Kume N, Suga K, Uchisako H, Matsui M, Shimizu K, Matsunaga N
Department of Radiology, Yamaguchi University School of Medicine, Japan.
Ann Nucl Med. 1995 Nov;9(4):179-84. doi: 10.1007/BF03168398.
We present fourteen patients with an abnormal extrapulmonary accumulation on lung perfusion scintigraphy with 99mTc-macroaggregated albumin (MAA), who were examined during the last decade. These included six patients with lung cancer, four with pulmonary arterio-venous fistula, two with congenital heart disease, one with inferior vena cava (IVC) syndrome and one with congenital bronchogenic cyst. All six patients with lung cancer had superior vena cava (SVC) syndrome, and the tumor invaded the thoracic wall. As causes of abnormal accumulation, fourteen patients had a right-to-left shunt, and one patient with IVC syndrome had a systemic vein-to-portal vein shut, and one patient with lung cancer associated with superior vena cava (SVC) syndrome had both right-to-left and systemic vein-to-portal vein shunts. In the two patients with systemic vein-to-portal vein shunts, a hot spot was observed at the hepatic hilum, and radionuclide venography revealed remarkably developed collateral pathways to the portal vein. An extrapulmonary accumulation seen on 99mTc-MAA lung perfusion scan therefore indicates the existence of unusual hemodynamics with a shunt. We should therefore be careful not to overlook this peculiar finding.
我们呈现了过去十年间接受检查的14例患者，这些患者在使用99m锝-大聚合白蛋白（MAA）进行肺灌注闪烁扫描时出现肺外异常聚集。其中包括6例肺癌患者、4例肺动静脉瘘患者、2例先天性心脏病患者、1例下腔静脉（IVC）综合征患者和1例先天性支气管囊肿患者。所有6例肺癌患者均患有上腔静脉（SVC）综合征，且肿瘤侵犯胸壁。作为异常聚集的原因，14例患者存在右向左分流，1例IVC综合征患者存在体静脉至门静脉分流，1例伴有上腔静脉（SVC）综合征的肺癌患者同时存在右向左分流和体静脉至门静脉分流。在2例存在体静脉至门静脉分流的患者中，在肝门处观察到一个热点，放射性核素静脉造影显示通向门静脉的侧支通路明显发达。因此，99mTc-MAA肺灌注扫描中出现的肺外聚集表明存在伴有分流的异常血流动力学。因此，我们应注意不要忽视这一特殊发现。
