Ohno Yasuharu, Ishida Haruo, Hayashi Akira, Kamagata Shoichiro, Hirobe Seiichi, Ishii Katsumi
Department of Surgery, Tokyo Metropolitan Kiyose Children's Hospital, Kiyose, Tokyo, Japan.
J Nucl Med. 2002 Dec;43(12):1611-5.
In this study, we attempted to evaluate the regional dynamic function of hepatocytes by introducing unique parameters in (99m)Tc-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99m)Tc-GSA) scintigraphy. (99m)Tc-GSA scintigraphy provides valuable information for the receptor population density. However, the conventional indices are the results of the analyses of 2 fixed points and, as a result, it is not possible to accurately estimate the regional dynamic function.
We performed (99m)Tc-GSA scintigraphy 100 times on a total of 54 pediatric patients. The average age at examination was 7.4 +/- 5.8 y. Ninety-one of the 100 scintigraphy cases were available for this study. We converted the time-activity curve for the liver of (99m)Tc-GSA to a horizontal mirror image curve, and, on the basis of the height-over-area method, calculated the mean transit time (MTT) in each pixel and depicted the functional image as unique parameters, which were thus compared with the conventional indices. For these parameters, we used the time-activity curve for only the liver.
The whole liver MTT showed a significant correlation with both the clearance (y = 590.3x + 10.3; r = 0.51; P < 0.0001) and the receptor (y = -1,836.2x + 2,038.8; r = -0.66; P < 0.0001) indices. On the basis of the MTT in each pixel, we could depict the functional image of the liver. In actual clinical situations, the functional image was quite useful for making a visual evaluation of the dynamic distribution of (99m)Tc-GSA. The functional image indicated that, even at an extremely early stage of biliary atresia, the hepatic functional reserve might be exacerbated earlier in the right lobe than in the left lobe.
The MTT and the functional image enable us to elucidate the regional dynamic function of hepatocytes both quantitatively and visually. In addition, this diagnostic modality can be used at virtually all medical institutions using a modified analytic program already in public use.
在本研究中，我们试图通过在（99m）锝 - 二乙三胺五乙酸 - 半乳糖基人血清白蛋白（99m）Tc - GSA）闪烁扫描中引入独特参数来评估肝细胞的区域动态功能。（99m）Tc - GSA闪烁扫描为受体群体密度提供了有价值的信息。然而，传统指标是对两个固定点分析的结果，因此无法准确估计区域动态功能。
我们对总共54例儿科患者进行了100次（99m）Tc - GSA闪烁扫描。检查时的平均年龄为7.4±5.8岁。100例闪烁扫描病例中有91例可用于本研究。我们将（99m）Tc - GSA肝脏的时间 - 活性曲线转换为水平镜像曲线，并基于高度 - 面积法计算每个像素的平均通过时间（MTT），并将功能图像描绘为独特参数，从而与传统指标进行比较。对于这些参数，我们仅使用肝脏的时间 - 活性曲线。
全肝MTT与清除率（y = 590.3x + 10.3；r = 0.51；P < 0.0001）和受体（y = -1,836.2x + 2,038.8；r = -0.66；P < 0.0001）指标均显示出显著相关性。基于每个像素的MTT，我们可以描绘肝脏的功能图像。在实际临床情况下，功能图像对于直观评估（99m）Tc - GSA的动态分布非常有用。功能图像表明，即使在胆道闭锁的极早期，右叶肝功能储备可能比左叶更早受到影响。
MTT和功能图像使我们能够在定量和直观上阐明肝细胞的区域动态功能。此外，这种诊断方式几乎可以在所有使用已公开的修改分析程序的医疗机构中使用。
