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目的 99mTc RBC连续减影显像为早期诊断胃肠出血提供了新的手段。本文评价其临床应用价值。方法 用数字Υ相机对 90例疑诊胃肠出血患者行99mTc体内标记红细胞胃肠出血显像。每帧 5分钟 ,连续采集 60分钟 ,得到 12帧常规非减影图像 (CNS)。 12帧动态图像用计算机以t+5分钟为时间轴作连续减影处理 ,得到 11帧减影图像 (SSS)。若早期显像结果为阴性或怀疑有再出血时行 3、6或 2 4小时延迟显像。结果 90例疑诊胃肠出血患者中 ,62例确诊为活动性胃肠出血。图像以 30分钟、60分钟以及 2 4小时内三个时间段进行分析。SSS的灵敏度分别为 87% ( 30分钟 )和 92 8% ( 60分钟 ) ,明显高于CNS的 56 4 % ( 30分钟 )和63 9% ( 60分钟 )。 2 4小时延迟显像CNS的灵敏度增至 85 4 %。两种方法的特异性之间无明显差异。 62例确诊病人中 4 2例经手术明确出血部位。SSS的定位诊断符合率为 92 8,明显高于CNS的 73 8%。结论 99mTc RBC连续减影显像是一种早期诊断胃肠出血的有效方法 ,较之常规非减影显像能够更早期、更准确地对微量胃肠出血作出定性定位诊断。
Objective 99mTc RBC continuous subtraction imaging for the early diagnosis of gastrointestinal bleeding provides a new means. This article evaluates its clinical value. Methods Ninety patients with suspected gastrointestinal bleeding underwent 99mTc labeled erythrocyte gastrointestinal bleeding in digital Υ camera. Five minutes per frame, continuous acquisition of 60 minutes to get 12 regular non-subtraction images (CNS). Twelve frames of moving images were continuously subtracted with a time of 5 minutes on t + 5 minutes to obtain 11 frames of subtracted images (SSS). If the early imaging results were negative or suspected of rebleeding 3,6 or 24 hours delayed imaging. Results Of the 90 cases of suspected gastrointestinal bleeding, 62 cases were diagnosed as active gastrointestinal bleeding. The images were analyzed in three periods of 30 minutes, 60 minutes and 24 hours. The sensitivity of SSS was 87% (30 min) and 92 8% (60 min), respectively, which was significantly higher than 56 4% (30 min) and 63 9% (60 min) of CNS. 2 4 hours delayed imaging CNS sensitivity increased to 85 4%. There was no significant difference between the specificity of the two methods. Forty-two of the 62 confirmed cases were confirmed by surgery. The coincidence rate of positioning diagnosis of SSS was 92 8, which was significantly higher than 73 8% of CNS. Conclusion 99mTc RBC continuous subtraction imaging is an effective method for early diagnosis of gastrointestinal hemorrhage. Compared with conventional non-subtractive imaging, 99mTc RBC can diagnose gastrointestinal bleeding more accurately and earlier than conventional non-subtractive imaging.