technetium-tc-99m-exametazime and Inflammatory-Bowel-Diseases

This paper presents the different views of the gastroenterologist, the radiologist and the nuclear medicine specialist in the management of inflammatory bowel disease. The role of clinical parameters and biochemical marker as well as the progressive use of the different imaging modalities: magnetic resonance, computerized tomography and nuclear medicine techniques is presented. The paper is an effort to combine the published European Crohn's and Colitis Organization, European Society of Gastrointestinal and Abdominal Radiology and European Association of Nuclear Medicine consensus with the conclusions of the multidisciplinary meeting organized in 2012 Milano during the EANM Congress with the objective of find a common diagnostic flowchart.

Topics: Congresses as Topic; Decision Support Systems, Clinical; Europe; Fluorodeoxyglucose F18; Humans; Inflammatory Bowel Diseases; Leukocytes; Magnetic Resonance Imaging; Nuclear Medicine; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The diagnosis of inflammatory bowel disease (IBD) needs a complex diagnostic work-up. Beside verifying the disease itself, it is fundamental to assess disease extent and activity and to detect associated complications, to find the most effective treatment and for follow up. Scintigraphy with radiolabelled leukocytes is able to provide a complete survey of the whole intestinal tract, both the small and large bowel, and detects septic complications successfully with negligible risk. Radionuclide procedures are useful in establishing or ruling out IBD in patients with intestinal complaints, in assessing disease severity, and in the evaluation of extraintestinal septic complications. Widely available radionuclide procedures are discussed, i.e. scintigraphy by 111Indium oxime or 99mTechnetium HMPAO labelled white blood cells and immunoscintigraphy with 99mTc anti-granulocyte antibodies. Advantages and disadvantages of all three methods are stressed out.. The immunoscintigraphies with 99mTc anti-granulocyte antibodies (ANTI-GRANULOCYTE(R) BW 250/183) of 27 patients with suspicion of IBD were retrospectively analysed. Planar anterior and posterior images were obtained 4 and 24 h postinjection, respectively. The bowel was divided into six segments and the activity was visually graded with reference to bone marrow in each segments. The scans were compared with the results of radiological and endoscopical investigations. The diagnosis of IBD was proved or ruled out by means of enteroclysis, large bowel enema or endoscopy.. In the 27 patients, 74 bowel segments with increased activity were detected. In the case of 30 segments in 16 patients, bowel inflammation was revealed by the other methods (true positives). In the case of 44 bowel segments, no underlying bowel inflammation could be verified, and these activities were regarded as aspecific activity. We could not differentiate between true positive and aspecific activity based on scan pattern or intensity.. These findings of aspecific bowel activity using imuunoscintigraphy are in contrast with the results of former studies, while the existence of non-specific activity decreases the reliability of the method. Based on the literature and our experiences, we conclude that 99mTc HMPAO labelling should be the method of choice for the investigation of IBD patients.

Topics: Adult; Antibodies, Monoclonal; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Radioimmunodetection; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

This work discusses the main clinical features of inflammatory bowel disease (IBD) and the methods to obtain an accurate diagnostic. Nuclear medicine procedures are deeply analyzed, with special emphasis in those where clinical experience is larger and that are available for clinical practice in most countries. In the opinion of the authors 99mTc-HMPAO is the first choice agent, while 111In-oxine could be considered as the gold standard for evaluation of new agents. In the context of IBD, the WBC scintigraphy is useful for its diagnosis (early and accurate) and the evaluation of disease extension (whole bowel examination, without patient preparation and negligible risk). The evaluation of disease severity deserves further experiences.

Topics: Antibodies, Monoclonal; Humans; Immunoglobulins; Indium Radioisotopes; Inflammatory Bowel Diseases; Isotope Labeling; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

The use of gamma emitting radioisotope labelled white cells for imaging inflammation was introduced in 1976. It was possible to study the whole body distribution of granulocytes using this method. Cells were labelled in plasma using tropolone as chelate to avoid cell activation which causes non-physiological persistent lung uptake. Such studies revealed labelled cell uptake in bone marrow, liver and spleen in normal subjects. Intense liver activity was found in cases of cell damage resulting in cell destruction by the liver. The large splenic pool of leucocytes could be mobilized rapidly to sites of inflammation and indeed the fall in splenic activity was a measure of the degree of inflammation. Measurements of the faecal excretion of 111In-labelled granulocytes were also used to assess Crohn's disease activity. Alternatively, the whole body retention of 111In was used. Later studies have involved the use of 99mTc, initially using labelled colloids, which resulted in cell activation and later using the lipophilic complex HMPAO to label leucocytes. The several advantages over 111In for imaging inflamed bowel are described. Early imaging is important to avoid non-specific bowel activity. Newer approaches include labelling immunoglobulins, monoclonal granulocyte antibodies and targeting of activated endothelium adhesion molecules. Such techniques remain experimental and the best current technique for localizing inflammation is to use radiolabelled leucocytes.

Topics: Antibodies, Monoclonal; Cell Movement; Granulocytes; Humans; Immunoglobulins; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Radiolabelled leucocytes migrate rapidly to sites of acute inflammation. The simplest technique for imaging intestinal inflammation involves radiolabelling patients' mixed while cells ex vivo with either 99mTc or 111In which are then reinjected. However, further purification of mixed white cells to granulocytes is needed for optimal results using 111In. Owing to the simpler labelling procedure, availability, image quality and dosimetry, 99mTc-HMPAO has gained favour for the investigation of acute inflammation including inflammatory bowel disease. Because of its longer half life. 111In is more suited to the imaging of chronic inflammation such as osteomyelitis. Attempts to radiolabel granulocytes in vivo using monoclonal anti-granulocyte antibodies have been largely unsuccessful to date, and this approach remains a challenge for the future.

