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目的评价99mTc-二乙基乙酰苯胺亚氨二醋酸(99mTc-EHIDA)肝胆断层显像在先天性胆道闭锁(EHBA)鉴别诊断中的价值。方法回顾性分析2000年8月至2011年9月自山东大学齐鲁医院小儿内、外科138例持续性黄疸患儿资料。比较患儿行单纯99mTc-EHIDA肝胆动态显像(平面显像)及99mTc-EHIDA肝胆动态显像(平面显像)加做99mTc-EHIDA肝胆断层显像(断层显像)两种显像结果的差异。结果肝胆平面显像诊断EHBA结果为:真阳性32例,假阳性40例、真阴性59例,假阴性7例;诊断EHBA的灵敏度为82%(32/39)、特异性为60%(59/99)、准确性为66%(91/138)、阳性预测值为44%(32/72)、阴性预测值为89%(59/66)。平面显像加作肝胆断层显像对EHBA诊断结果为:真阳性39例,假阳性24例、真阴性75例,假阴性0例;诊断EHBA的灵敏度为100%(39/39)、特异性为76%(75/99)、准确性为83%(114/138)、阳性预测值为62%(39/63)、阴性预测值为100%(75/75)。两种显像方法比较,在诊断EHBA的灵敏度、特异性、准确性、阳性预测值、阴性预测值方面差异均有统计学意义(P<0.05或0.01)。结论99mTc-EHIDA肝胆平面显像加作断层显像能降低诊断EHBA的假阳性及假阴性,提高对EHBA的鉴别诊断效能。
Objective To evaluate the value of 99mTc-diethylacetanilimidamide (99mTc-EHIDA) in the differential diagnosis of congenital biliary atresia (EHBA). Methods The data of 138 cases of persistent jaundice in pediatrics and pediatrics of Qilu Hospital of Shandong University from August 2000 to September 2011 were retrospectively analyzed. Comparison of 99mTc-EHIDA hepatobiliary dynamic imaging (plain imaging) and 99mTc-EHIDA dynamic imaging of liver and gallbladder (plain imaging) plus 99mTc-EHIDA hepatobiliary imaging (tomography) difference. Results The results of EHBA in diagnosing EHBA were 32 cases of true positive, 40 cases of false positive, 59 cases of true negative and 7 cases of false negative. The diagnostic sensitivity and specificity of EHBA were 82% (32/39) and 60% (59%) respectively / 99), the accuracy was 66% (91/138), the positive predictive value was 44% (32/72), and the negative predictive value was 89% (59/66). The results of plain imaging and hepatobiliary tomography on EHBA were 39 cases of true positive, 24 cases of false positive, 75 cases of true negative and 0 cases of false negative. The sensitivity of EHBA was 100% (39/39), specificity Was 76% (75/99) with an accuracy of 83% (114/138), a positive predictive value of 62% (39/63) and a negative predictive value of 100% (75/75). There was significant difference in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EHBA between the two imaging methods (P <0.05 or 0.01). Conclusion 99mTc-EHIDA hepatobiliary imaging combined with tomography can reduce false-positive and false-negative diagnosis of EHBA and improve the diagnostic efficacy of EHBA.