Department of Radiology, Graduate School of Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
Clin Nucl Med. 2012 Nov;37(11):1047-51. doi: 10.1097/RLU.0b013e31825b208f.
Orally administered I-labeled 15-(4-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP), a fatty acid analog, is absorbed from the intestine and ascends to the venous angle through the thoracic duct (TD). The objective of this study was to evaluate the clinical feasibility of 3-dimensional (3D) TD scintigraphy using SPECT/CT and BMIPP for the detection of anatomical anomalies of TD.
This study included 35 consecutive patients with esophageal cancer who underwent tumor resection after TD scintigraphy. For scintigraphy, 111 MBq of BMIPP was orally administered, and static images and SPECT/CT images were obtained. On the basis of the SPECT/CT fusion images, TD was divided into the following 4 segments: cervical, upper thoracic, middle thoracic, and lower thoracic. The TD visualization was categorized into 5 grades, from grade 1 (poor) to 5 (excellent). In addition, the diagnostic accuracy of 3D TD scintigraphy for the detection of anatomical anomalies of TD was calculated using the intraoperative finding as a criterion standard.
The TD visualization grades for the cervical, upper, middle, and lower thoracic segments were 4.4 ± 0.6, 3.7 ± 1.0, 3.1 ± 0.8, and 2.1 ± 0.9, respectively. The TD scintigraphy demonstrated an uncommon accumulation including that in the right- or bilateral-sided mediastinum or venous angle in 6 (17%) of the 35 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 3D TD scintigraphy for the detection of anatomical anomalies of TD were 0.75, 0.90, 0.5, 0.97, and 0.89, respectively.
Three-dimensional TD scintigraphy by BMIPP is a simple and minimally invasive method for imaging the anatomical configuration of the TD and for detecting any anatomical anomalies, except in the lower thoracic segment.
经口给予标记的 15-（4-碘苯基）-3（R，S）-甲基十五烷酸（BMIPP），一种脂肪酸类似物，从肠道吸收并通过胸导管（TD）上升到静脉角。本研究的目的是评估 SPECT/CT 和 BMIPP 用于检测 TD 解剖异常的 3 维（3D）TD 闪烁显像的临床可行性。
本研究包括 35 例连续接受 TD 闪烁显像后行肿瘤切除术的食管癌患者。进行闪烁显像时，口服 111MBq 的 BMIPP，获取静态图像和 SPECT/CT 图像。基于 SPECT/CT 融合图像，将 TD 分为以下 4 段：颈段、上胸段、中胸段和下胸段。TD 显像分为 5 个等级，从 1 级（差）到 5 级（优）。此外，使用术中发现作为标准，计算 3D TD 闪烁显像检测 TD 解剖异常的诊断准确性。
TD 颈段、上胸段、中胸段和下胸段的显像等级分别为 4.4±0.6、3.7±1.0、3.1±0.8 和 2.1±0.9。35 例患者中有 6 例（17%）出现 TD 闪烁显像异常，包括右或双侧纵隔或静脉角的不常见聚集。3D TD 闪烁显像检测 TD 解剖异常的灵敏度、特异性、阳性预测值、阴性预测值和诊断准确性分别为 0.75、0.90、0.5、0.97 和 0.89。
BMIPP 的 3D TD 闪烁显像术是一种简单、微创的方法，可用于成像 TD 的解剖结构，并检测任何解剖异常，除了下胸段。
