technetium-tc-99m-exametazime and Colitis--Ulcerative

Optimal management of chronic idiopathic inflammatory bowel disease requires determination of disease localization and intensity. Scintigraphy with the use of 99mTc-HMPAO-White Blood Cells (99mTc-HMPAO-WBC) is a relatively new noninvasive nuclear medicine procedure. We have evaluated more than 230 children and have found a high correspondence between the disease distribution shown by the 99mTc-HMPAO-WBC scan and that shown by endoscopic, radiologic, or surgical methods. Additionally the 99mTc-HMPAO-WBC scan has the ability of identifying extra intestinal site of inflammation, such as appendicitis and others. The erythrocyte sedimentation rate, the most frequently used indicator of disease activity in the clinical setting, has better correlation with the scan scores than the clinical activity index. The 99mTc-HMPAO-WBC scan is reliable in differentiating Crohn's disease from ulcerative colitis. Some patients because of unequivocal demonstrable small bowel uptake are reclassified from ulcerative colitis to Crohn's disease. The medication regimen is frequently altered because of the intensity of uptake displayed by the 99mTc-HMPAO-WBC scan. It is a practical and safe study even in an acutely ill patient who may not tolerate endoscopic or radiological study. At our institution, the 99mTc-HMPAO-WBC scan is now part of the initial evaluation, and follow-up of patients with inflammatory bowel disease. In conclusion the 99mTc-HMPAO-WBC is excellent for the detection, localization and characterization of inflammatory bowel disease in children. Compared with the other methods of investigation this study requires no bowel preparation, is noninvasive and has excellent diagnostic accuracy.

Topics: Child; Colitis, Ulcerative; Crohn Disease; Humans; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Inflammatory bowel disease (IBD) symptoms may be due not only to the effects of bowel inflammation, but also can result from many non-inflammatory consequences of the disease. Clinical scores and health questionnaire ratings produce a global assessment which is useful in the overall evaluation of the impact of the illness on the patient, and the effect of treatment. However many studies have failed to recognize the need to separately assess changes in the degree of bowel inflammation, in addition to a global clinical response. Radiolabelled white cell scanning using 111-indium has been shown to provide an accurate, quantitative and non-invasive method for assessing the degree of bowel inflammation in IBD and its response to therapy, using faecal collection or total body counts of radioactivity. More recently 99mTc hexamethyl propylene amine oxime (HMPAO) labelled white cell scanning has been introduced, which has advantages over the 111-indium method, including reduced radiation dosimetry and enhanced image quality. 99mTc-HMPAO scanning using three-dimensional white cell scanning (single photon emission computerized tomography; SPECT) allows visualization of the entire bowel separate from overlying structures. 99mTc-HMPAO white cell scanning with SPECT has now been computerized and automated to permit measurement of segmental and total bowel radiolabelled white cell infiltrate. This method could potentially provide the gold standard for objective assessment of the response of disease activity in Crohn's disease and ulcerative colitis, and merits application in clinical trials of novel therapies for IBD.

Topics: Acute-Phase Proteins; Colitis, Ulcerative; Crohn Disease; Humans; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Oximes; Severity of Illness Index; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The management of inflammatory bowel disease depends on knowledge of the site, extent and severity of inflammation. Early work showed that 111In-labelled white cells could fulfil this role. More recently. 99mTc-HMPAO white cell scanning was introduced. Several studies have shown that this test can reliably detect disease and can assess extent. Simple visual grading of uptake intensity can also be used to assess severity. The improved image resolution allows assessment of small bowel disease in addition with high sensitivity in the detection of ulcerating Crohn's disease. Other causes of bowel inflammation should be excluded. Complicating abscesses can be detected and the inflammatory component of strictures can be assessed. False positive activity can be avoided by imaging early at one hour, before such non-specific excretion occurs. Later images are also useful in order to help localize disease, but only in addition to the initial one hour scan. 99mTc-HMPAO white cell scanning, a simple non-invasive, highly informative test should be added to the armamentarium of every gastroenterologist.

Topics: Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Humans; Inflammatory Bowel Diseases; Intestine, Small; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Knowledge of the severity and extent of the inflammation in inflammatory bowel diseases provides a means of determining rational therapeutic strategies in affected patients. During the past 3 decades, several clinical, laboratory, and combined indices have been proposed for the assessment of inflammatory bowel disease; refinements in radiologic methods and the availability of endoscopy and biopsy have facilitated the accurate assessment of the extent and severity of the disease. In relapsing conditions such as inflammatory bowel disease, however, the use of such procedures is limited by the radiation exposure or the relatively invasive nature of the technique. In this article, we review the proposed methods and recent advances in assessment of patients with inflammatory bowel disease; we also discuss possible strategies at the time of diagnosis, during recurrence, and in evaluation of the efficacy of drug or dietic therapy.

Topics: Colitis, Ulcerative; Colon; Colonoscopy; Crohn Disease; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Organometallic Compounds; Oximes; Radiography; Radionuclide Imaging; Recurrence; Technetium; Technetium Tc 99m Exametazime

The rate of treatment failure in acute exacerbation of ulcerative colitis (UC) still reaches 20%-30%. Early identification of nonresponders to therapy is important, since intensified or other medical treatment or, ultimately, colectomy should be considered to reduce morbidity. Because 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) white blood cell (WBC) scintigraphy is accurate in determination of the severity and extent of UC lesions, the aim of this study was to assess whether WBC scintigraphy can predict early treatment failure in patients with an acute attack of UC.. We included 20 consecutive patients (7 women, 13 men; mean age +/- SEM, 36.8 +/- 10.9 y) with a history of UC who were hospitalized with severe exacerbations. All patients underwent endoscopy and scintigraphy within 24 h of admission and 1 wk after beginning treatment. WBCs were labeled with 200 MBq 99mTc-HMPAO. SPECT of the abdomen was performed 60 min after WBC reinjection. Maximum tracer uptake in the different colon segments was defined and expressed as a ratio of lumbar bone marrow uptake. The scintigraphic activity score (SAS) was expressed as the sum of segmental colon uptake ratios. Scintigraphic evolution was considered favorable when the SAS decreased by > or =50% and SPECT uptake ratios after therapy were < or =1.5 per segment. Rectosigmoidoscopy with biopsy was performed within 24 h after scintigraphy.. Outcome analysis after 3 mo showed 6 of 20 patients in clinical and endoscopic or histologic (rectosigmoid) remission, without alteration of treatment (responders). Of the other patients (nonresponders), 5 of 14 received a colectomy, 5 of 14 received prolonged or intensified treatment, and 4 of 14 received other treatment. In the responders group, the SAS (determined 1 wk after beginning therapy) significantly decreased in all patients. In the group of nonresponders, 10 patients had an increase of >10% in the SAS, 2 patients had an unchanged SAS, and 2 patients had a decreased SAS of >10% but had a residual mean segmental WBC uptake ratio of >1.5. There was a statistically significant difference between the responders and nonresponders (P < 0.01).. Repeated 99mTc-HMPAO scintigraphy seems to be able to predict therapy resistance in UC within 1 wk after beginning treatment.

Topics: Adult; Colectomy; Colitis, Ulcerative; Female; Humans; Leukocytes; Male; Patient Selection; Postoperative Care; Preoperative Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Treatment Outcome

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with frequent exacerbations, including the risk for toxic megacolon and severe complications. In very active disease, colonoscopy should not be performed to assess the severity and the extent of the disease. The aim of the current study was to determine whether Tc-99m HMPAO-labeled white blood cell (WBC) scintigraphy can be used as an alternative to colonoscopy to determine the extent and the severity of the disease in critically ill patients.. Twenty consecutive patients (7 women, 13 men; age 38.1 +/- 13.1 years) who had a severe attack of UC underwent scintigraphy on the day of admission. Leukocytes were labeled with 200 MBq (5.35 mCi) Tc-99m HMPAO. Planar anterior and posterior imaging of the abdomen was performed 45 and 120 minutes after WBC reinjection. The tracer uptake in the different colon segments was scored visually compared with bone marrow uptake. A symptom score was made and C-reactive protein was measured as a serologic marker of inflammation. Rectosigmoidoscopy with biopsy was performed within 24 hours of scintigraphy. Scintigraphic, endoscopic, and histologic results were compared for disease activity.. The mean symptom score was 12.7 (+/-0.7) on a scale of 21, and mean the C-reactive protein level was 6.8 (+/-1.2) mg/l. No significant difference was found between the scintigraphic score of the rectum and the endoscopic or the histologic score. The best correlation was found with the latter (r = 0.66, P < 0.01). Based on the results of scintigraphy, disease involved the left side of the colon up to the splenic flexure in 10 patients. The other patients had pancolitis.. Disease severity can be determined adequately by planar WBC scintigraphy in patients with severe attacks of UC. Because the presence and severity of disease correlates well with endoscopic and histologic findings, WBC scintigraphy can assess disease extent without the need for colonoscopy. This decreases the number and severity of complications that can occur in already critically ill patients.

