~（99m）Tc-EHIDA肝胆断层显像对婴儿持续性黄疸常见病因的鉴别诊断价值
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摘要
目的：先天性胆道闭锁(extrahepatic biliary atresia, EHBA)与婴儿肝炎综合征(infant hepatitis syndrome, IHS)是引起婴儿期持续性黄疸最常见的病因。EHBA发病率有地区和种族差异,一般认为亚洲人发病率较高,发病率约为1/8000,尤以日本和我国的发病率高。以女婴为多,男：女约为1：2。IHS通常认为男多于女,地区性、季节性发病规律不明显。EHBA与IHS的治疗原则和预后截然不同,应尽早对二者进行鉴别诊断,以选择适当的治疗手段,给予及时治疗。
99mTc-二乙基乙酰苯胺亚氨二醋酸(diethyl iminodiacetic acid, EHIDA)肝胆动态平面显像(肝胆平面显像)是目前公认的有效鉴别EHBA与IHS方法之一,其不足之处在于对EHBA的诊断特异性和对IHS的诊断灵敏度不高。因断层显像探测灵敏性高于平面显像,故在本研究中,对138例持续性黄疸患儿行肝胆平面显像的同时,加做99mTc-EHIDA肝胆断层显像(肝胆断层显像),分析两种显像结果,旨在探讨肝胆断层显像能否提高对EHBA与IHS的鉴别诊断效能。
资料和方法：选山东大学齐鲁医院持续性黄疸患儿138例,其中住院患儿112例,门诊患儿26例；男68例,女70例；日龄35～120d。以手术、病理及临床转归确诊结果为金标准。采用病例资料回顾性分析方法,对所选黄疸患儿的症状、体征及相关检查结果进行统计学分析。
通过问卷形式记录患儿日龄、持续性黄疸出现时间、大便颜色等,通过查体记录患儿肝脏大小、脾脏大小等。并记录相关的实验室检查结果。
138例患儿均行肝胆平面显像及肝胆断层显像。肝胆平面显像是指经静脉通道注射99mTc-EHIDA后将SPECT探测器置于肝脏和肠道区域表面,分别于5min、10min、20min、30min、40min、60min进行图像采集,观察肠道内有无放射性出现,若60min肠道无放射性出现,再于3～4h、6～8h、24h行肝胆平面显像,直到明确肠道有无放射性分布,如肠道出现放射性则停止显像。肝胆断层显像是在3～4h、6～8h、24h平面显像完成后患儿体位不动,将SPECT探测器绕体表作1800旋转,进行多体位投影信息采集,经计算机处理后,形成横断层影像、冠断层影像及矢断层影像,观察肠道内是否有放射性出现。由2位以上有丰富临床经验的核医学医师共同阅片,无论是肝胆平面显像或肝胆断层显像,只要肠道于24小时内出现放射性则诊断为IHS；肠道于24小时内未见放射性出现则诊断为EHBA。
症状、体征及实验室检查结果中,计量资料以均数±标准差(x±s)表示,各组数据采用t检验进行统计学分析,以P<0.05为差异有统计学意义；计数资料以百分比表示,两组之间比较采用四格表或行×列表卡方检验,以P<0.05为差异有统计学意义。分别计算肝胆平面显像、肝胆断层显像对EHBA及IHS诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值,用百分数表示；两种方法对EHBA、IHS诊断结果比较采用四格表卡方检验,以P<0.05为差异有统计学意义。
结果
1、经手术、病理及临床转归确诊EHBA39例,其中男15例,女24例；IHS99例,其中男53,女46例。39例EHBA及99例IHS患儿症状、体征及实验室检查结果比较：
1.1 EHBA与IHS患儿在日龄、持续性黄疸出现时间、粪便颜色、肝脾大小方面比较,差异均无统计学意义。
1.2 EHBA与IHS患儿CMV感染率比较,差异无统计学意义；
1.3 EHBA与IHS患儿ALT、AST、AKP比较,差异无统计学意义,但EHBA血清γ-GT活性高于IHS。
1.4 EHBA与IHS患儿在TBIL、DBIL、D/T含量方面比较,差异均无统计学意义；
2、肝胆平面显像结果
2.1对EHBA诊断结果为：真阳性32例,假阳性40例、真阴性59例,假阴性7例,假阳性率为40.4%(40/99)、假阴性率为17.9%(7/39)。诊断EHBA的灵敏度为82.1%、特异性为59.6%、准确性为65.9%、阳性预测值为44.4%、阴性预测值为89.4%。
2.2对IHS诊断结果为：真阳性59,假阳性7例、真阴性32例,假阴性40例。诊断IHS的灵敏度为59.6%、特异性为82.1%、准确性为65.9%、阳性预测值为89.4%、阴性预测值为44.4%
2.3 59例真阳性IHS患儿在3～4h、6～8h、24h时间段肠道出现放射性的分布比例分别为18.6%(11/59)、42.4%(25/59)、39.0%(23/59)。
3、肝胆断层显像结果
3.1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,假阳性率为24.2%(24/99)、假阴性率为0(0/39)。诊断EHBA的灵敏度为100.0%、特异性为75.7%、准确性为82.6%、阳性预测值为61.9%、阴性预测值为100.0%
