technetium-tc-99m-exametazime and Enteritis

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

To investigate the use of (99m)Tc-HMPAO (hexamethyl propylene amine oxime) leucocyte scintigraphy as a non-invasive screening test for inflammatory bowel disease.. 10 children with suspected Crohn's disease, in whom routine investigation using barium contrast radiology, upper gastrointestinal endoscopy, colonoscopy, and mucosal biopsies had identified severe gastroduodenal and/or jejunal involvement.. (99m)Tc-HMPAO leucocyte scintigraphic studies performed in each of these cases were assessed by a radiologist who was blinded to the disease distribution.. In nine cases there was no scintigraphic evidence of inflammation in the proximal gastrointestinal tract. The 10th child had both gastroduodenal and jejunal involvement, but scintigraphy only revealed faint jejunal positivity.. (99m)Tc-HMPAO leucocyte scintigraphy should not be depended upon as a screening test for Crohn's disease. False negative results are likely in cases with Crohn's disease confined to the proximal gastrointestinal tract.

Topics: Barium Sulfate; Biopsy; Child; Contrast Media; Crohn Disease; Duodenitis; Endoscopy, Gastrointestinal; Enteritis; False Negative Reactions; Gastritis; Humans; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Topics: Adolescent; Adult; Aged; Barium Sulfate; Colonic Neoplasms; Diagnosis, Differential; Enema; Enteritis; False Positive Reactions; Humans; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime; Yersinia Infections