Topics: Acute Disease; Adult; Aged; Colitis, Ulcerative; Female; Humans; Leukocytes; Male; Middle Aged; Radiometry; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

The purpose of our study was to compare the usefulness of hydrocolonic sonography and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)--labeled leukocyte scintigraphy in the examination of patients with inflammatory bowel disease, using precise sonographic criteria of bowel involvement.. Sixty-eight consecutive patients with active inflammatory bowel disease (34 ulcerative colitis and 34 Crohn's disease), 12 with inactive inflammatory bowel disease, and 10 control subjects were prospectively studied. Patients with active disease underwent clinical assessment, hydrocolonic sonography, scintigraphy, and colonoscopy within 72 hr, whereas patients with inactive disease and control subjects underwent clinical examination and hydrocolonic sonography.. Involvement of a colonic segment by active inflammatory bowel disease was best defined by mucosal thickness greater than 1.5 mm, bowel wall thickness greater than 4 mm, mucosal irregularity, or the absence of haustra; and involvement of the terminal ileum by bowel wall thickness greater than 4 mm. Using these criteria, hydrocolonic sonography had 100% sensitivity for identifying patients with active inflammatory bowel disease and a greater overall accuracy (87%) than scintigraphy (77%) in the assessment of disease extension. In addition, strong correlation was shown between a hydrocolonic sonography activity index and clinical and endoscopic activity indexes.. This prospective study provides precise sonographic criteria for the definition of bowel involvement by active inflammatory bowel disease. Hydrocolonic sonography has a greater accuracy than scintigraphy for assessing disease extension and activity. Therefore, hydrocolonic sonography should be considered a first-choice technique to complete the study of inflammatory bowel disease after confirmation of the diagnosis by histology.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Ultrasonography

Heparin given intravenously has shown beneficial effects in the treatment of refractory ulcerative colitis in open trials. Low molecular weight heparin (LMWH) offers advantages in the method of administration but have not been evaluated in inflammatory bowel disease conditions.. To assess the tolerability and safety of subcutaneous self-administered LMWH in outpatients with refractory ulcerative colitis and to evaluate any potential adjuvant therapeutic effect.. Twelve patients with mild to moderately active ulcerative colitis were included in the trial. The patients had either responded poorly to treatment with conventional therapy, including oral and/or rectal glucocorticosteroids, or had experienced a rapid relapse during or shortly after GCS therapy. Dalteparin sodium 5000 units s.c. injection was administered twice daily for 12 weeks. Patients were monitored for possible adverse events and changes in clinical symptoms, and endoscopic and histological scores were analysed. Leucocyte scanning was performed at inclusion and at the end of the study.. Tolerability and compliance were excellent and no serious adverse events occurred. Eleven patients improved symptomatically and six (50%) attained complete remission after 12 weeks of treatment. Endoscopic, scintigraphic and histological scores were found to be significantly improved.. Self-administered LMWH given s.c. may be a safe adjuvant therapy for patients with active, glucocorticosteroids-refractory ulcerative colitis. A controlled trial should be undertaken to confirm the positive effects found in this study.

Topics: Adult; Aged; Anticoagulants; Chemotherapy, Adjuvant; Colitis, Ulcerative; Female; Glucocorticoids; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Knowledge of the distribution of disease in patients with inflammatory bowel disease is important because it has diagnostic, prognostic, and therapeutic implications. We studied 215 patients with 99mTc-HMPAO-white blood cell scans, of whom 80 had Crohn's disease (CD), 34 had active ulcerative colitis (UC), and 31 were controls. In our 77 cases of active CD, uptake was seen exclusively in the small bowel in 18% of patients, only the large bowel in 44%, and both the large and small bowel in 38% of patients. Discontinuous colitis was seen in 63 of these patients. In the 29 cases of active UC, the uptake involved the entire colon in 50% of patients, extended farther than the sigmoid in 27% of patients, and was limited to the rectosigmoid in 23%. In the 29 cases of active UC, four of the scans incorrectly revealed discontinuous accumulation of 99mTc-HMPAO-WBC. In 31 controls, no significant colonic uptake was seen. Isolated small bowel involvement with CD is observed less frequently in children undergoing 99mTc-HMPAO-WBC scanning than in adults. In children, the segmental distribution of inflammation as depicted with 99mTc-HMPAO-WBC is similar to the radiologic distribution.

Topics: Adolescent; Adult; Child; Child, Preschool; Colitis; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Female; Humans; Ileitis; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

To compare two technetium-99m scintigraphic techniques - 99mTc-labelled antibodies against granulocyte non-specific cross-reacting antigen-95 and 99mTc-exametazime labelled leucocytes in ulcerative colitis - 23 consecutive patients undergoing colonoscopy were investigated in a prospective and randomized study. In each patient the two scans and colonoscopy and biopsy were performed within 10 days. Scans, endoscopy and histology were independently graded for degree of inflammation in eight different colorectal segments for each patient. Active inflammation in one or more segments was present on endoscopy in 22 patients and on histology in 17 patients. Twenty-two patients had increased uptake on the antibody scan and 21 patients on the exametazime scan. Twelve patients showed the same disease extent with both scan methods (total colitis, n=10; distal colitis, n=2). Compared with endoscopy, sensitivity for inflammation in individual segments was 0.51 for antibody scan and 0.87 for exametazime scan; specificity was 0.67 and 0.55, respectively. The predictive value for presence of inflammation was 0.66 for antibody scan and 0.72 for exametazime; the predictive value for absence of inflammation was 0.52 and 0.77, respectively. Segmental scan uptake of endoscopically or histologically visualized inflammation was consistently lower for antigranulocyte antibodies than for exametazime. It is concluded that in patients with active ulcerative colitis, inflammation is better visualized with 99mTc-exametazime labelled leucocytes than with 99mTc-labelled antigranulocyte antibodies. The antibody technique offers the advantage of in vivo labelling, but is less reliable than the exametazime method for imaging of colonic inflammation.

Topics: Adolescent; Adult; Aged; Autoantibodies; Colitis, Ulcerative; Female; Granulocytes; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease.. Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken.. Great Ormond Street Hospital for Children, London.. 39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years).. There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%).. The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.

Topics: Adolescent; Barium Sulfate; Child; Child, Preschool; Colitis, Ulcerative; Colonoscopy; Crohn Disease; Female; Granulocytes; Humans; Inflammatory Bowel Diseases; Male; Organotechnetium Compounds; Oximes; Prospective Studies; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocytes and indium-111 polyclonal immunoglobulin (IgG) were simultaneously injected into a group of 27 patients routinely referred for the investigation of inflammatory bowel disease (IBD). Ten-minute anterior abdomen and tail on detector views were obtained at 30 min, 4 h and 24 h p.i. of both tracers. The diagnosis of IBD was obtained in all cases by endoscopy with biopsy and/or surgery. Images were blindly evaluated by two experienced observers who only knew of the clinical suspicion of IBD. IBD was confirmed in 20 patients (12 with Crohn's disease and eight with ulcerative colitis). Sensitivity, specificity and accuracy were 100%, 85% and 96% respectively for labelled leucocytes and 70%, 85% and 74% for IgG. Both IgG and leucocyte scans were normal in six out of seven patients in whom a diagnosis of IBD was excluded; the remaining patient, with ischaemic colitis, was falsely positive with both agents. As far as disease extension is concerned, the IgG study localized 27 diseased segments, whereas 49 were seen with the leucocyte study. Eighty-four segments were normal and 25 showed tracer uptake with both agents. Twenty-four were positive only with the leucocyte study and two were positive only with the IgG study. Agreement between the agents was 80.7%. These results confirm that 111In-human polyclonal scintigraphy is less sensitive than 99mTc-HMPAO scintigraphy both for the diagnosis of IBD and in the evaluation of disease extension. Nevertheless, if leucocyte labelling is not available, labelled IgG can be used only for diagnostic purposes.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Humans; Immunoglobulins, Intravenous; Indium Radioisotopes; Lymphocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The objective assessment of inflammatory bowel disease activity is important for optimal management. The mucosal neutrophil infiltrate in acute bowel inflammation can be detected and quantified using 99mTc-HMPAO-radiolabelled leucocytes. Planar quantification methods have inherent inaccuracies due to variable depth and overlapping activities. SPECT (single-photon emission computerized tomography) is a technique which can quantify the three-dimensional distribution of radioactivity. We have applied this novel imaging technique to 23 patients with suspected colitis and 13 with small bowel disease. The SPECT activity score correlated well with the histological activity score for colonic segments with significant separation of grades. The total SPECT score for disease activity in both large and small bowel also correlated with clinical parameters. SPECT offers a non-invasive and objective approach to the assessment of disease activity which may be useful in the assessment of novel therapies for IBD.

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Image Processing, Computer-Assisted; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

In this study, our objective was to define the usefulness of technetium-99m hexamethyl propylene amine oxime (Tc-99m HMPAO)-labeled leukocyte scintigraphy at three different time points in the assessment of disease extension and severity in patients with active ulcerative colitis (UC).. Twenty-one consecutive patients (10 women, 11 men; mean age 42.4 +/- 12 years) with active UC were prospectively studied. All patients were diagnosed by colonoscopy and histopathology prior to inclusion. Scintigraphy was performed at 1 h, 2 h, and 4 h after Tc-99m HMPAO-labeled leukocyte injection. Clinic-biochemical activity score, total colonoscopic activity score, and total scintigraphic activity score at 1 h, 2 h, and 4 h were calculated for each patient.. Sensitivity, specificity, and accuracy values of Tc-99m HMPAO-labeled leukocyte scintigraphy were calculated as follows, respectively: 1 h imaging 86%, 73%, and 83%; 2 h imaging 89%, 74%, and 86%; 4 h imaging 90%, 58%, and 83% in the detection of active inflammatory segments. Even though no statistically significant difference was found between 1 h, 2 h, and 4 h imaging with respect to the sensitivity, specificity of labeled leukocyte scintigraphy, the largest area under the curve value was found for 2 h imaging.. Tc-99m HMPAO-labeled leukocyte scintigraphy has been found to be correlated well with colonoscopy in the assessment of both the extension and severity of UC. We recommend 2 h scintigraphic imaging because it provides the largest area under the curve value and decreases the number of false-positive results.

