Khurana Aditi, Garg Sumit, Ravindra Shubha G, Kumar Yadav Devendra, Jain Vishesh, Bajpai Minu, Agarwala Sandeep, Bal Chandrashekhar, Kumar Rakesh
Department of Nuclear Medicine.
Department of Pediatric Surgery, AIIMS, New Delhi, India.
Nucl Med Commun. 2023 Jan 1;44(1):12-17. doi: 10.1097/MNM.0000000000001629. Epub 2022 Nov 16.
The aim of our study was to describe the scintigraphic patterns of 99m Tc-pertechnetate uptake in patients who were referred to the department of nuclear medicine for evaluating and diagnosing ectopic gastric mucosa in foregut and midgut duplication cysts.
This hospital-based, retrospective cum prospective research spans a period of 8 years from April 2014 to January 2022. Previous hospital medical records were analyzed and subsequently, a database was prepared which included the age, sex, clinical indication of a 99m Tc-pertechnetate scan, and the planar and SPECT-computed tomography (CT) imaging findings. Postoperative histopathological reports were available for 21 patients. Dynamic and planar static imaging was performed. We included SPECT-CT in suspected duplication cysts to increase the sensitivity and specificity which is a tradeoff for a small amount of additional radiation exposure. A total of 69 patients were subjected to a 99m Tc-pertechnetate scan for suspected foregut or midgut duplication cysts. All were subjected to dynamic planar and delayed static images up to 24 h or until focal uptake of radiotracer was noted which corroborated the anatomical findings, whichever was earlier. SPECT-CT was performed along with the planar study in 31 patients which confirmed the findings. Previously performed CT scans were used for anatomical correlation in the remaining ones.
Duplication cysts were localized in a total of 28 patients (19 foregut duplication cysts and 12 small bowel duplications - 3 patients had dual duplication cysts, both foregut, and midgut). Forty-one patients had no scintigraphic evidence of ectopic gastric mucosa. Of these 69 patients, histopathological diagnosis was available for 21 patients (22 lesions). The report was concordant with the scan findings in 15 patients (16 lesions) and 6 patients showed discordance in histopathological diagnosis and scan findings.
In conclusion, multi-time point imaging is the key to diagnosing ectopic gastric mucosa of various sizes and in various locations. An abnormal radiotracer uptake in dynamic sequences, even before the appearance of the stomach in the region of the small bowel is indicative of intestinal duplication, and delayed radiotracer visualization in the region of the thorax is characteristic of intrathoracic foregut duplication cyst.
我们研究的目的是描述在因评估和诊断前肠及中肠重复囊肿中的异位胃黏膜而转诊至核医学科的患者中，99m锝-高锝酸盐摄取的闪烁显像模式。
这项基于医院的回顾性兼前瞻性研究涵盖了从2014年4月至2022年1月的8年时间。分析了既往医院病历，随后建立了一个数据库，其中包括年龄、性别、99m锝-高锝酸盐扫描的临床指征以及平面和单光子发射计算机断层扫描（SPECT）-计算机断层扫描（CT）成像结果。21例患者有术后组织病理学报告。进行了动态和平面静态成像。对于疑似重复囊肿，我们采用SPECT-CT以提高敏感性和特异性，这是以少量额外辐射暴露为代价的。共有69例患者因疑似前肠或中肠重复囊肿接受了99m锝-高锝酸盐扫描。所有患者均接受了动态平面和延迟静态图像检查，最长至24小时，或直至观察到放射性示踪剂的局灶性摄取，这与解剖学发现相符，以较早者为准。31例患者在进行平面研究的同时进行了SPECT-CT检查，证实了检查结果。其余患者使用先前进行的CT扫描进行解剖学对照。
共有28例患者发现重复囊肿（19例前肠重复囊肿和12例小肠重复囊肿 - 3例患者有双重重复囊肿，包括前肠和中肠）。41例患者没有异位胃黏膜的闪烁显像证据。在这69例患者中，21例患者（22个病变）有组织病理学诊断。15例患者（16个病变）的报告与扫描结果一致，6例患者的组织病理学诊断与扫描结果不一致。
总之，多时间点成像对于诊断各种大小和位置的异位胃黏膜至关重要。即使在小肠区域胃尚未出现之前，动态序列中放射性示踪剂摄取异常也提示肠重复，而胸部区域放射性示踪剂延迟显像是胸内前肠重复囊肿的特征。
