technetium-tc-99m-exametazime and Gastritis

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

We reviewed 312 (99m)Tc leukocyte (99m)Tc-WBC studies to evaluate the sensitivity and specificity of (99m)Tc-WBC for identifying small-bowel and gastric inflammation in children with Crohn's disease. The (99m)Tc-WBC scans were interpreted blindly and compared to the results of colonoscopy with biopsies and surgical specimens. In 46 children, total colonoscopy was done within a few days of a (99m)Tc- WBC scan and in 13 others surgical specimens were available. Of the 37 children in whom the terminal ileum was visualized endoscopically (24) or surgically (13), the WBC-Tc(99m) scan showed a similar degree of inflammation in 33. The sensitivity of (99m)Tc-WBC scanning was 91% and the specificity 96%. The scans allowed evaluation of inflammation in the terminal ileum in 22 children in whom the endoscopist did not cannulate it; the scans were abnormal in 10 of these 22 children. In the children with no ileoscopy the results of the (99m)Tc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment, and long-term clinical follow-up. Finally, the scans of 46 controls did not reveal any false-positive findings in the terminal ileum. Five children with gastritis documented by gastroscopy had normal (99m)Tc-WBC scans and upper gastrointestinal barium studies. This study demonstrates in a large number of normal and abnormal children with different pre-test probabilities of having inflammatory bowel disease that scintigraphy is reliable in identifying small-bowel inflammation.

Topics: Adolescent; Crohn Disease; Female; Gastritis; Humans; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Stomach Diseases; Technetium Tc 99m Exametazime

Topics: Adult; Crohn Disease; Gastritis; Humans; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime