Otemuyiwa Bamidele, Davenport Matthew S, Wale Daniel J, Munavar Ali Midhhath Afza, Viglianti Benjamin L
Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Division of Abdominal Radiology, Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA.
Heliyon. 2024 May 14;10(10):e31257. doi: 10.1016/j.heliyon.2024.e31257. eCollection 2024 May 30.
To determine the accuracy of Tc-99 m sestamibi for the diagnosis of acute cholecystitis during a supply chain disruption of mebrofenin.
During a national shortage of Tc-99 m mebrofenin in 2019, our institution initiated sestamibi imaging for suspected cases of acute cholecystitis using a standard hepatobiliary imaging protocol. Forty-one patients underwent hepatobiliary imaging with sestamibi, 39 to assess for acute cholecystitis. The examinations were initially interpreted by one nuclear medicine physician and subsequently overread by 5 blinded nuclear medicine physicians (8-30 years' experience). SPECT/CT was obtained for 8 of these patients at the discretion of the primary interpreter. An additional 23 asymptomatic patients (6 with prior cholecystectomy) underwent abdominal scintigraphy as a negative control to determine the normal time to sestamibi accumulation in the gallbladder. A composite reference standard was used (chart review by 3 physicians). Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated with and without SPECT/CT (mean ± 95%CI).
Of 39 symptomatic patients, 17/39 had acute cholecystitis and 22 did not. The sensitivity, specificity, PPV and NPV for acute cholecystitis at planar imaging were 97.6 ± 4.6, 62.7 ± 5.2, 67.0 ± 3.6, and 97.3 ± 5.2 % (N = 39). The values changed to 95.7 ± 4.7, 77.9 ± 4.7, 72.1 ± 4.1, and 97.0 ± 3.3 % when control patients were included (N = 62). With SPECT/CT, these mildly improved to 98.8 ± 2.3 %, 69.1 ± 4.4 %, 71.3 ± 3.2 %, and 98.7 ± 2.6 % (N = 39), but not significantly different. On average, sestamibi activity was detected in the gallbladder in negative controls within 1 h.
Tc-99 m sestamibi has excellent sensitivity and NPV for diagnosing acute cholecystitis and can serve as an alternative when mebrofenin is unavailable for evaluating cystic duct obstruction during shortages of standard agents.
在甲溴菲宁供应链中断期间，确定锝-99m 司他米比诊断急性胆囊炎的准确性。
在2019年全国性的锝-99m 甲溴菲宁短缺期间，我们机构对疑似急性胆囊炎病例采用标准肝胆显像方案进行司他米比显像。41例患者接受了司他米比肝胆显像，其中39例用于评估急性胆囊炎。检查最初由一名核医学医师解读，随后由5名不知情的核医学医师（经验8 - 30年）进行复核。其中8例患者由主解读医师酌情决定进行了SPECT/CT检查。另外23例无症状患者（6例曾行胆囊切除术）接受腹部闪烁扫描作为阴性对照，以确定司他米比在胆囊中正常的蓄积时间。采用综合参考标准（由3名医师进行病历审查）。计算有无SPECT/CT时的敏感性、特异性以及阳性（PPV）和阴性（NPV）预测值（均值±95%CI）。
39例有症状患者中，17/39例患有急性胆囊炎，22例未患。平面显像诊断急性胆囊炎的敏感性、特异性、PPV和NPV分别为97.6 ± 4.6、62.7 ± 5.2、67.0 ± 3.6和97.3 ± 5.2%（N = 39）。纳入对照患者后（N = 62），这些值变为95.7 ± 4.7、77.9 ± 4.7、72.1 ± 4.1和97.0 ± 3.3%。采用SPECT/CT时，这些值轻度改善为98.8 ± 2.3%、69.1 ± 4.4%、71.3 ± 3.2%和98.7 ± 2.6%（N = 39），但差异无统计学意义。阴性对照中，平均在1小时内胆囊中检测到司他米比活性。
锝-99m司他米比诊断急性胆囊炎具有出色的敏感性和NPV，在标准药物短缺期间，当甲溴菲宁无法用于评估胆囊管梗阻时，可作为替代方法。
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