Topics: Adult; Colitis, Ulcerative; Disease Progression; Drug Administration Schedule; Female; Humans; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime

Radiolabelled white cell scans provide non-invasive quantification of inflammatory activity. Clinical activity scores measure severity of disease but are partly subjective. White cell scans may provide a suitable method of monitoring the treatment response of active inflammatory bowel disease.. Ten subjects with active ulcerative colitis and 13 subjects with active Crohn's disease were recruited. White cell scans were carried out before and 2 weeks after treatment. Prior to each scan, activity scores for ulcerative colitis or Crohn's disease were calculated and serum and faecal tumour necrosis factor-alpha and calprotectin measured. White cell scan activity at 1 h was calculated by using a validated visual grading system.. Following anti-inflammatory treatment, 70% of white cell scans improved, 17% remained unchanged and 13% deteriorated. In the ulcerative colitis subgroup subjects there was modest agreement for change in scan score and activity scores. In the Crohn's disease subjects there was better agreement between change of white cell scan score and clinical scores. Planar white cell scans correlated with the van Hees activity index (r=0.68, P=0.002) and faecal calprotectin (r=0.58, P=0.0003). Changes in planar white cell scans correlated with changes in serum calprotectin (r=0.45, P=0.05).. Non-invasive white cell scanning is a feasible and objective method to monitor the anti-inflammatory efficacy of treatments for active inflammatory bowel disease.

Topics: Adult; Anti-Inflammatory Agents; Biomarkers; Colitis, Ulcerative; Crohn Disease; Feces; Female; Humans; Leukocyte L1 Antigen Complex; Male; Middle Aged; Phagocytes; Prednisolone; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tumor Necrosis Factor-alpha

Scintigraphy using radiolabeled leukocytes is a useful technique for assessing intestinal infiltration in Crohn's disease (CD). However, limits of planar images include overlapping activity in other organs and low specificity. To investigate the usefulness of (99m)Tc-HMPAO (hexametyl propylene amine oxime) labeled leukocyte single photon emission computerized tomography (SPECT) for assessing CD lesions, in comparison with planar images.. Twenty-two inflammatory bowel disease patients (19 CD; 2 ulcerative colitis, UC; 1 ileal pouch) assessed by conventional endoscopy or radiology were enrolled. Leukocytes were labeled with (99m)Tc-HMPAO. SPECT images were acquired at 2 h and planar images at 30 min and 2 h. Bowel uptake was quantitated in nine regions (score 0-3).. Both SPECT and planar images detected a negative scintigraphy (score 0) in the UC patient with no pouchitis and a positive scintigraphy (score 1-3) in the 21 patients showing active inflammation by conventional techniques. SPECT showed a higher global score than planar images (0.71 +/- 0.09 vs 0.30 +/- 0.05; p < 0.001), and in particular in the right iliac fossa (p= 0.003), right and left flank (p < 0.001; p= 0.02), hypogastrium (p= 0.002), and mesogastrium (p < 0.001). SPECT provided a better visualization and a higher uptake than planar images in patients with ileal and ileocolonic CD (6.45 +/- 0.82 vs 2.8 +/- 0.55, p < 0.001; 5.5 +/- 1.6 vs 2.6 +/- 0.7, p= 0.03), and with perianal CD (6.6 +/- 1.6 vs 3.4 +/- 1.2; p= 0.03).. (99m)Tc-HMPAO labeled leukocyte SPECT provides a more detailed visualization of CD lesions than planar images. This technique may better discriminate between intestinal and bone marrow uptake, thus being useful for assessing CD lesions within the pelvis, including perianal disease.

Topics: Colitis, Ulcerative; Crohn Disease; Female; Humans; Intestines; Isotope Labeling; Leukocytes; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Colitis, Ulcerative; Female; Graft Rejection; Humans; Kidney Transplantation; Leukocytes; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Mertiatide

In comparison to endoscopy, clinical and biological criteria are less predictive of severity in attacks of ulcerative colitis (UC). Our aim was to assess the value of the double-track scintigraphic appearance in the assessment of the severity of acute UC by comparing it to endoscopic criteria.. We reviewed medical records of 52 patients hospitalized for an acute attack of UC, who had undergone within 48 hours of presentation both a technetium 99m hexamethyl propylene amine oxime (99mTc-HMPAO) granulocyte scintigraphy and endoscopic examination (colonoscopy: n=20; rectosigmoidoscopy: n=32).. Taking into account the colonic segments examined together with both methods in the same patient or results obtained with colonoscopies, there was an excellent agreement between the double-track scintigraphic appearance and endoscopic criteria of severity.. In patients with previously diagnosed UC, 99mTc-HMPAO granulocyte scintigraphy when available may replace endoscopic examination to assess the severity of attacks.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Colitis, Ulcerative; Colon; Endoscopy, Gastrointestinal; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

To evaluate (99m)Tc-HMPAO leukocyte scintigraphy as an investigation for inflammatory bowel disease (IBD).. Scintigraphy was performed in 95 children undergoing investigation for IBD in a tertiary Gastroenterology Department. Diagnosis was based on conventional investigations including small bowel barium contrast radiology (BCR), upper gastrointestinal endoscopy (UGIE), colonoscopy, and endoscopic biopsy (the "gold standards"). IBD was confirmed in 73 (57 Crohn's disease; 10 ulcerative colitis; 6 indeterminate colitis) and excluded in 22 (controls). Scintigraphy was (1) evaluated as a screening test, (2) compared with individual conventional tests, (3) assessed for each gut segment.. Screening test: sensitivity 0.75 (95% CI, 0.63-0.85), specificity 0.82 (95% CI, 0.59-0.94), PPV 0.93, NPV 0.5. Comparison with BCR: sensitivity 0.87 (95% CI, 0.72-0.96), specificity 0.57 (95% CI, 0.39-0.73), PPV 0.69, NPV 0.2. Comparison with UGIE: specificity 0.9 (95% CI, 0.79-0.96), NPV 0.13 (sensitivity and PPV unavailable). Comparison with colonoscopy: sensitivity 0.57 (95% CI, 0.41-0.73), specificity 0.71 (95% CI, 0.54-0.85), PPV 0.71, NPV 0.42. Comparison with biopsies paralleled that with endoscopy. False negatives were especially common (NPV< or =0.2) in the proximal gut.. (99m)Tc-HMPAO leukocyte scintigraphy should not be relied on as a screening test for IBD because false negative results are common. This method is especially unreliable at detecting disease in the proximal gut.

Topics: Adolescent; Child; Child, Preschool; Colitis, Ulcerative; Colon; Colonoscopy; Crohn Disease; Duodenitis; Enteritis; Female; Gastritis; Humans; Intestinal Mucosa; Leukocytes; Male; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

The goal of this study was to evaluate the temporal correlation of Tc-99m WBC studies with the erythrocyte sedimentation rate, a commonly used index of intensity of inflammation, in a large population of children with inflammatory bowel diseases. Over a 6-year period, 313 Tc-99m WBC studies were performed and the hospital charts of these consecutive children were reviewed. In each set of scans (0.5-1 hour and 2-3 hours) from the 313 patients, the bowel was divided into 8 segments resulting in 5008 bowel segments for scoring. The intensity of uptake on the planar images was graded on a scale of 0 to 6 and compared with the erythrocyte sedimentation rate obtained within 3 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, or 1 year of the Tc-99m WBC scan, when available. A dataset of 508 erythrocyte sedimentation rates was available for computation. In children with Crohn's disease, when erythrocyte sedimentation rate is obtained within 3 days of the Tc-99m WBC scan, the correlation coefficient is R=0.314 (P<0.005), within 1 week R=0.358 (P<0.05), within 2 weeks R=0.254 (P=0.129), within 1 month R=-0.029 (P=0.84), within 3 months R=-0.002 (P=0.989), within 6 months R=0.241 (P=0.145), and within 1 year R=0.068 (P=0.759). In children with Crohn's disease, the uptake of Tc-99m WBC correlates well with the erythrocyte sedimentation rate during the flare of inflammation, and the correlation progressively subsides after a few weeks. No such correlation was noted in children with ulcerative colitis.