3.2对IHS诊断结果：真阳性75例,假阳性0例、真阴性39例,假阴性24例。诊断IHS的灵敏度为75.7%、特异性为100%、准确性为82.6%、阳性预测值为100%(75/75)、阴性预测值为61.9%。
3.3 75例真阳性IHS患儿在3～4h、6～8h、24h时间段肠道内出现放射性的分布比例分别为33.3%(25/75)、44.0%(33/75)、22.7%(17/75)。
4、肝胆平面显像及断层显像结果比较
4.1对EHBA诊断评价指标比较,肝胆断层显像在灵敏度、特异性、准确性、阳性预测值、阴性预测值方面均显著高于平面显像(P<0.05或<0.01)
4.2对IHS诊断评价指标比较,肝胆断层显像在灵敏度、特异性、准确性、阳性预测值、阴性预测值方面均显著高于平面显像(P<0.05或<0.01)。
4.3肝胆断层显像诊断EHBA的假阳性率及假阴性率显著低于肝胆平面显像(P<0.05)。
4.4肝胆断层显像诊断IHS所需观察时间显著少于肝胆平面显像(P<0.05)
结论
1、单纯的临床表现及一般化验室检查不易区别EHBA与IHS。
2、肝胆平面显像不足之处在于对EHBA的诊断特异性和对IHS的诊断灵敏度不高。
3、肝胆断层显像能降低诊断EHBA的假阳性率、消除假阴性,提高对EHBA与IHS鉴别诊断的效能,并能缩短诊断IHS所需的时间。
4、肝胆断层显像诊断EHBA时,仍有一定比例的假阳性存在。
Objective Both extrahepatic biliary atresia(EHBA) and Infant hepatitis syndrome(IHS) are the most frequent etiological factor which cause persistent jaundice in infants. The incidence rate of EHBA is different in different territory and race of people. The incidence rate of oriental is or so 1/8000, and the incidence rate in Japan and china is higher than the other territory. The ratio of male and female is or so 1:2. The morbility is not regularly in IHS. It is difficult to diagnosis EHBA and IHS in clinic. Image medical examinations were all insufficient. The insufficiency is low specificity to EHBA and low saitivity to IHS, for hepatobiliary dynamic surface imaging.
In this study,138 infants with persistent jaundice underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging, the results of two imagings were compared, objective was to discuss the differential diagnosis value of hepatobiliary section imaging to EHBA and IHS.
Materials and Methods There were 138 infants with persistent jaundice,112 from paediatrics ward of qilu hospital of Shan dong university,26 from paediatrics clinic. Male 68, female 70, their ages were from 35 to 120 days. The gold standard is the consequences of operation, pathematology, and clinical turnover. The retrospective analytical methods were adopted to the symptoms, physical signs, and the correlating examination results, for the infants with jaundice.
The ages, the emergence time of persistent jaundice, and dejecta colors were recorded by questionnaire. The liver size, and spleen size were written down by medical examination. The laboratory examination results were taken down.
