Nakajima Kenichi, Kawano Masaya, Kinuya Keiko, Sato Shinichi, Takehara Kazuhiko, Tonami Norihisa
Department of Nuclear Medicine, Kanazawa University Hospital, Japan.
Nucl Med Commun. 2004 Apr;25(4):375-81. doi: 10.1097/00006231-200404000-00010.
Oesophageal complications are common in systemic sclerosis (SSc). However, the ability to determine the severity of oesophageal complications according to SSc type and skin lesion has not been evaluated.
The study groups consisted of 35 patients with SSc who were classified into diffuse (n=20) and limited (n=15) cutaneous types, and 16 control subjects. An additional 26 consecutive patients were studied for an analysis of the reproducibility. The severity of a skin lesion was quantified by using a modification of Rodnan's total skin thickness scores. Oesophageal scans were performed after the subjects, in sitting and supine positions, had consumed potage soup. Condensed images of the dynamic study were classified into four patterns: normal, transient retention, slight retention and severe retention, in conjunction with parameters of retention fraction by analysing the time-activity curve.
The highest reproducibility was obtained using retention at 90 s (R90, r=0.93). Analysis of the condensed images showed that the SSc patients had a higher incidence of severe retention than did the control subjects. Groups with diffuse-type SSc or a high skin thickness score showed a higher incidence of severe retention (P=0.041 and 0.0048, respectively) compared with the control and less severe groups. The R90 in the supine position differed significantly among the controls, the limited-type and diffuse-type SSc groups (mean+/-SEM, 10+/-1%, 24+/-5%, 38+/-6%, respectively; P=0.0004)). The group with high skin scores (i.e. > or =10) showed a higher R90 (41+/-6%) than did either the group with low skin scores (R90=23+/-5%) or the control group (P=0.0001).
An oesophageal scan can detect both slight and severe types of oesophageal dysfunction, and can be used as a quantitative method that reflects functional abnormality in SSc.
食管并发症在系统性硬化症（SSc）中很常见。然而，根据SSc类型和皮肤病变来确定食管并发症严重程度的能力尚未得到评估。
研究组由35例SSc患者组成，分为弥漫性（n = 20）和局限性（n = 15）皮肤型，另有16例对照受试者。对另外连续26例患者进行研究以分析可重复性。通过对罗德南总皮肤厚度评分进行修改来量化皮肤病变的严重程度。受试者在坐位和仰卧位饮用浓汤后进行食管扫描。通过分析时间 - 活性曲线，将动态研究的浓缩图像分为四种模式：正常、短暂潴留、轻度潴留和重度潴留，并结合潴留分数参数。
使用90秒时的潴留情况（R90，r = 0.93）可获得最高的可重复性。对浓缩图像的分析表明，SSc患者重度潴留的发生率高于对照受试者。与对照和病情较轻的组相比，弥漫型SSc组或皮肤厚度评分高的组重度潴留的发生率更高（分别为P = 0.041和0.0048）。仰卧位时的R90在对照组、局限性和弥漫性SSc组之间有显著差异（平均值±标准误，分别为10±1%、24±5%、38±6%；P = 0.0004）。皮肤评分高（即≥10）的组R90（41±6%）高于皮肤评分低的组（R90 = 23±5%）或对照组（P = 0.0001）。
食管扫描可检测到轻度和重度食管功能障碍类型，并可作为反映SSc功能异常的定量方法。
