Rypins E B, Kipper S L
Department of Surgery, Tri-City Medical Center, Oceanside, California, USA.
Am Surg. 1997 Oct;63(10):878-81.
We used a radiolabeled white blood cell (WBC) scan as an adjunct to diagnose appendicitis in 100 children with equivocal signs or symptoms of appendicitis. WBC separation and labeling took 2 hours. Patients were imaged up to 3 hours after injection of labeled Tc-WBC. Accuracy was established in all 100 children by histopathological findings, medical records and follow-up interviews. Scans were positive in 40 and negative in 60. Positive scans averaged 76 +/- 40 minutes after injection (mean +/- SD); negative scans required 150-180 minutes. Tc-WBC scan correctly identified appendicitis in 36 of 37 children (sensitivity, 97%) and correctly excluded appendicitis in 59 of 63 (specificity, 94%). The false negative scan occurred in a patient whose perforated appendix was discovered at operation 3 days following the scan. Accuracy of the examination was 95 per cent, with a positive predictive value of 90 per cent and a negative predictive value of 98 per cent. The negative laparotomy rate for the entire group was 4 per cent. Tc-WBC imaging is an accurate, noninvasive test for ruling out appendicitis in children with right lower quadrant abdominal pain and equivocal presentation, although positive scans require more clinical judgment. The high sensitivity and negative predictive value suggest its potential for screening and discharging children from the emergency department.
我们采用放射性标记白细胞（WBC）扫描作为辅助手段，对100例有阑尾炎可疑体征或症状的儿童进行阑尾炎诊断。白细胞分离和标记耗时2小时。在注射标记的锝标记白细胞后长达3小时对患者进行成像。通过组织病理学检查结果、病历和随访访谈确定了所有100例儿童的诊断准确性。扫描结果阳性的有40例，阴性的有60例。阳性扫描在注射后平均76±40分钟（平均值±标准差）；阴性扫描需要150 - 180分钟。锝标记白细胞扫描在37例儿童中的36例正确识别出阑尾炎（敏感性为97%），在63例中的59例正确排除了阑尾炎（特异性为94%）。假阴性扫描发生在一名患者身上，其穿孔性阑尾炎在扫描后3天手术时被发现。该检查的准确性为95%，阳性预测值为90%，阴性预测值为98%。整个组的阴性剖腹率为4%。锝标记白细胞成像对于排除右下腹痛且表现不明确的儿童阑尾炎是一种准确的非侵入性检查，尽管阳性扫描需要更多临床判断。高敏感性和阴性预测值表明其在急诊科对儿童进行筛查和让其出院方面具有潜力。