Topics: Adolescent; Blood Sedimentation; Case-Control Studies; Colitis, Ulcerative; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

The aims of this study were to assess the reliability of the distribution of fecal residue, mucosal irregularity, and colonic wall thickening on plain abdominal x-ray as markers of disease extent assessed by technetium-99 m hexamethylpropylene amine oxine-labeled leukocyte scans in active ulcerative colitis (UC).. Plain abdominal radiographs were blindly assessed for the distribution of fecal residue, mucosal irregularity, and colonic wall thickening (>3 mm) in 30 patients with active UC. Most patients were too sick to safely allow total colonoscopy. In 11 patients for whom details of disease extent were available from total colonoscopy or surgery undertaken at the time, there was a close correlation with disease extent defined by technetium-99 m hexamethylpropylene amine oxine-labeled leukocyte scans. Contemporaneous radiolabeled leukocyte scans were therefore used to assess disease extent in comparison with plain abdominal radiographs.. Of 30 patients, 15 had pancolitis and 15 had subtotal or distal disease as indicated by radiolabeled leukocyte scans. The distribution of fecal residue on plain abdominal radiographs correctly identified disease extent defined on radiolabeled leukocyte scans in 40% of patients, overestimating it in 13% and underestimating it in 47%. There was no significant correlation between distribution of fecal residue on plain abdominal radiographs and disease extent on radiolabeled leukocyte scans or colonoscopy or surgery. Of patients with pancolitis, 60% had fecal residue present on plain abdominal radiograph with 40% showing stool distal to the hepatic flexure as well as in the right colon. For total UC on radiolabeled leukocyte scanning, the sensitivity and specificity of absence of fecal residue on plain abdominal radiographs were 40% and 80% respectively. Irregularity of mucosal edge and colonic wall thickening were even less accurate than fecal residue in defining disease extent.. The distribution of fecal residue, irregularity of mucosal edge, and colonic wall thickening on plain abdominal radiography do not provide a reliable guide to disease extent in active UC.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Colitis, Ulcerative; Colonoscopy; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Radiographic Image Enhancement; Radionuclide Imaging; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime

The purpose of this study was to evaluate retrospectively the value of leukocyte-labeled scintigraphy, ultrasonography, and contrast radiography compared with endoscopy in children suspected of having inflammatory bowel disease (IBD).. Twenty-eight children (17 boys; mean age, 10.2 years) with IBD based on standard colonoscopic, histologic, and radiologic criteria (16 with Crohn's disease, 5 with ulcerative colitis, 5 with nonspecific colitis, I with granulomatous disease, and I with Beh,cet's disease) were included. Endoscopic, ultrasonographic, and contrast radiologic examinations were realized for 28, 23, and 19 children respectively.. Sensitivity and specificity were 75% and 92% for leukocyte-labeled scintigraphy, 39% and 90% for ultrasonography, and 58% and 83% for contrast radiography. The authors noted discontinuous uptake for 14 of 15 true-positive results for patients with Crohn's disease and continuous uptake for 4 of 4 true-positive results for patients with ulcerative colitis. A negative correlation between scan activity index and Lloyd-Still clinical score was found for 11 patients with Crohn's disease (r = -0.77).. Leukocyte-labeled scintigraphy, a noninvasive and reproducible technique, is a useful tool in the diagnosis and therapeutic strategy of IBD, and provides information on the presence, the intensity, and the extent of the disease, particularly in the terminal ileum. Leukocyte-labeled scintigraphy may not replace colonoscopy with biopsies for diagnosis confirmation. Its reliability seems higher than that of ultrasonography.

Topics: Adolescent; Barium Compounds; Child; Child, Preschool; Colitis, Ulcerative; Colonoscopy; Crohn Disease; Diagnosis, Differential; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Ultrasonography

Although [99mTc]HMPAO-labeled leukocyte scintigraphy is widely used in the assessment of IBD, the time point chosen for imaging is still controversial. The aim of the present study was to determine the optimal scanning sequence to assess IBD extension and activity. Sixty-two consecutive patients with active and 18 with inactive IBD were prospectively studied. Clinical evaluation, colonoscopy, radiology, and scintigraphy were performed within three days, without changes in the patient's treatment. Compared to early scan (45 min), late scan (3 hr) had a higher sensitivity (85% vs 100%) and accuracy (85% vs 95%) in identifying patients with active IBD and in defining IBD extension. Combinations of values from both scans did not improve accuracy of scintigraphy, which is lower in Crohn's disease than in ulcerative colitis and also in patients receiving steroid treatment. In conclusion, a single late scintigraphy scan provides the best means to identify patients with active IBD and to assess disease extension.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

We aimed to determine the activity of Crohn's Disease (CD) and Ulcerative Colitis (UC) with this radiotracer and to compare it with the normal clinical indexes. 32 patients with CD (19 women) and 18 with UC (13 women) were studied and a sequential abdominal 99mTc-HMPAO-label leukocyte scintigraphy was performed after evaluating the activity clinical scales indexes (Harvey's for CD and Lictiger for UC). Quantification was performed to obtain intestinal activity indexes in regards to intestinal uptake with background, bone marrow, liver and spleen, comparing them with the clinical indexes. In CD, all scintigraphic indexes showed a significant correlation (p < 0.001) with clinical activity. The best results were obtained with gut/background (r: 0.73) and gut/bone marrow (r: 0.72). In UC, we obtain a lower correlation between clinical and scintigraphic indexes. Significant correlations (p < 0.05) were only found with the gut/background (r: 0.52) and gut/bone marrow growth indexes (r: 0.58). The others showed no correlation. In conclusion, IBD activity estimated with 99mTc-WBC and scintigraphy indexes showed moderate correlation with clinical scales. However, the information of the scintigraphy was very useful in the management of these patients.

Topics: Adult; Aged; Colitis, Ulcerative; Crohn Disease; Evaluation Studies as Topic; Female; Humans; Inflammation; Intestines; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Leukocyte scintigraphy has been used as a standard diagnostic procedure for the detection of inflammation in vivo. In this study, we developed a method of labelling purified lymphocytes with technetium99m-hexamethyl propyleneamine oxime (Tc99m-HMPAO) without significantly impairing their function. This was confirmed by measurements of in vitro lymphocyte adhesion and migration and of both necrotic and apoptotic cell death. The results of the in vitro control studies indicate that the dysfunction of leukocytes caused by Tc99m-HMPAO labelling can be minimized by using a gentle labelling method and low Tc99m activity. Because lymphocytes have been thought to participate specifically in the pathogenesis of inflammatory bowel disease (IBD), we compared scintigraphies obtained with Tc99m-HMPAO-labelled purified lymphocytes and mixed leukocytes in colitis patients. We found that a lower number of Tc99m-HMPAO-labelled peripheral blood lymphocytes accumulated in the inflamed colon during the first 4 h than labelled mixed leukocytes. The results are likely to reflect the dissimilar kinetics of lymphocyte traffic compared with granulocytes in IBD. We do not recommend the use of Tc99m-HMPAO-labelled purified lymphocytes as a diagnostic tool in chronic colitis. However, the in vitro data indicate that Tc99m-HMPAO-labelled lymphocytes may be suitable for studying short term lymphocyte recirculation and lymphocyte kinetics in other types of inflammation.

Topics: Adolescent; Adult; Apoptosis; Cell Adhesion; Cell Survival; Colitis, Ulcerative; Crohn Disease; Endothelium, Vascular; Female; Humans; Inflammation; Isotope Labeling; Lymphocytes; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Exametazime

The diagnostic value of Tc-99m leukocyte imaging for evaluating disease activity and monitoring treatment response in ulcerative colitis was compared with that of colonoscopy. A total of 48 studies were performed in 28 patients with ulcerative colitis. Forty-six studies had both Tc-99m leukocyte imaging and colonoscopy within 2 weeks of each other, and the remaining two studies had only Tc-99m leukocyte imaging. In 46 studies, semiquantitative grading of colonic radioactivity by comparison with iliac crest marrow activity on radionuclide imaging correlated well with macroscopic grading based on Matts' criteria on colonoscopy. Fourteen (82%) of 17 studies with slight colonoscopic change showed a negative result on the radionuclide image. In 15 patients treated with glucocorticoids or leukapheresis, radionuclide imaging showed nearly the same statistical results as colonoscopy in monitoring treatment response. Tc-99m leukocyte imaging could be used as an alternative to colonoscopy to evaluate the disease activity of ulcerative colitis or to monitor the treatment response, although it is insensitive for detecting disease with only slight macroscopic changes.

Topics: Adult; Colitis, Ulcerative; Colonoscopy; Female; Glucocorticoids; Humans; Leukapheresis; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Exametazime

We retrospectively evaluated the incidence of late accumulation of 99Tcm-HMPAO leukocytes (99Tcm-WBC) in the right lower quadrant of a large population of children and characterized some predictive patterns that would enable differentiation of active inflammation from this late occasional accumulation of 99Tcm-WBC. We reviewed the charts of 211 children. The first group evaluated consisted of 79 controls: 30 normal children with no gastrointestinal disease, but who underwent 99Tcm-WBC scanning for other medical problems, and 49 children who had non-specific gastrointestinal (GI) complaints, but had no demonstrable inflammatory bowel disease by conventional diagnostic methods. The second group consisted of 132 children with inflammatory bowel disease: 80 children with Crohn's disease (CD), 34 with ulcerative colitis (UC) and 18 with indeterminate colitis (IC). Children were imaged at 30 min and 3 h. Fifteen (19%) of the 79 controls scanned showed accumulation of 99Tcm-WBC in the right lower quadrant at 3 h and none at 30 min. Of those 15, 8 were from the control population and 7 from the group with non-specific GI complaints and negative work-ups. There was no uptake in other segments of the bowel. The accumulation was faint, of lesser intensity than in the iliac wing, and diffuse, such that identification of a specific loop of involved bowel was not possible. Migration of the 99Tcm-WBC distal to the terminal ileum was demonstrated. The other 64 children in the control group showed no accumulation of 99Tcm-WBC at any time during their scans. All 79 scans were blindly interpreted as normal studies. There were no false-positive readings encountered in the 132 children with inflammatory bowel disease (80 CD, 34 UC, 18 IC) when the aforementioned characteristics of the late accumulation of 99Tcm were used to differentiate inflammation from this physiological excretion. In conclusion, the late accumulation of 99Tcm-WBC in the right lower quadrant is characterized by (1) accumulation at no less that 3 h, (2) no accumulation in other segments of the bowel, (3) faint accumulation of lesser intensity than in the iliac wing, (4) a diffuse accumulation pattern and (5) migration of the 99Tcm-WBC into the caecum and ascending colon over time. Recognition of this excretion pattern enables differentiation of active Crohn's disease of the small bowel from migration and accumulation of 99Tcm-WBC in the right lower quadrant of the abdomen.

