Shih W J, Domstad P A, Kenady D E, DeLand F H
Nuclear Medicine Service, Veterans Administration Medical Center, Lexington, Kentucky.
Clin Nucl Med. 1987 Sep;12(9):717-20. doi: 10.1097/00003072-198709000-00009.
Nine patients who had surgically proven acute gangrenous cholecystitis and Tc-99m DISIDA scintigrams were reviewed retrospectively. Three types of scintigraphic findings were presented: 1) nonvisualization of the gallbladder, three cases; 2) nonvisualization of the gallbladder plus a rim sign, two cases; and 3) nonvisualization of the gallbladder plus an enlarged photon deficient area corresponding to the gallbladder fossa, four cases. A rim sign or an enlarged gallbladder fossa reflect the direct spread of inflammation from the gallbladder into the liver, causing impaired hepatocyte function. An enlarged gallbladder fossa may represent a later stage of a rim sign. Presumably tracer excretion by hepatocytes is affected initially by the inflammatory process, followed by impairment of tracer concentrating ability. Since the gallbladder may be suspended occasionally by a mesentery and not in contact with the liver, the secondary signs may be absent in acute gangrenous cholecystitis.
回顾性分析9例经手术证实为急性坏疽性胆囊炎且行锝-99m二异丙基乙酰苯胺（Tc-99m DISIDA）闪烁扫描的患者。呈现出三种闪烁扫描结果：1）胆囊不显影，3例；2）胆囊不显影加边缘征，2例；3）胆囊不显影加对应胆囊窝的光子缺乏区扩大，4例。边缘征或胆囊窝扩大反映炎症从胆囊直接蔓延至肝脏，导致肝细胞功能受损。胆囊窝扩大可能代表边缘征的后期阶段。推测肝细胞对示踪剂的排泄最初受炎症过程影响，随后示踪剂浓缩能力受损。由于胆囊偶尔可能被肠系膜悬吊而不与肝脏接触，急性坏疽性胆囊炎可能不存在继发性征象。
