Lantsberg S, Lanchbury E E, Drolc Z A
Nuclear Medicine Department, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Nucl Med Commun. 1990 Nov;11(11):761-9. doi: 10.1097/00006231-199011000-00005.
A new radiopharmaceutical for hepatobiliary scanning, 99Tcm Iodida, which has significant advantages in patients with high bilirubinaemia, was used to assess biliary tract complications in 30 consecutive liver transplant patients. There was adequate hepatic extraction and excretion for diagnostic imaging even in patients with serum bilirubin levels up to 877 mumol l-1 (51.6 mg dl-1). Twelve out of 12 cases (100%) without any biliary complication were correctly diagnosed. Extrahepatic obstruction was recognized in 5 out of 7 cases (71%). In one case the scintigraphic findings showed no perfusion of the transplanted liver caused by vascular thrombosis due to acute rejection. One small biliary leak was missed. The correct diagnosis of intrahepatic cholestasis was made in 3 out of 9 patients. However six equivocal studies were observed in profoundly jaundiced patients with bilirubin levels above 400 mumol l-1 due to difficulties in differentiating extrahepatic obstruction from severe intrahepatic cholestasis. Quantitative analysis of the kinetics of 99Tcm Iodida may permit better discrimination between the wide variety of disease in the posttransplant period.
一种用于肝胆扫描的新型放射性药物99锝依地碘，在高胆红素血症患者中具有显著优势，被用于连续评估30例肝移植患者的胆道并发症。即使血清胆红素水平高达877 μmol/L（51.6 mg/dl）的患者，也有足够的肝脏摄取和排泄用于诊断成像。12例无任何胆道并发症的患者中，12例（100%）诊断正确。7例肝外梗阻患者中，5例（71%）被识别。1例患者的闪烁扫描结果显示，由于急性排斥反应导致血管血栓形成，移植肝无灌注。1例小胆漏被漏诊。9例患者中有3例正确诊断为肝内胆汁淤积。然而，在胆红素水平高于400 μmol/L的深度黄疸患者中，由于难以区分肝外梗阻与严重肝内胆汁淤积，观察到6例诊断不明确的研究。对99锝依地碘动力学的定量分析可能有助于更好地区分移植后时期的各种疾病。