Topics: Abdomen; Adolescent; Case-Control Studies; Child; Colitis, Ulcerative; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

The 99mTc-exametazine labelled leukocytes (99mTc-WBC) scintigraphy is an established method for the inflammatory bowel disease (IBD) diagnosis, but the labelled procedure is a large and laborious process. The 111In-labelled human polyclonal immunoglobulin G (111In-IgG) can be an alternative in the non invasive IBD diagnosis.. Thirty-four patients routinely referred for investigation of IBD were studied. The 99mTc-WBC and 111In-IgG were simultaneously injected and images were obtained at 30 min, 3 and 24 h post-injection. The diagnostic was established by histology of endoscopy and/or surgery samples. Images were blindly evaluated by two experienced observers who only knew of the clinical suspicion of IBD. IBD was confirmed in 27 patients (17 with Crohn's disease [CD] and 10 with ulcerative colitis [UC]).. Sensitivity, specificity and accuracy were 88.5, 100 and 90.3% respectively for endoscopy, 73.7, 75 and 73.9% for radiology, 59.3, 85.7 and 64.7% for 111In-IgG scan and 96.3, 85.7 and 94.1% for 99mTc-WBC scan. In the diagnosis of CD involvement of small bowel, the 99mTc-WBC scan identified 9/11 patients with confirmed disease, whereas the 111In-IgG scan diagnosed only four of them. In the evaluation of colonic disease, the 99mTc-WBC scan correctly diagnosed 21/22 confirmed patients, being the 111In-IgG scan positive in 13 of them. As far as disease extension concerned, the 99mTc-WBC demonstrated a statistically significance rather number of disease segments than endoscopy, radiology and 111In-IgG scan.. The 99mTc-WBC was an effective method in the diagnosis of suspected IBD patients, both in the evaluation of small bowel disease and colonic disease, with slightly best results for colonic disease, whereas the 111In-IgG scan seems to have no utility neither in diagnosis nor in extension evaluation of IBD.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Crohn Disease; Endoscopy; Evaluation Studies as Topic; Female; Humans; Immunoglobulin G; Indium Radioisotopes; Infant, Newborn; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Studies have suggested that scans with technetium-tagged white blood cells (WBC-Tc99m) may be equal to endoscopy in the assessment of extent and activity of inflammatory bowel disease (IBD).. We have retrospectively examined the accuracy of WBC-Tc99m scans in differentiating continuous from discontinuous colitis in pediatric IBD.. There were 207 children in the study (96 boys, 111 girls, median age 13 years). This included 29 controls - children with no gastrointestinal disease (NL) who underwent WBC-Tc99m scans for other medical problems. Scans were obtained at 30 minutes and 2-4 hours following injection. Scans were interpreted as showing continuous colitis, discontinuous colitis, or no colitis.. In the 77 children with active Crohn's disease (CD) of the colon, the scans revealed discontinuous uptake in 63 children and continuous uptake in 14. In the 29 children with ulcerative colitis (UC), 23 scans showed continuous uptake and 6 revealed discontinuous uptake. Two of these 6 showed focal activity near the appendix, and subclinical appendicitis could not be excluded. Another child was bleeding and the scan could have been misinterpreted as showing small- bowel inflammation. In the last three patients, skip areas were clearly identifiable. In none of these last three patients were the biopsies typical of CD (i. e., no granuloma was identified) nor was inflammation patchy. In summary, of the 106 scans showing inflammation, 6 were classified into the wrong group.. These data show that WBC-Tc99m scanning can be useful in distinguishing discontinuous from continuous colitis.

Topics: Adolescent; Child; Colitis, Ulcerative; Colon; Colonoscopy; Crohn Disease; Diagnosis, Differential; Female; Humans; Leukocytes; Male; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

The aim of the work was to value the utility of semiquantitative scintigraphics indexes (GI) as predictive factor of activity grade of intestinal inflammatory process in patients with confirmed diagnosis of inflammatory bowel disease (IBD). 64 patients have been studied (39 males and 25 females), mean age was 40,2 years (range: 18-88 years) with diagnosis of IBD in acute exacerbation confirmed by endoscopy and biopsy. In all patients was obtained abdominal scintigraphy with 99mTc-exametazine labelled leukocytes. The severity of intestinal inflammatory process was quantified using clinical indexes -Truelove-Witts index (TI) for ulcerative colitis (UC) and Crohn's disease activity index (CDAI), Harvey index (HI) for Crohn disease (CD)-, endoscopic index (EI) and haematological parameters: erythrocyte sedimentation rate (ESR), hematocrit, haemoglobin, leukocyte and platelet count, fibrinogen and albumin level. In all the scans regions of interest were drawn over liver, spleen, bone, abdominal background and positive intestinal segments. Subsequently three GI were calculated: GI1, GI2 and GI3 for the scans obtained at 30 min (P) and 3 h p.i. (T). The evaluation of UC severity showed significant correlation between: 1) The GI1 P and T and TI, EI, ESR, leukocyte and platelet count; 2) The GI2 P and TI and EI; 3) The IG2 T and EI, hematocrit and platelet count; 4) The GI3 P and TI, EI, ESR and platelet count; 5) The GI3 T and TI, EI, leukocytes and platelet count. In the evaluation of CD was observed significant correlation between the GI1 P and GI3 P with the CDAI and EI, between the GI1 T and the GI3 T with the CDAI and ESR; the GI2 did not show significant correlation with any of the valorised parameters. In conclusion, the scintigraphic activity indexes based in the semiquantitative evaluation of scans obtained with 99mTc-exametazine labelled leukocytes showed usefulness in the evaluation of the IBD severity, especially in the UC. Among the studied indexes, IG1 seems the more accurate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Colitis, Ulcerative; Colonoscopy; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Models, Theoretical; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Technetium Tc 99m Exametazime

Technetium Tc 99m hexamethyl propylene amine oxine (99mTc-HMPAO) has been used to radiolabel leukocytes with promising results for its clinical use in inflammatory bowel disease. During active ulcerative colitis, colonoscopy is indicated to determine the extent and the intensity of the disease for proper management. The aim of this prospective study was to determine whether 99mTc-HMPAO-labeled leukocyte scintigraphy can give information similar to that obtained with colonoscopy during acute attacks of ulcerative colitis.. Thirty-three consecutive patients with 50 acute episodes of ulcerative colitis underwent 99mTc-HMPAO scintigraphy and colonoscopy with biopsies. Scintigraphic determination of disease extent and intensity were compared with those obtained by colonoscopy with biopsies and clinicobiologic markers.. The scintigraphic index of disease intensity was correlated with endoscopic index, Truelove index, biologic markers, and local release of interleukin-8. The extent measured by scintigraphy was well correlated to the endoscopic and histologic extent.. 99mTc-HMPAO scintigraphy accurately determines the extent and the intensity of acute ulcerative colitis lesions. This noninvasive method can specify the extent and the intensity of an acute attack in patients with previously known ulcerative colitis.

Topics: Adult; Biomarkers; Colitis, Ulcerative; Colonoscopy; Female; Humans; Interleukin-8; Leukocytes; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime

The aim of this study was to establish the usefulness of Tc-99m human polyclonal immunoglobulin (HIG) imaging in a group of patients who were suspected of having inflammatory bowel disease (IBD). The authors performed 30 scans (15 with Tc-99m HMPAO leukocytes and 15 with Tc-99m HIG) on 15 patients with IBD. Ten patients had Crohn's disease and five had ulcerative colitis. The sensitivity of Tc-99m HIG scintigraphy for detecting IBD was 33%, while the sensitivity of Tc-99m HMPAO leukocyte imaging was 100%. The Tc-99m HMPAO leukocyte imaging also detected a larger number of affected segments and provided better image quality of the extent of disease than Tc-99m HIG. On the basis of these results, the authors believe that Tc-99m HIG imaging is not a useful technique in the evaluation of patients with IBD, in the identification of location, or the extension or degree of disease activity.

