Jian-Hua Wang, Department of Radiology, Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, Zhejiang Province, China.
World J Gastroenterol. 2013 Aug 14;19(30):4897-906. doi: 10.3748/wjg.v19.i30.4897.
To evaluate (99m)Tc-ciprofloxacin scintigraphy compared with computed tomography (CT) for detecting secondary infections associated with severe acute pancreatitis (SAP) in swine.
Six healthy swine were assigned to a normal control group (group A, n = 6). SAP was induced in group B (n = 9) and C (n = 18), followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli (E. coli) (group B) and active E. coli (group C), respectively. At 7 d after inoculation, a CT scan and a series of analyses using infecton imaging (at 0.5, 1, 2, 3, 4 and 6 h after the administration of 370 MBq of intravenous infecton) were performed. The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments. The differences in infecton uptake and changes in the lesion-background radioactive count ratios (L/B) in the 3 groups were recorded and compared. After imaging detection, histopathology and bacterial examinations were performed, and infected SAP was regarded as positive. The imaging findings were compared with histopathological and bacteriological results.
In group A, 6 animals survived without infection in the pancreas. In group B, 7/9 swine survived and one suffered from infection. In group C, 15/18 animals survived with infection. Hence, the number of normal, non-infected and infected SAP swine was 6, 6 and 16, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the infecton method were 93.8% (15/16), 91.7% (11/12), 92.9% (26/28), 93.8% (15/16) and 91.7% (11/12), whereas these values for CT were 12.5% (2/16), 100.0% (12/12), 50.0% (14/28), 100.0% (2/2) and 46.2% (12/26), respectively. The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine (P < 0.001). The mean L/B of the infectious foci at 0.5, 1, 2, 3, 4 and 6 h was 1.17 ± 0.10, 1.71 ± 0.30, 2.46 ± 0.45, 3.36 ± 0.33, 2.04 ± 0.37 and 1.1988 ± 0.09, respectively. At 3 h, the radioactive counts (2350.25 ± 602.35 k) and the mean L/B of the infectious foci were significantly higher than that at 0.5 h (P = 0.000), 1 h (P = 0.000), 2 h (P = 0.04), 4 h (P = 0.000) and 6 h (P = 0.000).
(99m)Tc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.
评价（99m）Tc-环丙沙星闪烁扫描与计算机断层扫描（CT）在检测猪重症急性胰腺炎（SAP）相关继发性感染中的应用。
将 6 头健康猪分为正常对照组（A 组，n=6）。B 组（n=9）和 C 组（n=18）SAP 诱导后，分别用失活大肠埃希菌（E. coli）和活性 E. coli 接种胰腺坏死灶。接种后 7d，行 CT 扫描和一系列感染成像分析（静脉注射 370MBq 后 0.5、1、2、3、4 和 6h）。视觉评估闪烁图像，并使用感兴趣区赋值进行半定量分析。记录并比较 3 组感染摄取的差异和病变-背景放射性计数比值（L/B）的变化。成像检测后行组织病理学和细菌学检查，感染性 SAP 被视为阳性。将影像学结果与组织病理学和细菌学结果进行比较。
A 组 6 只动物胰腺无感染存活。B 组 9 只猪中有 7 只存活，1 只感染。C 组 18 只动物中有 15 只存活并感染。因此，正常、非感染和感染性 SAP 猪的数量分别为 6、6 和 16。感染法的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为 93.8%（15/16）、91.7%（11/12）、92.9%（26/28）、93.8%（15/16）和 91.7%（11/12），CT 分别为 12.5%（2/16）、100.0%（12/12）、50.0%（14/28）、100.0%（2/2）和 46.2%（12/26）。感染性 SAP 的 L/B 变化与非感染和正常猪的变化有显著差异（P<0.001）。感染灶在 0.5、1、2、3、4 和 6h 的平均 L/B 分别为 1.17±0.10、1.71±0.30、2.46±0.45、3.36±0.33、2.04±0.37 和 1.1988±0.09。3h 时放射性计数（2350.25±602.35k）和感染灶平均 L/B 显著高于 0.5h（P=0.000）、1h（P=0.000）、2h（P=0.04）、4h（P=0.000）和 6h（P=0.000）。
（99m）Tc-环丙沙星闪烁扫描可能是一种有效的检测 SAP 继发性感染的方法，其灵敏度和准确性均高于 CT。
