各種陰嚢内疾患のTesticular scanningによる診断

Abstract

1975年より1984年12月までの過去10年間に経験した各種陰嚢内疾患152例に睾丸スキャンを施行し, スキャンの方法と診断上の有用性について検討した.テクニケア社のDN-100型を用い, 核種は99mTcO4-を使用, 立位にて軽い開脚状態とし, 陰茎は腹壁に固定し, コリメーターは低エネルギー, 高感度のものを使用して陰嚢部に可能な限り接近させてスキャニングした.睾丸回転症の術前診断的中率は100%であり, 本疾患の診断に最も有用な検査法であった.急性副睾丸炎の診断適中率も100%であったが, focal epididymitisの場合には鑑別困難の場合があるとされる.睾丸腫瘍は特に特徴的所見に乏しく, 睾丸スキャン単独では40～50%の診断率であった.精系静脈瘤では特徴的な像が得られ, 有用でった.睾丸外傷においても損傷の程度や範囲の描出可能であり, sonographyよりも有意義であった.本法は被曝線量も極めて少なく優れた検査法といえる

Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with a variety of intrascrotal lesions. Scrotal images were obtained serially in the perfusion, tissue phase, illustrating the features of each phase in various clinical conditions. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion of the testicular appendix, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. Technical problems of the scanning are also discussed.; PIP: Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with various intrascrotal lesions. Prior to scanning, the patients were given an oral dose of 200 mg KD104 to control thyroid gland's exposure to radiation. Scrotal images were obtained 16 times with 2 seconds' interval in the perfusion phase and twice with 5 minutes' interval in the tissue phase. The rate of correct diagnosis by scrotal images were 100% for testicular torsion and acute epididymitis, significantly high for scrotal abscess and varicocele, 40-50% for testicular tumor, and low in the cases of hydrocele, testicular trauma and spermatocele. In testicular torsion, a rounded cold area and a halo of dartos perfusion were observed. Scrotal imaging proved to be useful for post-operative diagnosis of testicular vascularity also. In "missed" testicular torsion, scrotal scan showed a "halo sign" in the tissue phase due to intensified vascularity in the dartos, and a "nubbin sign" in the perfusion phase due to the increased perfusion of spermatic cord vessels. In acute epididymitis scrotal scan showed increased activity spanning spermatic cord vessels and scrotum in the perfusion phase, and increased curvilinear activity in the tissue phase. In scrotal abscess increased perfusion from spermatic cord vessels and pudendal artery were observed in the perfusion phase. In the tissue phase increased dartos perfusion and a cold area due to the formation of abscess was observed. In varicocele, increased perfusion in the location which corresponded to the pampiniform plexus of the vein was observed in venous phase.