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Immunoglobulins; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Tc 99m Exametazime; Time Factors

The aims of this study were to investigate whether labelling with technetium-99m exametazime alters the expression of adhesion molecule CD11b on granulocytes and monocytes, and to study whether the expression of CD11b on unlabelled or labelled cells correlates with uptake of the labelled cells in the inflamed bowel, in the lungs or in the reticuloendothelial system. Leucocytes were obtained from 25 patients with inflammatory bowel disease who underwent leucocyte scan. The cellular expression of CD11b was analysed using flow cytometry. Labelling with 99mTc-exametazime induced an increased surface expression of CD11b on granulocytes (P<0.01), but not on monocytes. The increase in CD11b expression on granulocytes was lower than the spontaneous mobilization that occurred at 37 degrees C and correlated neither with this, nor with N-formyl-methionyl-phenylalanine induced expression of the same receptor. Basal expression of CD11b on unlabelled granulocytes, but not on monocytes, correlated with bowel and lung uptake 45 min after reinjection of labelled cells, but not with uptake on later images. No correlation was found between the CD11b expression on labelled granulocytes or monocytes and scintigraphic uptake. Our findings show that labelling with 99mTc-exametazime increases the expression of adhesion protein CD11b on granulocytes. The increase in surface expression of CD11b does not correlate with the scintigraphic uptake of labelled cells in the bowel, in the lungs or in the reticuloendothelial system.

Topics: Adult; Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Isotope Labeling; Leukocytes, Mononuclear; Macrophage-1 Antigen; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Up-Regulation

The accuracy of computed tomography (CT) and [99mTc]HMPAO granulocyte scintigraphy (GS) for detection of bowel localization, inflammatory activity, and complications in acute inflammatory bowel disease (IBD) was prospectively studied in 32 patients. Of each bowel segment, findings on CT and GS were scored by one blinded observer. Findings on operation or endoscopy served as the gold standard. In Crohn's disease (CD, 17 patients), CT detected bowel pathology (sensitivity 71%, specificity 98%), abscesses (sensitivity and specificity 100%), and fistulas (sensitivity 80%, specificity 100%). In CD, GS had a sensitive of 79% and a specificity of 98% for detection of inflammatory activity. The detection of complications with GS was poor. Segmental inflammatory activity correlated with endoscopy-operative findings for CT (r = 0/86, P < 0.0001) and GS (r = 0.86, P < 0.0001). In ulcerative colitis (UC, 15 patients), GS predicted proximal extension of bowel involvement better than CT. In CD, CT is Superior to GS for localization of both active and fibrostenotic bowel disease, and in detection of the abscesses and fistulas. In UC, GS showed proximal extension more accurately than CT.

Topics: Acute Disease; Adult; Biopsy; Colitis, Ulcerative; Crohn Disease; Endoscopy, Gastrointestinal; Female; Granulocytes; Humans; Intestines; Male; Organotechnetium Compounds; Oximes; Prospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

This study was a retrospective evaluation of the use of technetium-99m hexamethylpropyleneamineoxime (HMPAO) labelled leucocytes in the investigation of suspected inflammatory bowel disease in children. The images were analysed in 35 children and the findings were compared with the results of endoscopy/biopsy, barium studies and antinuclear cytoplasm antibody (ANCA) serology. The sensitivity of the white cell scan was 83% and the specificity 81%. This compares well with other studies in adults and is superior to barium investigations. The technique is recommended as a first line investigation to detect inflammatory bowel disease with a resultant reduction in the use of endoscopy and barium imaging.

Topics: Adolescent; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Barium Sulfate; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The prognosis of attacks of ulcerative colitis is clearly linked to the extent and activity of the disease. The aim of this study was to investigate the value of high resolution ultrasonography in assessing both the extent and activity of severe ulcerative colitis and its response to medical treatment.. Fifty-seven consecutive patients affected by a severe (32 patients) or moderately severe (25 patients) attack of ulcerative colitis underwent ultrasonographic examination. The ultrasonographic extent of the disease was evaluated in 32 patients by comparing ultrasonography and scintigraphy.. Compared with scintigraphy, sensitivity, specificity, and overall accuracy of ultrasonographic extent were 89%, 100%, and 91%, respectively. These results were also confirmed in a subgroup of patients submitted to surgery, comparing ultrasonographic and scintigraphic data versus specimens. Using the ultrasonographic score of activity, it was possible to discriminate severe and moderately severe attacks with a specificity, sensitivity, and diagnostic accuracy of 96%, 90.3%, and 92.9% respectively. A close correlation was also found between ultrasonographic and scintigraphic activity (r = 0.78; p < 0.001). After 10 days of intensive treatment, the ultrasonographic activity significantly decreased in severe and moderate groups (p < 0.001) and in both subgroups of nonoperated patients (p < 0.001) but not in operated patients (p = NS).. High resolution ultrasonography can be useful in assessing both extent and activity of severe ulcerative colitis, in monitoring the patient's condition, and in objectively evaluating the response to medical therapy.

Topics: Adult; Colitis, Ulcerative; Colon; Female; Granulocytes; Humans; Male; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Prognosis; Radionuclide Imaging; Rectum; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime; Ultrasonography

The value of 99mTc-hexamethylpropyleneamine oxime (HMPAO) leukocyte images has been confirmed in patients with Inflammatory Bowel Disease. We performed 121 scintigraphic examination. The results were evaluated by radiologic and/or endoscopic examinations. The patients were divided into three subgroups: A) patients with active disease and less than 15 days of corticotherapy (n = 42). B) patients with active disease and more than 15 days of corticotherapy (n = 31). C) asymptomatic patients (n = 48). Over all sensitivity and specificity were 86% and 92.2% respectively. The sensitivity in subgroup A was 97.5% and 70% in the subgroup B. In the subgroup A the isotopic study showed the entire area of active inflammation in 95% (38/40) and colonoscopy in 32.5% (13/40). The leucocyte scanning showed clear pathologic activity in the ileum with a sensitivity of 86%. We conclude that 99mTc-leukocyte scintigraphy is the best method to assess the location of active inflammation in patients with less than 15 days of treatment. Scintigraphy was best in the assessment of active disease especially in Crohn's disease of the small bowel.

Topics: Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Fifty patients with suspected intra-abdominal abscess were investigated prospectively with ultrasound and with 99mTc-hexamethylpropylene-amine oxime (HMPAO) isotope labelled mixed leucocytes, using 111-In tropolonate granulocyte scanning as the reference standard. Twenty five patients had inflammatory bowel disease (three were postoperative): 21 of these had Crohn's disease and four had ulcerative colitis. The remainder comprised nine with postoperative fever and 16 with fever and abdominal pain. An abscess was diagnosed when focal activity on serial 111-In tropolonate and 99m-Tc-HMPOA images at one, three, and 24 hours resulted in activity at least equal to liver activity at 24 hours. Thirteen abscesses were diagnosed using each type of white cell scanning, resulting in 100% sensitivity for 99m-Tc-HMPAO compared with 111-In tropolonate. Bowel inflammation was easily distinguished from abscess on serial images. Eight of these 13 abscesses were detected by ultrasound. Altogether 17 abscesses were found. Ultrasound detected 12, including four liver abscesses which were not purulent and had not been detected by white cell scanning. Ultrasound had a sensitivity of 71% (12 of 17) and a specificity of 87% (33 of 38) using all confirmed abscesses as the reference standard. White cell scanning showed a sensitivity of 76% (13 of 17: as a result of the four non-purulent liver abscesses) and a specificity of 100%. 99m-Tc-HMPAO scanning is as accurate as 111-In tropolonate scanning, and has several advantages including simplicity, availability, superior image quality, and reduced radiation dose. Both methods are more sensitive and specific than ultrasound for intra-abdominal abscess detection but ultrasound is advisable if a neutrophil infiltrate is not suspected.

Topics: Abdominal Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tropolone; Ultrasonography

Leucocyte scintigraphy offers an alternative to more invasive techniques in the investigation of inflammatory bowel disease. The accuracy of 99Tcm-HMPAO leucocyte scintigraphy has not been assessed by comparison with colonic histology, which was the aim of this study. 15 patients with ulcerative colitis underwent 99Tcm-HMPAO leucocyte scintigraphy (TLS) less than 5 days before colonoscopy. Histological features of mucosal biopsies were compared with total and segmental colonic TLS scores. Segmental and total scintigraphy scores correlated most strongly with histological grades for acute inflammation (r = 0.75, p < 0.001 and r = 0.9, p < 0.001, respectively) and chronic inflammatory cell infiltration in the lamina propria (r = 0.76, p < 0.001 and r = 0.86, p < 0.001, respectively). 99Tcm-HMPAO leucocyte scintigraphy detected acute inflammation in the colon of patients with ulcerative colitis with a sensitivity of 91% and negative predictive value of 80% and localized acute inflammation to a particular colonic segment with a sensitivity of 82%, specificity of 94%, accuracy of 88%, positive predictive value of 94% and negative predictive value of 91%. 99Tcm-HMPAO leucocyte scintigraphy positivity predicts and localizes colonic acute inflammation with a high degree of confidence, but negative scintigraphy does not exclude acute inflammation.

Topics: Adult; Aged; Colitis, Ulcerative; Colonoscopy; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The aim was to analyse the abdominal scintigraphy pattern in patients with seronegative spondylarthropathy (SSp), ulcerative colitis (UC) and Crohn's disease (CD). A total of 117 patients with defined histological lesions of inflammatory bowel disease (IBD) (68 UC and 49 CD), 32 patients with active SSp [European Spondylarthropathy Study Group (ESSG) 1991 criteria] without clinical evidence of IBD and 21 controls without IBD or SSp were studied. All patients with SSp and controls received similar doses of non-steroidal anti-inflammatory drugs. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of 99m-technetium hexamethyl propylene amine oxime (99mTc-HMPAO)-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%), 45 patients with UC (66.1%) and 33 patients with CD (67.3%). Rectum and sigma involvement was more frequent in patients with UC (68.8%) than in patients with SSp (23.5%) or CD (33.3%) (P < 0.05) [odds ratios (OR): 7.1 and 4.4, respectively]. Terminal ileum involvement was more frequent in patients with CD (63.6%) than in patients with SSp (23.5%) or UC (8.8%) (P < 0.05) (OR: 5.6 and 17.9, respectively). The 99mTc-HMPAO-labelled leucocyte scan shows an increased uptake in patients with SSp without evidence of IBD. Perhaps these patients represent one end of the spectrum of IBD, but rectal and terminal ileum involvement were less frequent in patients with SSp than in patients with UC or CD.

