Zhang Li, Zhang Xiaoyue, Wen Zhe, Tong Guansheng, Hao Kun, Qiu Yongkang, Kang Lei
Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tie Yi Rd, Haidian Dist., Beijing, 100038, China.
Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Str., Xicheng Dist., Beijing, 100034, China.
EJNMMI Res. 2023 Aug 3;13(1):72. doi: 10.1186/s13550-023-01014-0.
Chylothorax is a condition that can be challenging to diagnose due to its nonspecific clinical presentation. Several biochemical parameters of chylous pleural effusion have been identified as important indicators for the diagnosis of chylothorax. Lymphoscintigraphy is utilized to assess chylothorax and determine the location of chyle leakage. The present study aimed to evaluate the correlation between the biochemical parameters of chylous pleural effusion and Tc-dextran (Tc-DX) lymphoscintigraphy in diagnosing chylothorax.
A total of 120 patients were enrolled in the study, 83 of the patients with unilateral chylothorax, and 37 with bilateral chylothorax. All patients underwent both Tc-DX lymphoscintigraphy and pleural effusion laboratory analysis. The Tc-DX lymphoscintigraphy images were categorized as positive or negative groups based on the presence or absence of abnormal radioactive tracer accumulation in the thorax, respectively. The biochemical parameters of the two groups were subsequently compared.
Among these patients, 101 (84.17%) had exudative effusions, while 19 (15.83%) had transudative effusions, as determined by the levels of pleural effusion protein, lactate dehydrogenase and cholesterol. Abnormal tracer accumulation in thorax was observed in 82 patients (68.33%). Our findings indicated that lymphoscintigraphy results were not associated with exudative and transudative chylothorax (P = 0.597). The lymphoscintigraphy positive group displayed significantly higher levels of pleural effusion triglyceride and pleural effusion triglyceride/serum triglyceride ratio in all biochemical parameters, compared to the negative group (P = 0.000 and P = 0.005). We identified cutoff values of 2.870 mmol/L for pleural effusion triglycerides and 4.625 for pleural effusion triglyceride/serum triglyceride ratio, respectively, which can facilitate differentiating the positive and negative cases on lymphoscintigraphy.
Lymphoscintigraphy technique is a dependable diagnostic tool for the qualitative assessment of chylous pleural effusion. Higher pleural effusion triglyceride level and pleural effusion triglyceride/serum triglyceride ratio indicate a positive result in patients with chylothorax on lymphoscintigraphy, with the cutoff values of 2.870 mmol/L and 4.625 aiding in the diagnosis.
乳糜胸因临床表现不具特异性，诊断颇具挑战性。乳糜性胸腔积液的多项生化参数已被确定为乳糜胸诊断的重要指标。淋巴闪烁造影术用于评估乳糜胸并确定乳糜漏的位置。本研究旨在评估乳糜性胸腔积液生化参数与锝 - 葡聚糖（Tc - DX）淋巴闪烁造影术在诊断乳糜胸中的相关性。
本研究共纳入120例患者，其中83例为单侧乳糜胸，37例为双侧乳糜胸。所有患者均接受了Tc - DX淋巴闪烁造影术及胸腔积液实验室分析。根据胸部是否存在异常放射性示踪剂积聚，将Tc - DX淋巴闪烁造影图像分为阳性或阴性组。随后比较两组的生化参数。
根据胸腔积液蛋白、乳酸脱氢酶和胆固醇水平测定，这些患者中，101例（84.17%）为渗出液，19例（15.83%）为漏出液。82例患者（68.33%）胸部观察到示踪剂异常积聚。我们的研究结果表明，淋巴闪烁造影结果与渗出性及漏出性乳糜胸无关（P = 0.597）。在所有生化参数中，淋巴闪烁造影阳性组的胸腔积液甘油三酯水平及胸腔积液甘油三酯/血清甘油三酯比值显著高于阴性组（P = 〈0.0001〉和P = 0.005）。我们分别确定胸腔积液甘油三酯的截断值为2.870 mmol/L，胸腔积液甘油三酯/血清甘油三酯比值的截断值为4.625，这有助于区分淋巴闪烁造影的阳性和阴性病例。
淋巴闪烁造影技术是定性评估乳糜性胸腔积液的可靠诊断工具。较高的胸腔积液甘油三酯水平及胸腔积液甘油三酯/血清甘油三酯比值表明乳糜胸患者淋巴闪烁造影结果为阳性，截断值2.870 mmol/L和4.625有助于诊断。