All cases underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The detecting head of the SPECT were played the surface of the region of liver and intestinal tract, the hepatobiliary dynamic surface imaging were deployed in 5 minutes,10 minutes,20 minutes,30 minutes,40 minutes,60 minutes after the imaging agent was injected. Supposing the radioaction didn't emerge in intesinal tract, the delayed imaging were adopted in 3 to 4 hour,6 to 8 hour, and 24 hour. The hepatobiliary shape and excretion of radionuclide were observed. When radionuclide was found in intesinal tract, the imagings were stopped. The hepatobiliary section imagings were undertaken immediately after the delayed imagings were completed. The data from collection system of VG Acq were sent to image processing system. The section imagings of transverse plane, sagittal plane, coronal plane were gained by computer software. The pictures were observed by the nuclear medicine doctor with plentiful clinical experience. Regardless of hepatobiliary dynamic surface imaging and hepatobiliary section imaging, as long as adioaction emerged in intestinal tract within 24 hour, the infants were diagnosised as IHS. Supposing adioaction was not found in intestinal tract within 24 hour, the infants were diagnosised as EHBA.
About clinical data and laboratory examinations, the measurement data from different groups were compared by t-test, the enumeration data from different groups were compared by x2-test of four-fold table or line×array table, there are statistical significance when probability is less than 0.05. Sensibility, specificity, accuracy, positive predictive value, and negative predictive value were calculated and expressed by percentage, respectively, for hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The results of the two methods were compared by x2-test of four-fold table, there are statistical significance when probability is less than 0.05.
Results
1、According to the consequences of operation, pathematology, and clinical treatment,39 infants were diagnosised as EHBA,male 15, female 24,99 infants were confirmded as IHS,male 53, female 46. Compare the symptoms, physical signs, and laboratory examination results from 39 EHBA and 99 IHS:
1.1 There were not statistical significance in the ages, the emergence time of persistent jaundice, dejecta colors, liver size, and spleen size, for EHBA and IHS.
1.2 There was not statistical significance in the infection rate of CMV, for EHBA and IHS.
1.3 There were not statistical significance in the contents of ALT, AST, AKP, for EHBA and IHS. But the activity ofγ-GT in EHBA was significantly higher than in IHS。
1.4 There were not statistical significance in TBIL, DBIL, and D/T, for EHBA and IHS.
2、The results of hepatobiliary dynamic surface imaging
2.1 The diagnosis results to EHBA is true positive 32, false positive 40, true negative 59, false negative 7, false positive rate40.4%(40/99), false negative rate17.9%(7/39). The diagnostic evaluation index is saitivity 82.1%(32/39), specificity 59.6%(59/99), accuracy 65.9%(91/138), positive predictive value 44.4%(32/72), negative predictive value 89.4%(59/66).
2.2 The diagnosis results to IHS is true positive 59, false positive 7, true negative 32, false negative 40. The diagnostic evaluation index is saitivity 59.6%(59/99), specificity 82.1%(32/39), accuracy 65.9%(91/138), positive predictive value 89.4%(59/66), negative predictive value 44.4%(32/72).
2.3 The disposition percentage of 59 true positive IHS in 3 to 4 hour to 8 hour、24 hour were18.6%、42.4%、39.0%, respectively.
3、The results of hepatobiliary section imaging
3.1 The diagnosis results to EHBA is true positive 39, false positive 24, true negative 75, false negative 0, false positive rate24.2%(24/99), alse negative rate0(0/39). The diagnostic evaluation index is saitivity 100.0%(39/39), specificity 75.7%(75/99),accuracy82.6%(114/138), positive predictive value 61.9%(39/63), negative predictive value 100.0%(75/75).
3.2 The diagnosis results to IHS is true positive 75, false positive 0, true negative 39, false negative 24. The diagnostic evaluation index is saitivity 75.7%(75/99), specificity 100%(39/39), accuracy 82.6%(114/138), positive predictive value 100%(75/75), negative predictive value 61.9%(39/63).
3.3 The disposition percentage of 75 true positive IHS in 3 to 4 hour、6 to 8 hour、24 hour were 33.3%、44.0%、22.7%, respectively.
4、The comparison of the rerults from two imaging methods
4.1 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity,accuracy, positive predictive value, and negative predictive value, for EHBA.
4.2 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity, accuracy, positive predictive value, and negative predictive value, for IHS.
4.3 The hepatobiliary section imaging was significantly lower than hepatobiliary dynamic surface imaging in false positive rate and false negative rate, for EHBA.
4.4 The time which diagnosed IHS by hepatobiliary section imaging.was significantly shorter than by hepatobiliary dynamic surface imaging.
Conclusions
1、It is hard to differentiate EHBA from IHS by single clinical manifestation and common laboratory examination.
2、The deficients of hepatobiliary dynamic surface imaging are low specificity to EHBA and low saitivity to IHS.