Topics: Abdomen; Adult; Arthritis, Psoriatic; Arthritis, Reactive; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Spinal Diseases; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

In order to compare visual interpretation of inflammation detected by leukocyte scintigraphy with that of different computer-aided quantification methods, 34 patients (25 with ulcerative colitis and 9 with endoscopically verified non-inflamed colonic mucosa), were investigated using 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) leukocyte scintigraphy and colonoscopy with biopsies. Scintigrams were obtained 45 min and 4 h after the injection of labelled cells. Computer-generated grading of seven colon segments using four different methods was performed on each scintigram for each patient. The same segments were graded independently using a 4-point visual scale. Endoscopic and histological inflammation were scored on 4-point scales. At 45 min, a positive correlation was found between endoscopic and scan gradings in individual colon segments when using visual grading and three of the four computer-aided methods (Spearman's rs = 0.30-0.64, P < 0.001). Histological grading correlated with visual grading and with two of the four computer-aided methods at 45 min (rs = 0.42-0.54, P < 0.001). At 4 h, all grading methods correlated positively with both endoscopic and histological assessment. The correlation coefficients were, in all but one instance, highest for the visual grading. As an inter-observer comparison to assess agreement between the visual gradings of two nuclear physicians, 14 additional patients (9 ulcerative colitis, 5 infectious enterocolitis) underwent leukocyte scintigraphy. Agreement assessed using kappa statistics was 0.54 at 45 min (P < 0.001). Separate data concerning the presence/absence of active inflammation showed a high kappa value (0.74, P < 0.001). Our results showed that a simple scintigraphic scoring system based on assessment using the human eye reflects colonic inflammation at least as well as computer-aided grading, and that highly correlated results can be achieved between different investigators.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Colon; Colonoscopy; Enterocolitis; Female; Humans; Image Interpretation, Computer-Assisted; Intestinal Mucosa; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

To compare air enema radiology with a leukocyte scintigraphy technique using technetium-99m-hexamethyl propylene amine oxime-labelled leukocytes for imaging colonic inflammation in ulcerative colitis.. Prospective study in a University hospital. One radiologist and one nuclear physician independently graded the degree of inflammation in six colon segments per patient using radiographs and leukocyte scans.. Twenty consecutive patients with symptoms of active ulcerative colitis requiring corticosteroids, inflammation on rigid sigmoidoscopy and a positive leukocyte scan above the rectum.. Using air enema radiology, inflammation above the rectum was observed in 17 of the 20 patients. Eleven patients had the same extent of disease with both imaging techniques (total n = 5; extensive n = 3; distal n = 3). Seven patients had more widespread colitis using leukocyte scintigraphy. In the remaining two patients with extensive inflammation at scintigraphy, air enema films showed total colitis. When the colon was subdivided into six different segments, prediction of the presence of inflammation in individual segments was 0.88 for air enema radiology compared with leukocyte scintigraphy and 0.60 for the prediction of absence of inflammation. All segments with an irregular mucosal contour or ulceration on air enema films had intense inflammation at scintigraphy.. In patients with active ulcerative colitis, air enema radiology underestimates the extent of inflammation because this investigation shows secondary patho-anatomical changes, while leukocyte scintigraphy visualizes the acute cellular infiltrate. In patients with more severe inflammation, there is excellent agreement between the two methods.

Topics: Adolescent; Adult; Colitis, Ulcerative; Colon; Enema; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Pneumoradiography; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Technetium-99m HMPAO labelled white cell bowel uptake was quantified in 23 patients with suspected colitis by means of the novel technique of single photon emission computerised tomography (SPECT) using a standard gamma-camera. Uptake in colon segments was quantified on transaxial images and expressed as a fraction of marrow uptake (SPECT score). Segmental histological disease activity was assessed at colonoscopy (20) or at surgery (3). Segmental histology score correlated with SPECT score r = 0.79 (p < 0.001). Overall SPECT score for all affected segments correlated with Crohn's disease activity index (CDAI) r = 0.66, p = 0.001 and with laboratory activity indices; erythrocyte sedimentation rate r = 0.44, p = 0.03, C reactive protein r = 0.38, p = 0.05, and albumin r = -0.46, p = 0.03. Small bowel SPECT score in 13 patients correlated with CDAI r = 0.65, p < 0.01 but not with erythrocyte sedimentation rate or C reactive protein. Five patients with positive small bowel white cell uptake had normal C reactive protein and erythrocyte sedimentation rate. Overall SPECT score for disease at all sites correlated with both CDAI and with laboratory indices of inflammation. 99mTc HMPAO SPECT provides non-invasive and accurate quantification of inflammatory bowel disease activity in both large and small bowel and may be useful in the objective evaluation of treatment for inflammatory bowel disease.

Topics: Adult; Aged; Blood Sedimentation; C-Reactive Protein; Colitis, Ulcerative; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Organotechnetium Compounds; Oximes; Serum Albumin; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Technetium Tc 99m-labeled hexamethylpropyleneamine-oxime (Tc-HMPAO) scintigraphy has been evaluated in adults with inflammatory bowel diseases and has shown promising ability to define intensity and extent of disease. To evaluate the method's utility in children, we studied 27 pediatric patients-23 with inflammatory bowel diseases and 4 control subjects without abdominal inflammation. Autologous leukocytes labeled with Tc-HMPAO were reinjected into each patient and serial scans were obtained up to 4 hours later. None of the control subjects had any uptake of Tc-HMPAO by the bowel. Disease localization as defined by the scan correlated well with that visualized in surgical specimens from five patients, at endoscopy in three patients, with barium studies of two patients, and with computed tomography scanning of the abdomen in one patient. A "scan score" was calculated by comparing uptake of tracer in five bowel segments with iliac crest bone marrow activity. Scan score correlated much better with clinical disease activity (correlation coefficient = 0.62) than did the erythrocyte sedimentation rate (correlation coefficient = 0.24). Scintigraphy with Tc-HMPAO appears to be useful in evaluation of disease localization and intensity in children with inflammatory bowel disease.

Topics: Adolescent; Child; Child, Preschool; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Evaluation Studies as Topic; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime

Topics: Colitis, Ulcerative; Colon; Humans; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Technetium-99m-HMPAO-labeled leukocyte imaging is now an accepted technique in the assessment of adult patients with inflammatory bowel disease (IBD), but its role in pediatric patients has not been studied.. We evaluated the efficacy of 99mTc-HMPAO-labeled leukocyte imaging in 21 children. We studied 16 children with active IBD (4 ulcerative colitis, 10 Crohn's disease, 1 indeterminate colitis, 1 C-difficile) and 5 controls.. The sensitivity and specificity for active bowel inflammation were excellent. The intensity of uptake noted in most patients rendered image interpretation easy and straightforward. The inclusion of a tail on detector (TOD) view and anterior standing view of the abdomen is important. All patients with ulcerative colitis showed rectosigmoid disease and no small bowel activity, whereas, all patients with Crohn's disease showed discontinuous uptake and often small bowel activity. It was therefore possible to differentiate ulcerative colitis from Crohn's disease on the basis of location and distribution.. The 99mTc-HMPAO-labeled leukocyte scan is an excellent technique for the detection, localization and characterization of IBD in children.

Topics: Child; Colitis, Ulcerative; Colon; Crohn Disease; Evaluation Studies as Topic; Humans; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Rectum; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tissue Distribution

This paper has retrospectively analysed the ability of 99Tcm HMPAO leucocyte scintigraphy to distinguish Crohn's disease from ulcerative colitis. The diagnostic criteria were established by reviewing 99Tcm HMPAO leucocyte scintigrams in 123 patients with histologically proven Crohn's disease (83) or ulcerative colitis (40). Uptake in the right iliac fossa with or without other segments of colon, irregular bowel uptake, small bowel uptake or colonic activity with rectal sparing were all strongly suggestive of Crohn's disease. Left sided colitis was found to indicate ulcerative colitis. Total colitis occurred in both ulcerative colitis and Crohn's disease. The criteria were later tested in an additional 62 patients with excellent results (accuracy 98%). In 63 patients in whom the results of barium radiology were also available, the accuracy of scintigraphy was higher (93% and 83%, respectively). We conclude that 99Tcm HMPAO leucocyte scintigraphy can accurately distinguish between Crohn's disease and ulcerative colitis in a large proportion of cases and appears to be more reliable than conventional radiology.

