Tatsch K, Voderholzer W A, Weiss M J, Schröttle W, Hahn K
Department of Nuclear Medicine, Medizinische Klinik Innenstadt, University of Munich, Germany.
J Nucl Med. 1996 Nov;37(11):1799-805.
This study investigates whether systematic analyses of methodological issues contribute to improve and renew the diagnostic role of quantitate esophageal scintigraphy.
Forty-seven patients with normal (n = 26) and pathologic (n = 21) esophageal function were studied with scintigraphy and manometry, using the latter findings as the gold standard. Scintigraphic data were analyzed by receiver operator characteristic (ROC) methods to: establish the optimal decision threshold for six different quantitative parameters, evaluate their inherent discrimination capacity and compare liquid compared with solid bolus data.
Quantitative parameters have shown remarkable differences in their potential to discriminate between normal and pathologic findings (percentage of emptying at definite time points > mean time > transit time > mean transit time > Tmax). Sensitivity of 95% at a specificity of 96% was the optimum obtained. At comparable specificity levels, solid bolus studies generally demonstrated higher sensitivity than liquid bolus studies.
The diagnostic performance of optimized esophageal scintigraphy is close to that of manometry. Our findings do not only renew the role of esophageal scintigraphy as an accurate screening test for esophageal motility disorders but also invalidate recent reservations about the diagnostic potential of this method.
本研究调查了对方法学问题进行系统分析是否有助于改善和更新定量食管闪烁扫描的诊断作用。
对47例食管功能正常（n = 26）和病理状态（n = 21）的患者进行了闪烁扫描和测压研究，以后者的结果作为金标准。通过接受者操作特征（ROC）方法分析闪烁扫描数据，以：确定六个不同定量参数的最佳决策阈值，评估其内在的鉴别能力，并比较液体与固体团注数据。
定量参数在区分正常和病理结果的潜力方面表现出显著差异（特定时间点的排空百分比>平均时间>通过时间>平均通过时间>Tmax）。在特异性为96%时获得的最佳灵敏度为95%。在可比的特异性水平下，固体团注研究通常显示出比液体团注研究更高的灵敏度。
优化后的食管闪烁扫描的诊断性能接近测压。我们的发现不仅更新了食管闪烁扫描作为食管动力障碍准确筛查试验的作用，也消除了最近对该方法诊断潜力的质疑。
