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Tc-99m Heat-Damaged Red Blood Cells Scintigraphy With Single-Photon-Emission Computed Tomography/Computed Tomography (SPECT/CT) for Splenosis: A Case Report

鎝99m熱破壞紅血球閃爍攝影合併單光子斷層/電腦斷層掃描於脾組織異位再生:病例報告

摘要


Splenosis is autotransplantation of splenic tissue after traumatic splenic rupture or splenectomy. It is often misdiagnosed as a tumor on imaging studies. Tc-99m heat-damaged red blood cells (RBCs) scintigraphy is a method with high specificity for functional splenic tissue. Using a single-photon-emission computed tomography (SPECT/ CT) technique, splenosis can be accurately confirmed to avoid invasive biopsy, resection, or treatment. A 71-year-old male patient is a case of hepatitis B and C virus-related liver disease. The patient has a history of splenectomy after blunt abdominal trauma. Liver tumors were found using sonography, and the patient’s alpha-fetoprotein (AFP) level was rising to 105 ng/mL. CT and magnetic resonance imaging revealed tumors in the S6 and the S2 of the liver and the left subphrenic region. After treatment of the S6 tumor, the patient’s AFP level returned to the normal range. Tc-99m heat-damaged RBCs SPECT/CT demonstrated that the S2 and the left subphrenic tumors were splenosis. A 60-year-old male patient was diagnosed with hepatitis C. The patient has a history of splenectomy after blunt abdominal trauma. Abdominal CT showed bilateral adrenal masses with peritoneal nodules. The initial impression was malignancy with peritoneal carcinomatosis. Because of the patient’s history of splenectomy, Tc-99m heat-damaged RBCs scintigraphy was suggested to rule out splenosis. After carefully identifying all adrenal and peritoneal lesions using SPECT/CT, the diagnosis of splenosis was confirmed. Tc-99m heat-damaged RBC scintigraphy with SPECT/CT can noninvasively confirm the diagnosis of splenosis to avoid invasive biopsy, resection, or treatment.

並列摘要


對於曾經出過車禍且有脾臟損傷,或是有手術切脾臟的患者來說,多年以後有可能會在腹腔內發現脾組織異位再生。有脾組織異位再生的患者通常沒有症狀而常在影像上意外發現。脾組織異位再生可以是單個或多個,常在腹腔內發現,肝內、胸腔內、皮下還有顱內也有可能發現,不過很少見。它常被誤診為其他的腫瘤。以往的電腦斷層或是核磁共振照影因為它沒有典型的影像特徵而難以鑑別。鎝99m熱破壞紅血球閃爍攝影針對脾組織異位再生具有高度的特異性。搭配單光子斷層/電腦斷層掃描能夠增加該檢查的靈敏度。在本次的案例報告,我們呈現兩個病患一開始被診斷為癌症,後來利用鎝99m熱破壞紅血球閃爍攝影合併單光子斷層/電腦斷層掃描診斷出是脾組織的異位再生。一個患有B型肝炎和C型肝炎的71歲男性病患,曾經因為腹部鈍傷接受過脾切除手術。在一次超音波檢查中發現到肝腫瘤,a胎兒蛋白指數升高到105ng/mL。在電腦斷層和核磁共振中發現在肝臟的第2和第6分段還有左邊橫膈下段區域有腫瘤。在治療完肝臟第6分段的腫瘤後,病患的a胎兒蛋白指數回復到正常。用鎝99m熱破壞紅血球閃爍攝影合併單光子斷層/電腦斷層掃描發現肝臟第2分段和左邊橫膈下段區域的腫瘤是脾組織異位再生。一個患有C型肝炎的病患曾經因為腹部鈍傷接受過脾切除手術。在一次腹部電腦斷層發現到雙側腎上腺腫塊和腹膜結節。本來診斷是腹膜癌變,但因為病患有脾切除手術病史,所以被安排鎝99m熱破壞紅血球閃爍攝影掃描以排除脾組織異位再生的可能。在利用合併單光子斷層/電腦斷層掃描仔細審查每一個結節,最終確認是脾組織異位再生。鎝99m熱破壞紅血球閃爍攝影合併單光子斷層/電腦斷層掃描可以非侵入性的方式診斷脾組織異位再生,避免侵入性的切片、手術切除或不必要的治療。

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