Butler S P, Boyd S J, Parkes S L, Quinn R J
Department of Nuclear Medicine, St. George Hospital, Sydney, Australia.
J Nucl Med. 1996 May;37(5):744-8.
We report a method for deep venous thrombosis (DVT) detection which uses 99mTc-labeled modified recombinant tissue plasminogen activator (rt-PA) scintigraphy. A Phase III clinical trial was performed on 79 patients with suspected DVT.
The plasminogen binding site of rt-PA was permanently inhibited without inactivating the fibrin binding site. The modified molecule was radiolabeled with 99mTc. Scintigraphy was performed and the results were compared to those of contrast venography.
Of 14 thrombosed proximal segments, 13 had positive scans; in the 53 nonthrombosed proximal segments, 49 had negative scans. In proximal vein thrombosis, rt-PA scintigraphy had a sensitivity of 93% and a specificity of 92%. Of the 36 thrombosed calf vein segments, 31 had positive scans; in the 30 nonthrombosed calf segments, 28 had negative scans. In calf vein thrombosis, scanning has a sensitivity of 86% and a specificity of 93%.
Scintigraphic scanning with this 99mTc modified rt-PA permits accurate detection of thrombus in both proximal and calf veins in patients with clinically suspected DVT. The technique detects both fresh and aged thrombi and is unaffected by heparin administration. Further study in other patient groups is needed to define the overall clinical utility.
我们报告了一种使用99mTc标记的改良重组组织型纤溶酶原激活剂（rt-PA）闪烁扫描术检测深静脉血栓形成（DVT）的方法。对79例疑似DVT患者进行了一项III期临床试验。
rt-PA的纤溶酶原结合位点被永久抑制，而纤维蛋白结合位点未失活。用99mTc对改良分子进行放射性标记。进行闪烁扫描，并将结果与静脉造影结果进行比较。
在14个血栓形成的近端节段中，13个扫描结果为阳性；在53个无血栓形成的近端节段中，49个扫描结果为阴性。在近端静脉血栓形成中，rt-PA闪烁扫描术的敏感性为93%，特异性为92%。在36个血栓形成的小腿静脉节段中，31个扫描结果为阳性；在30个无血栓形成的小腿节段中，28个扫描结果为阴性。在小腿静脉血栓形成中，扫描的敏感性为86%，特异性为93%。
使用这种99mTc改良rt-PA进行闪烁扫描可准确检测临床疑似DVT患者近端和小腿静脉中的血栓。该技术可检测新鲜和陈旧血栓，且不受肝素给药的影响。需要在其他患者群体中进行进一步研究以确定其总体临床应用价值。