3、The hepatobiliary section imaging can depress the false positive rate, dismiss the false negative rate of EHBA, elevate the differential diagnosis efficacy to EHBA and IHS, and shorten the time of diagnosising IHS.
4、There is still false positive when EHBA is diagnosised by the hepatobiliary section imaging.
99mTc-二乙基乙酰苯胺亚氨二醋酸(diethyl iminodiacetic acid, EHIDA)肝胆动态平面显像(肝胆平面显像)是目前公认的有效鉴别EHBA与IHS方法之一,其不足之处在于对EHBA的诊断特异性和对IHS的诊断灵敏度不高。因断层显像探测灵敏性高于平面显像,故在本研究中,对138例持续性黄疸患儿行肝胆平面显像的同时,加做99mTc-EHIDA肝胆断层显像(肝胆断层显像),分析两种显像结果,旨在探讨肝胆断层显像能否提高对EHBA与IHS的鉴别诊断效能。
资料和方法：选山东大学齐鲁医院持续性黄疸患儿138例,其中住院患儿112例,门诊患儿26例；男68例,女70例；日龄35～120d。以手术、病理及临床转归确诊结果为金标准。采用病例资料回顾性分析方法,对所选黄疸患儿的症状、体征及相关检查结果进行统计学分析。
通过问卷形式记录患儿日龄、持续性黄疸出现时间、大便颜色等,通过查体记录患儿肝脏大小、脾脏大小等。并记录相关的实验室检查结果。
138例患儿均行肝胆平面显像及肝胆断层显像。肝胆平面显像是指经静脉通道注射99mTc-EHIDA后将SPECT探测器置于肝脏和肠道区域表面,分别于5min、10min、20min、30min、40min、60min进行图像采集,观察肠道内有无放射性出现,若60min肠道无放射性出现,再于3～4h、6～8h、24h行肝胆平面显像,直到明确肠道有无放射性分布,如肠道出现放射性则停止显像。肝胆断层显像是在3～4h、6～8h、24h平面显像完成后患儿体位不动,将SPECT探测器绕体表作1800旋转,进行多体位投影信息采集,经计算机处理后,形成横断层影像、冠断层影像及矢断层影像,观察肠道内是否有放射性出现。由2位以上有丰富临床经验的核医学医师共同阅片,无论是肝胆平面显像或肝胆断层显像,只要肠道于24小时内出现放射性则诊断为IHS；肠道于24小时内未见放射性出现则诊断为EHBA。
症状、体征及实验室检查结果中,计量资料以均数±标准差(x±s)表示,各组数据采用t检验进行统计学分析,以P<0.05为差异有统计学意义；计数资料以百分比表示,两组之间比较采用四格表或行×列表卡方检验,以P<0.05为差异有统计学意义。分别计算肝胆平面显像、肝胆断层显像对EHBA及IHS诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值,用百分数表示；两种方法对EHBA、IHS诊断结果比较采用四格表卡方检验,以P<0.05为差异有统计学意义。
结果
1、经手术、病理及临床转归确诊EHBA39例,其中男15例,女24例；IHS99例,其中男53,女46例。39例EHBA及99例IHS患儿症状、体征及实验室检查结果比较：
1.1 EHBA与IHS患儿在日龄、持续性黄疸出现时间、粪便颜色、肝脾大小方面比较,差异均无统计学意义。
1.2 EHBA与IHS患儿CMV感染率比较,差异无统计学意义；
1.3 EHBA与IHS患儿ALT、AST、AKP比较,差异无统计学意义,但EHBA血清γ-GT活性高于IHS。
1.4 EHBA与IHS患儿在TBIL、DBIL、D/T含量方面比较,差异均无统计学意义；
2、肝胆平面显像结果
2.1对EHBA诊断结果为：真阳性32例,假阳性40例、真阴性59例,假阴性7例,假阳性率为40.4%(40/99)、假阴性率为17.9%(7/39)。诊断EHBA的灵敏度为82.1%、特异性为59.6%、准确性为65.9%、阳性预测值为44.4%、阴性预测值为89.4%。
2.2对IHS诊断结果为：真阳性59,假阳性7例、真阴性32例,假阴性40例。诊断IHS的灵敏度为59.6%、特异性为82.1%、准确性为65.9%、阳性预测值为89.4%、阴性预测值为44.4%
2.3 59例真阳性IHS患儿在3～4h、6～8h、24h时间段肠道出现放射性的分布比例分别为18.6%(11/59)、42.4%(25/59)、39.0%(23/59)。
3、肝胆断层显像结果
3.1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,假阳性率为24.2%(24/99)、假阴性率为0(0/39)。诊断EHBA的灵敏度为100.0%、特异性为75.7%、准确性为82.6%、阳性预测值为61.9%、阴性预测值为100.0%
3.2对IHS诊断结果：真阳性75例,假阳性0例、真阴性39例,假阴性24例。诊断IHS的灵敏度为75.7%、特异性为100%、准确性为82.6%、阳性预测值为100%(75/75)、阴性预测值为61.9%。
3.3 75例真阳性IHS患儿在3～4h、6～8h、24h时间段肠道内出现放射性的分布比例分别为33.3%(25/75)、44.0%(33/75)、22.7%(17/75)。
4、肝胆平面显像及断层显像结果比较
4.1对EHBA诊断评价指标比较,肝胆断层显像在灵敏度、特异性、准确性、阳性预测值、阴性预测值方面均显著高于平面显像(P<0.05或<0.01)
4.2对IHS诊断评价指标比较,肝胆断层显像在灵敏度、特异性、准确性、阳性预测值、阴性预测值方面均显著高于平面显像(P<0.05或<0.01)。
4.3肝胆断层显像诊断EHBA的假阳性率及假阴性率显著低于肝胆平面显像(P<0.05)。
4.4肝胆断层显像诊断IHS所需观察时间显著少于肝胆平面显像(P<0.05)
结论
1、单纯的临床表现及一般化验室检查不易区别EHBA与IHS。
2、肝胆平面显像不足之处在于对EHBA的诊断特异性和对IHS的诊断灵敏度不高。
3、肝胆断层显像能降低诊断EHBA的假阳性率、消除假阴性,提高对EHBA与IHS鉴别诊断的效能,并能缩短诊断IHS所需的时间。
4、肝胆断层显像诊断EHBA时,仍有一定比例的假阳性存在。
