sodium-pertechnetate-tc-99m and Appendicitis

The aim of this study was to investigate the potential role of a technetium 99m-labeled antigranulocyte murine antibody Fab' fragment (sulesomab) as a diagnostic imaging agent in children with suspected acute nonclassic appendicitis.. Serial planar images at 15 to 30 minutes, 1, 2, and 4 hours and single-photon emission computed tomography (SPECT) images were acquired after sulesomab injection. In 40 children with suspected acute nonclassic appendicitis, imaging results were confirmed surgically in 21 patients, whereas 19 nonsurgical patients resolved presenting signs and symptoms and were considered to not have appendicitis.. Sulesomab imaging had 95% sensitivity, 90% specificity, 95% negative predictive value, and 90% positive predictive value for acute appendicitis. In 78% of patients, sulesomab accurately detected or excluded acute appendicitis and would have changed management plans. No patients had adverse events, and no human antimurine antibody response occurred in 18 evaluable patients.. Sulesomab was well tolerated with no side effects and with no apparent immunogencity. Appendicitis was rapidly and accurately detected. In pediatric patients with suspected nonclassic appendicitis, management decisions incorporating sulesomab imaging provided benefit in separating surgical from nonsurgical patients.

Topics: Acute Disease; Adolescent; Animals; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antigens, Neoplasm; Appendectomy; Appendicitis; Artifacts; Case Management; Cell Adhesion Molecules; Child; Child, Preschool; False Negative Reactions; False Positive Reactions; Female; Granulocytes; Humans; Immunoglobulin Fab Fragments; Laparotomy; Male; Mice; Predictive Value of Tests; Radioimmunodetection; Radiopharmaceuticals; Reagent Kits, Diagnostic; Rupture, Spontaneous; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Topics: Abdominal Pain; Anorexia; Appendicitis; Child; Diagnosis, Differential; Diarrhea; Diverticulitis; Fever; Humans; Male; Meckel Diverticulum; Peritonitis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Spiral Computed; Vomiting

We evaluated 99mTc-labeled anti-CD15 immunoglobulin M monoclonal antibody (LeuTech) for diagnosing acute appendicitis in patients with an equivocal clinical presentation. LeuTech avidly binds to circulating and sequestered human polymorphonuclear neutrophils in vivo, eliminating in vitro cell labeling and blood handling.. We studied 49 patients to evaluate the safety and efficacy of LeuTech imaging. 99mTc-labeled LeuTech was prepared on site using a lyophilized kit, 99mTc-labeled pertechnetate, and 2 different incubation techniques, 1 at room temperature and the other at 37 degrees C. The abdomen was serially imaged for up to 3 h after the intravenous administration of 370-740 MBq 99mTc-labeled LeuTech. Scans were read as positive or negative for acute appendicitis or other intraabdominal infection. The institutional diagnosis was established by surgery, other diagnostic studies, or 1-mo clinical follow-up.. Scans were positive for appendicitis in all 26 patients with appendicitis, for a sensitivity of 100%, and negative for appendicitis in 19 of 23 patients without appendicitis, for a specificity of 83%. Accuracy, positive predictive value, and negative predictive value were 92%, 87%, and 100%, respectively. Results were not different between the LeuTech preparations. The rate of laparotomies with negative findings in patients who underwent surgery was 10%. The average time from injection to LeuTech visualization in the appendix for cases positive for appendicitis was 9 min. No serious adverse reactions occurred.. LeuTech imaging is safe, rapid, and sensitive for diagnosis of appendicitis in equivocal cases. The potential advantages of LeuTech over currently available radiopharmaceuticals for infection imaging are ease of preparation, absence of blood handling, excellent image quality, no requirement for SPECT, and rapid diagnostic uptake.

Topics: Acute Disease; Adult; Animals; Antibodies, Monoclonal; Appendicitis; Female; Humans; Isotope Labeling; Lewis X Antigen; Male; Mice; Neutrophils; Radioimmunodetection; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Topics: Acute Disease; Animals; Antibodies, Monoclonal; Appendicitis; Emergency Service, Hospital; Humans; Lewis X Antigen; Mice; Radioimmunodetection; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

A new cause of a false-positive result of a Meckel's scan is reported. An 11-year-old girl had a 3-week history of constant right lower quadrant pain that was initially managed by laparoscopic appendectomy. A repeated laparoscopy for persistent pain was nondiagnostic. A missed Meckel's diverticulum was considered as the cause of this pain, which prompted a Meckel scan. This scan revealed a periumbilical focus of activity that was interpreted as a Meckel's diverticulum attached to the anterior abdominal wall by a band. The laparotomy showed no Meckel's diverticulum. The false-positive result of the Meckel scan may be the result of inflammation from the periumbilical laparoscopic port site.

Topics: Abdominal Pain; Appendectomy; Appendicitis; Child; False Positive Reactions; Female; Humans; Laparoscopy; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m