Kartamihardja A H S, Kurniawati Y, Gunawan R
Department of Nuclear Medicine and Molecular Medicine, Dr. Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
Faculty of Medicine, Universitas Andalas Padang, Padang, Indonesia.
Ann Nucl Med. 2018 Jan;32(1):60-68. doi: 10.1007/s12149-017-1220-1. Epub 2017 Dec 5.
Tuberculosis (TB) still remains the world's endemic infection. TB affects the lungs and any part of the body other than the lung. The diagnosis of TB has not changed much over the decades. Ethambutol is one of the first line treatments for TB. It can be labeled using Tc. Tc-ethambutol will be accumulated in the site of TB lesion and can be imaged using gamma camera. The aim of this study was to evaluate the diagnostic value of Tc-ethambutol scintigraphy in detecting and localizing of TB.
Retrospective cross-sectional study was done. Subjects were patients suspected of having TB infection. Whole body and SPECT-CT imaging at the suspected area was done 1 and 4 h after injection of 370-555 MBq Tc-ethambutol. Tc-ethambutol scintigraphy was analyzed visually. The results were compared with that of histopathological or microbiological tests. Statistical analysis was done to determine the sensitivity, specificity, PPV, NPV and accuracy.
One hundred and sixty-eight subjects were involved in this study. There were 110 men and 58 women with mean age of 34.52 ± 11.94 years. There were concordance results in 156 (92.86%) and discordant in 12 (7.14%) subjects between Tc-ethambutol scintigraphy and histopathological or microbiological result. The sensitivity, specificity, PPV, NPV and accuracy of Tc-ethambutol scintigraphy in the diagnosis of pulmonary TB were 93.9, 85.7, 93.9, 85.7 and 91.4%, respectively, for extra-pulmonary TB 95.5, 77.8, 97.9, 63.6, and 85.1%, respectively, and for total tuberculosis 94.9, 83.3, 96.3, 78.1 and 92.8%, respectively. There was no side effect observed in this study.
Tc-ethambutol scintigraphy is a useful diagnostic imaging technique to detect and localize intra- and extra-pulmonary TB. It is safe to be performed even in pediatric patient. Consuming ethambutol less than 2 weeks did not influence the result.
结核病仍然是全球范围内的地方性感染疾病。结核病可累及肺部以及肺部以外的身体任何部位。几十年来，结核病的诊断方法变化不大。乙胺丁醇是结核病的一线治疗药物之一。它可用锝进行标记。锝-乙胺丁醇会在结核病灶部位蓄积，可通过伽马相机进行成像。本研究的目的是评估锝-乙胺丁醇闪烁扫描术在检测和定位结核病方面的诊断价值。
开展回顾性横断面研究。研究对象为疑似结核感染的患者。在注射370 - 555MBq锝-乙胺丁醇后1小时和4小时，对可疑区域进行全身及单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）成像。对锝-乙胺丁醇闪烁扫描图像进行视觉分析。将结果与组织病理学或微生物学检测结果进行比较。进行统计分析以确定敏感性（灵敏度）、特异性、阳性预测值、阴性预测值和准确性。
本研究纳入了168名研究对象。其中男性110名，女性58名，平均年龄为34.52±11.94岁。锝-乙胺丁醇闪烁扫描术与组织病理学或微生物学检测结果一致的有156例（92.86%），不一致的有12例（7.14%）。锝-乙胺丁醇闪烁扫描术诊断肺结核的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为93.9%、85.7%、93.9%、85.7%和91.4%；肺外结核分别为95.5%、77.8%、97.9%、63.6%和85.1%；总结核病分别为94.9%、83.3%、96.3%、78.1%和92.8%。本研究未观察到副作用。
锝-乙胺丁醇闪烁扫描术是一种用于检测和定位肺内及肺外结核病的有用诊断成像技术。即使在儿科患者中进行该检查也是安全的。服用乙胺丁醇少于2周不会影响检查结果。