Objective Both extrahepatic biliary atresia(EHBA) and Infant hepatitis syndrome(IHS) are the most frequent etiological factor which cause persistent jaundice in infants. The incidence rate of EHBA is different in different territory and race of people. The incidence rate of oriental is or so 1/8000, and the incidence rate in Japan and china is higher than the other territory. The ratio of male and female is or so 1:2. The morbility is not regularly in IHS. It is difficult to diagnosis EHBA and IHS in clinic. Image medical examinations were all insufficient. The insufficiency is low specificity to EHBA and low saitivity to IHS, for hepatobiliary dynamic surface imaging.
In this study,138 infants with persistent jaundice underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging, the results of two imagings were compared, objective was to discuss the differential diagnosis value of hepatobiliary section imaging to EHBA and IHS.
Materials and Methods There were 138 infants with persistent jaundice,112 from paediatrics ward of qilu hospital of Shan dong university,26 from paediatrics clinic. Male 68, female 70, their ages were from 35 to 120 days. The gold standard is the consequences of operation, pathematology, and clinical turnover. The retrospective analytical methods were adopted to the symptoms, physical signs, and the correlating examination results, for the infants with jaundice.
The ages, the emergence time of persistent jaundice, and dejecta colors were recorded by questionnaire. The liver size, and spleen size were written down by medical examination. The laboratory examination results were taken down.
All cases underwent hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The detecting head of the SPECT were played the surface of the region of liver and intestinal tract, the hepatobiliary dynamic surface imaging were deployed in 5 minutes,10 minutes,20 minutes,30 minutes,40 minutes,60 minutes after the imaging agent was injected. Supposing the radioaction didn't emerge in intesinal tract, the delayed imaging were adopted in 3 to 4 hour,6 to 8 hour, and 24 hour. The hepatobiliary shape and excretion of radionuclide were observed. When radionuclide was found in intesinal tract, the imagings were stopped. The hepatobiliary section imagings were undertaken immediately after the delayed imagings were completed. The data from collection system of VG Acq were sent to image processing system. The section imagings of transverse plane, sagittal plane, coronal plane were gained by computer software. The pictures were observed by the nuclear medicine doctor with plentiful clinical experience. Regardless of hepatobiliary dynamic surface imaging and hepatobiliary section imaging, as long as adioaction emerged in intestinal tract within 24 hour, the infants were diagnosised as IHS. Supposing adioaction was not found in intestinal tract within 24 hour, the infants were diagnosised as EHBA.
