Klingensmith W C, Johnson M L, Kuni C C, Dunne M G, Fritzberg A R
Radiology. 1981 Jan;138(1):177-84. doi: 10.1148/radiology.138.1.7455080.
Fifty-one patients underwent both radionuclide and ultrasound studies of the hepatobiliary system. Eleven patients had large bile duct obstruction, six had intrahepatic diffuse small duct obstruction, and 37 had no obstruction. In all 11 patients with large duct obstruction, the radionuclide images were abnormal, but in nine of these studies the level of obstruction could not be determined. Ultrasound was abnormal in nine studies (with correct identification of level), normal in one, and technically inadequate in one, ultrasound scans were also abnormal in six patients without obstruction. In small duct obstruction, the radionuclide scan was abnormal in all six, but in five patients it could not differentiate small from large duct obstruction. In all six patients, ultrasound showed no large duct obstruction, thus allowing identification of the level of obstruction in patients whose radionuclide scans were equivocal. A cost analysis indicated that in suspected large duct obstruction, the best strategy is ultrasound first, followed by radionuclide imaging in all positive or technically inadequate ultrasound studies. In suspected small duct obstruction, the best strategy is radionuclide scanning first followed by ultrasound in all Tc-99m-diethyl-IDA studies equivocal as to level of obstruction.
51例患者接受了肝胆系统的放射性核素和超声检查。11例患者存在大胆管梗阻，6例存在肝内弥漫性小胆管梗阻，37例无梗阻。在所有11例大胆管梗阻患者中，放射性核素图像均异常，但其中9例研究无法确定梗阻水平。超声检查9例异常（梗阻水平判断正确），1例正常，1例技术上不充分，6例无梗阻患者的超声扫描也异常。在小胆管梗阻患者中，所有6例放射性核素扫描均异常，但5例患者无法区分小胆管与大胆管梗阻。在所有6例患者中，超声检查未显示大胆管梗阻，从而在放射性核素扫描结果不明确的患者中确定了梗阻水平。成本分析表明，在怀疑有大胆管梗阻时，最佳策略是先进行超声检查，然后对所有超声检查阳性或技术上不充分的患者进行放射性核素成像。在怀疑有小胆管梗阻时，最佳策略是先进行放射性核素扫描，然后对所有99m锝 - 二乙基亚氨基二乙酸（Tc-99m-diethyl-IDA）检查中梗阻水平不明确的患者进行超声检查。
