎蛋白陽性反應和病灶灌注良好之任一爲診斷依據，則敏感性可提升至72%。可見，在肝、胆閃爍攝影術中，加照1張血中貯留相閃爍影像，對於本地區肝細胞癌症之診斷是既簡便又值得推行的檢査歩驟。

並列摘要

Routine liver-spleen radionuclide scintigrams usually include 3 views: the anterior, the posterior and the right lateral views. In addition to these standard views, we took another anterior view at 1 minute after intravenous injection of 3 to 6 mci 99mTc-phytate as the blood-pool phase image for each patient who received an examination during the period from November, 1981 to June, 1982. Among the 56 cases with hepatoma (53 male and 3 female, aged 48±17 years), 30 (54%) had good perfusion or higher vascularity of the tumor evidenced by radioactivity somewhat less than, equal, or higher than the surrounding hepatic tissue; the tumor became a cold nodule or cold nodules in the standard views. In the 28 cases with non-hepatomatous space-occupying lesion, 22 (79%) had poor perfusion evidence by lacking radioactivity of the tumor, that remains cold in the standard views, at the blood-pool phase. Eleven cases with hepatoma and 5 non-hepatomatous cases had a blood-pool phase image insufficient for telling a good or poor perfusion. Conclusively on the basis of high vascularity of the primary hepatocellular carcinoma the blood-pool phase radionuclide imaging is valuable in diagnosis of that tumor. And it gave a sensitivity of 54% (30/56), a specificity of 79% (22/28), and an accuracy of 62% (52/84).