Booster administration of Tc-99m PMT for delayed static imaging in patients with biliary atresia

IF 2.5 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Takahiro Hosokawa, Mayuki Uchiyama, Yutaka Tanami, Yumiko Sato, Yasuharu Wakabayashi, Eiji Oguma
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引用次数: 0

Abstract

Objective

Tc-99m N-pyridoxyl-5-methyl-tryptophan (PMT) hepatobiliary scintigraphy has high diagnostic performance for biliary atresia. Our hospital implements standard Tc-99m PMT administration followed by a 6 h static imaging review; booster doses are given in cases requiring 24 h delayed scans. This study aimed to evaluate the diagnostic performance of this method.

Methods

A total of 37 pediatric patients who underwent Tc-99m PMT biliary scintigraphy were classified into the surgically-diagnosed biliary atresia or non-biliary atresia groups. The absence of tracer accumulation in the small bowel was considered a hepatobiliary scintigraphic diagnosis of biliary atresia. The Clopper–Pearson method was used to calculate the 95% confidence intervals (CIs) for determining the diagnostic accuracy, negative predictive value, positive predictive value, sensitivity, and specificity of Tc-99m PMT biliary scintigraphy.

Results

Among the 37 patients, 12 were classified into the diagnosis of biliary atresia group. Regarding biliary scintigraphy findings, 16 of 37 patients demonstrated tracer accumulation in the small bowel within 6 h of testing. These cases were diagnosed as non-biliary atresia, requiring no further testing or booster administration. In contrast, 21 patients underwent delayed testing requiring booster administration, which revealed 13 without tracer excretion and 11 who were diagnosed with biliary atresia. Among the eight patients with tracer accumulation, only one was diagnosed with biliary atresia. Furthermore, two cases without tracer excretion and seven cases with tracer excretion were clinically diagnosed as non-biliary atresia. The diagnostic performance of our examination was as follows: a diagnostic accuracy of 91.9% (34/37; 95% CIs 78.0–98.3%), sensitivity of 91.6% (11/12; 95% CIs 61.5–99.8%), specificity of 92.0% (23/25; 95% CIs 74.0–99.0%), a positive predictive value of 84.6% (11/13; 95% CIs 54.6–98.0%), and a negative predictive value of 95.8% (23/24; 95% CIs 78.9–99.9%).

Conclusions

Our protocol for Tc-99m PMT biliary scintigraphy using tracer booster administration demonstrated reliable diagnostic performance for biliary atresia. Notably, 43% of cases did not require booster administration, indicating that lesser radiation exposure may still yield comparable diagnostic accuracy.

Abstract Image

Abstract Image

对胆道闭锁患者进行锝-99m PMT 增效治疗以进行延迟静态成像。
目的:锝-99m N-吡哆醇-5-甲基色氨酸(PMT)肝胆闪烁扫描对胆道闭锁具有很高的诊断性能。我院采用标准锝-99m PMT 给药,然后进行 6 小时静态成像复查;对于需要延迟 24 小时扫描的病例,则给予加强剂量。本研究旨在评估该方法的诊断效果:方法:共有37名小儿患者接受了锝-99m PMT胆道闪烁扫描,被分为手术诊断的胆道闭锁组和非胆道闭锁组。小肠内无示踪剂积聚被认为是胆道闭锁的肝胆闪烁扫描诊断。采用Clopper-Pearson方法计算Tc-99m PMT胆道闪烁成像诊断准确性、阴性预测值、阳性预测值、敏感性和特异性的95%置信区间(CI):结果:37 例患者中,12 例被诊断为胆道闭锁组。关于胆道闪烁扫描结果,37 例患者中有 16 例在检测后 6 小时内显示小肠内有示踪剂积聚。这些病例被诊断为非胆道闭锁,无需进一步检测或使用增强剂。相比之下,21 名患者接受了延迟检测,需要进行强化给药,结果显示 13 人没有示踪剂排泄,11 人被诊断为胆道闭锁。在 8 例示踪剂积聚的患者中,只有 1 例被诊断为胆道闭锁。此外,2 例无示踪剂排泄的患者和 7 例有示踪剂排泄的患者被临床诊断为非胆道闭锁。我们的检查诊断结果如下:诊断准确率为 91.9% (34/37; 95% CIs 78.0-98.3%),敏感性为 91.6% (11/12; 95% CIs 61.5-99.8%),特异性为 92.0% (23/25; 95% CIs 74.0-99.0%),阳性预测值为 84.6% (11/13; 95% CIs 54.6-98.0%),阴性预测值为 95.8% (23/24; 95% CIs 78.9-99.9%):结论:我们的锝-99m PMT胆道闪烁扫描方案采用示踪剂增量给药,对胆道闭锁具有可靠的诊断性能。值得注意的是,43%的病例不需要加强给药,这表明较少的辐射照射仍可获得相当的诊断准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Nuclear Medicine
Annals of Nuclear Medicine 医学-核医学
CiteScore
4.90
自引率
7.70%
发文量
111
审稿时长
4-8 weeks
期刊介绍: Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.
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