Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula

Abstract Objective: To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods: Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results: In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion: We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.

摘要
目的：评估肺通气灌注闪烁显像（pulmonary inhalation-perfusion scintigraphy）作为支气管胸膜瘘（bronchopleural fistula, BPF）患者检查与随访替代方案的应用价值。
材料与方法：纳入9例支气管胸膜瘘患者，采用超说明书用药方式置入经导管房间隔缺损封堵器（经内镜途径），并接受肺通气灌注闪烁显像检查：以雾化器吸入900~1300 MBq（25~35 mCi）锝-99m标记二乙三胺五乙酸，使用双探头γ相机行单光子发射计算机断层扫描。
结果：2例患者存在残余气道漏气，支气管镜及亚甲蓝试验均未检出该异常，仅肺通气灌注闪烁显像可检测到。上述结果与患者病程高度吻合，2例患者均出现迟发性漏气征象，证实了闪烁显像结果的准确性。对于支气管镜下显示症状完全缓解、瘘管闭合的患者，闪烁显像结果完全为阴性。在支气管胸膜瘘未闭合的病例中，闪烁显像可确认漏气持续存在。另有2例患者，支气管镜已未见瘘管残留，但肺通气灌注闪烁成像是唯一可检出残余支气管胸膜瘘的检查手段。
结论：本研究证实，肺通气灌注闪烁显像可有效识别残余支气管胸膜瘘，同时可作为支气管胸膜瘘检查及患者随访的替代方法。