About clinical data and laboratory examinations, the measurement data from different groups were compared by t-test, the enumeration data from different groups were compared by x2-test of four-fold table or line×array table, there are statistical significance when probability is less than 0.05. Sensibility, specificity, accuracy, positive predictive value, and negative predictive value were calculated and expressed by percentage, respectively, for hepatobiliary dynamic surface imaging and hepatobiliary section imaging. The results of the two methods were compared by x2-test of four-fold table, there are statistical significance when probability is less than 0.05.
Results
1、According to the consequences of operation, pathematology, and clinical treatment,39 infants were diagnosised as EHBA,male 15, female 24,99 infants were confirmded as IHS,male 53, female 46. Compare the symptoms, physical signs, and laboratory examination results from 39 EHBA and 99 IHS:
1.1 There were not statistical significance in the ages, the emergence time of persistent jaundice, dejecta colors, liver size, and spleen size, for EHBA and IHS.
1.2 There was not statistical significance in the infection rate of CMV, for EHBA and IHS.
1.3 There were not statistical significance in the contents of ALT, AST, AKP, for EHBA and IHS. But the activity ofγ-GT in EHBA was significantly higher than in IHS。
1.4 There were not statistical significance in TBIL, DBIL, and D/T, for EHBA and IHS.
2、The results of hepatobiliary dynamic surface imaging
2.1 The diagnosis results to EHBA is true positive 32, false positive 40, true negative 59, false negative 7, false positive rate40.4%(40/99), false negative rate17.9%(7/39). The diagnostic evaluation index is saitivity 82.1%(32/39), specificity 59.6%(59/99), accuracy 65.9%(91/138), positive predictive value 44.4%(32/72), negative predictive value 89.4%(59/66).
2.2 The diagnosis results to IHS is true positive 59, false positive 7, true negative 32, false negative 40. The diagnostic evaluation index is saitivity 59.6%(59/99), specificity 82.1%(32/39), accuracy 65.9%(91/138), positive predictive value 89.4%(59/66), negative predictive value 44.4%(32/72).
2.3 The disposition percentage of 59 true positive IHS in 3 to 4 hour to 8 hour、24 hour were18.6%、42.4%、39.0%, respectively.
3、The results of hepatobiliary section imaging
3.1 The diagnosis results to EHBA is true positive 39, false positive 24, true negative 75, false negative 0, false positive rate24.2%(24/99), alse negative rate0(0/39). The diagnostic evaluation index is saitivity 100.0%(39/39), specificity 75.7%(75/99),accuracy82.6%(114/138), positive predictive value 61.9%(39/63), negative predictive value 100.0%(75/75).
3.2 The diagnosis results to IHS is true positive 75, false positive 0, true negative 39, false negative 24. The diagnostic evaluation index is saitivity 75.7%(75/99), specificity 100%(39/39), accuracy 82.6%(114/138), positive predictive value 100%(75/75), negative predictive value 61.9%(39/63).
3.3 The disposition percentage of 75 true positive IHS in 3 to 4 hour、6 to 8 hour、24 hour were 33.3%、44.0%、22.7%, respectively.
4、The comparison of the rerults from two imaging methods
4.1 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity,accuracy, positive predictive value, and negative predictive value, for EHBA.
4.2 The hepatobiliary section imaging was significantly higher than hepatobiliary dynamic surface imaging in saitivity, specificity, accuracy, positive predictive value, and negative predictive value, for IHS.
4.3 The hepatobiliary section imaging was significantly lower than hepatobiliary dynamic surface imaging in false positive rate and false negative rate, for EHBA.
4.4 The time which diagnosed IHS by hepatobiliary section imaging.was significantly shorter than by hepatobiliary dynamic surface imaging.
Conclusions
1、It is hard to differentiate EHBA from IHS by single clinical manifestation and common laboratory examination.
2、The deficients of hepatobiliary dynamic surface imaging are low specificity to EHBA and low saitivity to IHS.
3、The hepatobiliary section imaging can depress the false positive rate, dismiss the false negative rate of EHBA, elevate the differential diagnosis efficacy to EHBA and IHS, and shorten the time of diagnosising IHS.
4、There is still false positive when EHBA is diagnosised by the hepatobiliary section imaging.
引文
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