Japanese
Title肝局在性病変の断層シンチグラフィー
Subtitle原著
Authors勝山直文*
Authors(kana)
Organization*東京慈恵会医科大学放射線医学教室
Journal核医学
Volume16
Number2
Page127-139
Year/Month1979/4
Article原著
Publisher日本核医学会
Abstract「要旨」肝局在性病変 (SOL), および肝内胆管拡張症例におけるRI多面断層装置 (PHO/CON) の臨床的有用性について検討した. 1976年4月より1977年10月までに行なわれた1,500例の肝断層シンチグラフィーのうち, SOLまたは肝内胆管拡張を有する症例を対象とした. 〔結果〕1) 剖検, 血管造影, 手術, 腹腔鏡でSOLの大きさが確認できた66例についてRI断層の検出能を検討した. 66例の内訳は, 肝細胞癌24例, 転移性肝癌36例, 肝膿瘍2例, 肝嚢胞4例である. 66例中59例 (89%) でSOLを検出しえた. 検出できなかった7例は全て3cm以下のSOLであった. 2) CT (ACTA 0100) とRI断層の併用検査を行なったのは71例で, そのうちSOLを有したのは40例で, 肝細胞癌13例, 転移性肝癌18例, 肝膿瘍4例, 肝嚢胞6例である. 両者のSOLの描出能を比較するために5段階に分け. スコアの平均値をとった (0 : 欠損を描出しえないもの 1 : 欠損が疑われるもの 2 : 欠損の存在は確認できるがあまり明瞭でないもの 3 : 明瞭な欠損を示すもの 4 : 非常に明瞭な欠損を示すもの). 肝細胞癌, 転移性肝癌, 肝膿瘍のそれぞれのRI断層像のスコアは3.5, 3.0, 3.3で, CT像のそれは, 1.7, 1.5, 1.0で, RI断層がCTに比し優れていた. 肝嚢胞ではCT 3.5, RI断層2.9でCTがRI断層に比し優れていた. 3) 従来のシンチカメラ (HP型ガンマカメラ) との比較をSOL, 肝内胆管拡張例について行なった. a) SOLを有する58例で前後面像と右側面像のそれぞれについて描出能を比較検討した. 前後面像では58例中15例 (26%) でRI断層がカメラに比し優れており, そのうち3例はカメラで検出できなかった. 右側面像でSOLを検出できなかった3例を含めた19例 (43%) においてRI断層が優れていた. b) 16例の肝内胆管拡張例で, 次の4つの所見について, カメラとRI断層の検出能を比較した. (1) 肝門部欠損, (2) 線状の欠損, (3) 樹枝状の放射能の減少, (4) 著明な胆嚢切痕. (1)の所見を有した11例中5例 (45%), (2)の所見では8例中8例 (100%), (3)の所見では4例中2例 (50%), (4)の所見では5例中2例 (40%) においてRI断層がカメラに比し優れていた. 〔結語〕SOLのRI断層の検出率は89%で, 3cm以上のSOLは全て検出しえた. CTとの比較では肝嚢胞以外のSOLの描出能はRI断層が優れていた. カメラとの比較ではSOL, および肝内胆管拡張症の検出にRI断層がより有用であった.
Practice臨床医学：一般
Keywordsliver scintigraphy, Radionuclide tomographic scan, space occupying lesion of the liver, dilatation of intrahepatic bile ducts, CT
English
TitleRadionuclide Tomographic Scan of the Liver
SubtitleOriginal Articles
AuthorsNaofumi KATSUYAMA
Authors(kana)
OrganizationDepartment of Radiology, Jikei University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume16
Number2
Page127-139
Year/Month1979/4
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] Diagnostic value of a multiplane tomographic scanner (PHO/CON) was evaluated on subjects with space-occupying lesions (S.O.L.) in the liver and intrahepatic bile ducts dilatation. (I.H.D.D.) A total of 1,500 tomoscan of the liver has been performed throughout October 1977 since April 1976. 1. Diagnostic value of the tomoscan. The ability of the tomographic scan to detect the S.O.L. was examined on 66 cases in whom S.O.L. was confirmed by autopsy, angiography, operation and laparoscopy. These materials consisted of 24 patients of hepatoma, 36 of metastasis, 2 abscesses and 4 cysts. The tomoscan detected the S.O.L. in 59 (89%) of the 66 patients. The size of S.O.L. in the 7 false negatives was less than 3 cm in diameter in all cases. 2. Correlation of the radionuclide tomoscan and the computed tomography. Duplicate examinations by the radionuclide tomoscan and the computed tomography (CT, ACTA 0100) were performed on 71 patients ; 31 patients were considered to have normal livers. Of leaving 40 patients, 13 had hepatoma, 18 metastasis, 6 cyst and 4 abscess. For comparing the ability of two modalities to detect the S.O.L., following numerical rating scales were employed ; 0 : negative, 1 : equivocal, 2 : difinite SOL poorly demonstrated, 3 : definite SOL well visualized, 4 : definite SOL excellently resolved. On the numerical scale, overall rating was higher in the tomoscan than CT. In cases of hepatoma, metastasis and abscess, the tomoscan scored 3.5, 3.0 and 3.3, whilst CT scored 1.7, 1.5 and 1.0 respectively. For demonstration of cystic lesions, CT was given higher score with 3.5 than the tomoscan had 1 case of false negative, whilst CT had 7 false negatives. CT provided better visualization of cystic lesions than the tomoscan, but was much inferior to the tomoscan in demonstrating solid lesions. 3. Correlation of the tomoscan and the conventional camera. a) Demonstration of S.O.L. Comparative study of the camera and the tomoscan was done in liver images of 58 patients with the S.O.L. In anterior and posterior views, the tomoscan was superior in 15 of 58 patients (26%), including 3 false negatives on the camera study. In 44 patients noted the S.O.L. in right lateral view, 19 cases (43%) were superior in the tomoscan to the camera, including 3 false negatives on the camera. b) Demonstration of intrahepatic bile ducts dilatation. Correlative study was done on 16 patients with intrahepatic bile ducts dilatation. Images by two modalities were compared on the following 4 findings. 1) A focal defect in the region of porta hepatis. 2) Band like or linear defects. 3) Stellate appearance of decreased activity. 4) Prominent gall bladder fossa. The tomoscan was superior in 5 of 11 patients (45%) with the first finding, all of 8 patients (100%) with the 2nd, 2 of 4 patients (50%) with the 3rd and 2 of 5 patients (40%) with the 4th finding. [Conclusion] The ability of the tomoscan to detect S.O.L. in the liver was discussed. All of S.O.L. over 3 cm were identified with the tomoscan. In comparison with CT and the convetional camera, the tomoscan was more usefull of the assessment of focal hepatic lesiors or intrahepatic bile ducts dilatation.
PracticeClinical medicine
Keywordsliver scintigraphy, Radionuclide tomographic scan, space occupying lesion of the liver, dilatation of intrahepatic bile ducts, CT

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