Topics: Barium Sulfate; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Evaluation Studies as Topic; Humans; Leukocytes; Organotechnetium Compounds; Oximes; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy (LS) was performed on 45 occasions in 30 patients with ulcerative colitis and on 53 occasions in 34 patients with Crohn's disease. Serial images were taken following re-injection of the labelled leucocytes. The segmental extent of the inflammation and the grade of the leucocyte uptake were calculated, and compared with the laboratory results and colonoscopy findings. The sensitivity and specificity of LS proved higher in ulcerative colitis (87% and 93%) than in Crohn's disease (53% and 89% in cases with large intestine involvement, and 82% and 100% in cases with small intestine involvement). The activity of the process determined by LS correlates with the alpha 2-globulin level (r = 0.47), fibrinogen level (r = 0.50), fS iron level (r = -0.57), sedimentation (r = 0.44), leucocyte count (r = 0.38), platelet count (r = 0.34) and Best index (r = 0.31) in ulcerative colitis, but not in Crohn's disease.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

In a prospective comparative study of 14 patients with inflammatory bowel disease (IBD), the abilities of 99mTc-HMPAO labeled white blood cells (WBCs) and 111In-granulocytes to assess the presence and location of active disease were compared. The two examinations were carried out within 2 wk of each other. Scintigraphically concordant positive or discordant segments were evaluated by radiologic or endoscopic examination performed within 14 days. When bowel segments were compared, concordance was found for 102/111 (91.8%) segments between 99mTc-WBC images obtained at 1 hr after injection and 3-hr 111In-granulocyte images. For five of five 99mTc-WBCs positive/111In-granulocyte negative segments, it could be proven that the 99mTc-WBC result was caused by active disease. For patients, 99mTc-WBC scintigraphy detected four more patients with active disease than 111In-granulocytes (11 and 7 patients, respectively). Technetium-WBCs was superior in the assessment of active disease, especially for small bowel segments. We conclude that early imaging 1 hr after the injection of 99mTc-WBCs can reliably replace 111In-granulocyte scintigraphy in IBD patients because the radiopharmaceutical is available on a daily basis. Thus, there is less radiation burden to the patient and cell separation is simpler and less time-consuming.

Topics: Adult; Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Indium Radioisotopes; Leukocytes; Male; Organometallic Compounds; Organotechnetium Compounds; Oximes; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tropolone

Twenty-five patients with ulcerative colitis and nine controls with macroscopically non-inflamed colon were investigated with technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy and colonoscopy with biopsies. The interval between leukocyte scintigraphy and colonoscopy was < or = 14 days in all patients with ulcerative colitis and < or = 30 days in eight of nine controls. Scintigrams were obtained at approximately 45 min and 4 h after injection of labeled leukocytes. One nuclear physician, one internist, and one pathologist graded blindly and independently of each other the degree of active inflammation in seven different colonic segments for each patient, using 4-grade scales for scans and macroscopically and histologically viewed inflammation, respectively. A positive correlation between endoscopic and histologic grading of all colonic segments and scan gradings for all subjects and for ulcerative colitis patients separately was found (all, p < 0.001). By means of kappa statistics, the inter-observer agreement between scintigraphic grading at 45 min and endoscopy was, for all subjects, 0.32 (95% confidence interval (CI), 0.20-0.44; p < 0.001) and, for patients with ulcerative colitis, 0.19 (CI, 0.07-0.31; p < 0.001). When 17 patients who had complete colonoscopies were divided into those with total, extensive, or distal colitis, leukocyte scintigraphy underestimated the extension of active inflammation. A simple scintigraphic scoring system reflects the colonic inflammation viewed endoscopically and histologically in patients with ulcerative colitis but underestimates the presence of active inflammation in individual colonic segments.

Topics: Adolescent; Adult; Aged; Colitis, Ulcerative; Colonoscopy; Female; Humans; Intestinal Mucosa; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The inflammatory activity in 108 bowel segments of 40 patients with suspected or known inflammatory bowel disease was assessed macroscopically by endoscopy, histology and technetium-99m hexamethyl propylene amine oxine (99mTc-HMPAO) leucocytes using a numerical grading system (scores 0-3). A 4-h series of scintigrams showed a significant correlation with both histological and macroscopical assessment of disease activity (rho = 0.850, P less than 0.001 and rho = 0.773, P less than 0.001, respectively). Sensitivity, specificity and accuracy of scintigraphy in detecting active inflammatory segments were 85%, 92% and 89%, respectively. A normal scintigram did not completely exclude mild inflammatory activity, especially in the rectosigmoid area. 99mTc-HMPAO leucocytes offer an accurate and non-invasive alternative for the assessment of disease activity in ulcerative colitis and Crohn's disease.

Topics: Adult; Aged; Colitis, Ulcerative; Crohn Disease; Female; Finland; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime

The validity of using autologous leucocytes labelled with technetium -99m hexamethyl-propyleneamine-oxine (Tc-HMPAO) for scintigraphy in inflammatory bowel disease was evaluated in 12 patients with clinically active ulcerative colitis (UC) and 10 with Crohn's disease (CD). Colonoscopy and biopsy were used as reference. Scintigrams taken 1 h and 3 h after leucocyte reinjection were evaluated blindly by two independent observer groups. Full agreement was found in 11 of 12 UC patients when compared with colonoscopy but in only 3 of 10 CD patients. Segments with agreement in CD patients often showed neutrophilic granulocyte infiltration at biopsy. The judgements of clinicians and physiologists differed for only 2 of totally 70 UC segments but for 13 of 59 CD segments (kappa, 0.94 and 0.52). It is concluded that Tc-HMPAO scintigraphy might be an alternative to colonoscopy in the control of disease extent in UC. In CD patients the technique might warn about infections complications.

Topics: Adult; Aged; Biopsy; Colitis, Ulcerative; Colonoscopy; Crohn Disease; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Abscess; Colitis, Ulcerative; Crohn Disease; Granulocytes; Humans; Organometallic Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

The in vitro and in vivo behaviour of 99Tcm-HMPAO (hexamethylpropyleneamineoxime) (n = 12) and 111In-oxine (n = 11) labelled granulocytes, isolated by density-gradient centrifugation (Metrizamide/plasma gradients), was compared in patients with suspected inflammatory diseases. The in vitro elution of both labels and the viability of the labelled cells (99Tcm, 98.5%; 111In, 96.5%) was comparable but the labelling efficiency was different (99Tcm, 44 +/- 13%; 111In, 72.5 +/- 5.5%). In vivo, the lung (t1/2 max: 7.7 min), liver and spleen perfusion patterns were nearly identical; the image quality for detail in 99Tcm scans was superior to 111In images. The blood disappearance curves of 99Tcm and 111In were comparable. In the small number of patients examined all infections could be diagnosed correctly, without false-positive or false-negative results. Disadvantageous is the renal excretion of 99Tcm complexes (3+% over 20 h) with kidney and bladder activity from the beginning of the study. The biliary excretion in half of the patients (n = 6) with unspecific positive small and large bowel visualization and the late intestinal excretion also render the diagnosis more difficult. The recommended best imaging times for abdominal and retroperitoneal inflammations are 30 min to 2 h after injection. Late scans in septic prosthetic joints have disproportionate long acquisition times. As a potential cell labelling compound, 99Tcm-HMPAO has a promising future in comparison to 111In scans because of the good availability of 99Tcm, the image quality and the lower radiation exposure to the patient when lower activities for the early diagnosis of abdominal inflammatory diseases are reinjected.

Topics: Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Hydroxyquinolines; Indium Radioisotopes; Inflammation; Isotope Labeling; Joint Diseases; Lung Diseases; Male; Organometallic Compounds; Oximes; Oxyquinoline; Polycystic Kidney Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

The lipophilic complex, 99Tcm-hexamethylpropyleneamine oxime (HMPAO) is an efficient leucocyte label, and labels granulocytes with more stability than mononuclear leucocytes. The recovery of 99Tcm-HMPAO granulocytes, expressed as the percentage of injected granulocyte-associated activity circulating as granulocyte-associated activity 40-45 min after injection, was 37% (S.E. 3%), similar to the recovery of 111In-labelled granulocytes isolated and labelled in plasma using tropolone. The T1/2 of 99Tcm-HMPAO labelled granulocytes in blood was 4.4 h (S.E. 0.4 h), less than that of 111In-labelled granulocytes, although when a correction was made for 99Tcm elution, it was 6.4 h. The initial biodistribution of 99Tcm-labelled leucocytes was similar to 111In-labelled granulocytes, with a rapid initial lung transit, prominent splenic activity, bone marrow activity and minimal hepatic activity, although, unlike 111In, 99Tcm activity was also seen in urine, occasionally in the gallbladder, and, from about 4 h, consistently in the colon. Bone marrow activity was particularly prominent with 99Tcm. About 6% of 99Tcm was excreted in the faeces up to 48 h after injection, and about 17% in urine up to 24 h. The time-activity curves of reticuloendothelial activity up to 24 h were broadly similar for the two labelled cell preparations, and the differences that were observed can be explained on the basis of a higher rate of 99Tcm elution. Clinical information given by the two agents was similar in 27 of 30 patients who received both. Of the three who gave different information, one received 111In-labelled granulocytes which were considered to be functionally suboptimal and two, with inflammatory bowel disease, showed different distributions of abnormal bowel activity. We conclude that with respect to granulocyte kinetics and clinical data, 99Tcm-HMPAO labelled leucocytes are comparable with 111In-tropolonate labelled granulocytes.

Topics: Colitis, Ulcerative; Crohn Disease; Cycloheptanes; Female; Granulocytes; Humans; Indium Radioisotopes; Inflammation; Leukocytes; Male; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime; Tissue Distribution; Tropolone