Topics: Cell Separation; Granulocytes; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Monocytes; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

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

99mTc-HMPAO-labelled white cell scanning is compared with other radionuclide techniques in this contribution. The sensitivity and specificity using both 111In and 99mTc-HMPAO-labelled leucocytes are comparably high. Both imaging methods are therefore suitable for imaging inflammation. However, images are available more quickly using 99mTc-HMPAO; their quality is superior and the radiation dose is lower. 111In is beneficial for chronic infections. 67Ga citrate is less specific for inflammation, since it also localizes in tumours, but it is useful in chronic infection. 99mTc nanocolloid has not been found suitable for imaging abdominal inflammation, but more so for bone and joint diseases. Comparisons of 99mTc-HMPAO leucocytes with 123I-labelled monoclonal antibodies show poorer results using the monoclonal antibody because of non-specific binding to plasma proteins. Visualization of lesions is generally poorer using 99mTC-HIG than 99mTc-HMPAO leucocytes and is less sensitive and specific. Few reports using 99mTc-labelled monoclonal antibodies are available. Early results are promising and more specific antibodies may be available in the future. Synthetic chemotactic peptides offer a novel approach to the detection of infection. However, at present the recommended method for imaging acute abdominal inflammation is 99mTc-HMPAO leucocytes.

Topics: Abdomen; Antibodies, Monoclonal; Diagnostic Techniques, Radioisotope; Gallium Radioisotopes; Humans; Immunoglobulins; Indium Radioisotopes; Inflammation; Inflammatory Bowel Diseases; Iodine Radioisotopes; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Abscess; Diagnosis, Differential; Granulocytes; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Intestinal Fistula; 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

(99m)Tc-HMPAO labelled leukocyte imaging (white cell scan) is used in the investigation and assessment of patients with inflammatory bowel disease (IBD), while (99m)Tc LeukoScan has been used to demonstrate the presence of orthopaedic infections and appendicitis. The single-injection technique used for the administration of LeukoScan removes the need for handling blood and the complex separation and labelling techniques that are required for white cell imaging. This study set out to investigate whether LeukoScan could be used to image IBD.. Twenty-two patients under investigation for suspected IBD agreed to undergo LeukoScan imaging within 7 days of their routine planar white cell scan. Following injection of 650 MBq (99m)Tc LeukoScan planar images were acquired at 1, 2 and 4 h and single photon emission computed tomography (SPECT) images at 4 h post-injection.. When both sets of images were compared to the clinical diagnosis, the sensitivity and specificity were 0.88 and 0.83 for white cell imaging and 0.88 and 0.50 for LeukoScan SPECT at 4 h. The figures for the specificity and sensitivity of the LeukoScan 2 h and 4 h planar images were 0.44 and 1.00, and 0.75 and 0.50, respectively. When the LeukoScan and white cell images were compared, the 4 h LeukoScan SPECT images showed additional areas of uptake in 10 patients.. The study demonstrates that LeukoScan locates IBD. However, the sensitivity and specificity preclude its use for the routine detection of this disease. Comparisons with white cell scan images show that LeukoScan is taken up slowly in IBD and also appears in the normal bowel by 4 h.

Topics: Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Whole-body gamma camera counting is an alternative to faecal 111In collection for quantifying disease activity in inflammatory bowel disease (IBD) but requires administration of imaging activities of 111In. The aim of this study was to explore a dedicated whole-body counter which requires 20-fold less activity than gamma camera counting.. Thirty patients with known or suspected IBD received 99mTc-granulocytes (approximately 200 MBq) and 111In-granulocytes (approximately 0.5 MBq). The 99mTc-cells were injected 45 min after the 111In-cells and immediately after a baseline 111In whole-body count. The decay-corrected count at 120 h was expressed as a fraction of baseline to give whole-body 111In retention (WBR). One patient was excluded as the injected cells were non-viable.. Median 45-min intravascular 111In recovery was 35% in patients compared with 43% in six normal volunteers (p<0.05). WBR in normals ranged from 91% to 93% and in 11 patients with negative 99mTc imaging from 87% to 96%. Only one of 11 patients with negative imaging had WBR <90% while 11/12 patients with WBR <90% had abnormal imaging. Ten of 13 patients with Crohn's disease (CD) had abnormal imaging. The lowest WBR in these ten was 77% and six had values of >90%. There was a significant association between WBR and 99mTc image grade (Rs=0.73, p<0.002) in 16 patients without CD, but not in 13 patients with CD (Rs=0.54, p>0.05).. Dedicated whole-body counting is able to quantify disease activity in IBD but may give normal values in active CD.

Topics: Adult; Aged; Feasibility Studies; Female; Granulocytes; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime; Whole-Body Counting

The aim of this study was to determine whether biochemical markers for inflammation could prove effective in identifying the most appropriate patients with suspected inflammatory bowel disease (IBD) for labelled white cell scanning. One hundred and twenty-five patients referred for 99mTc-HMPAO labelled white cell scans were investigated. The values of C-reactive protein (CRP), antichymotrypsin (ACT) and acid glycoprotein (AGP) were measured in 73 patients, AGP and CRP in 10 and CRP only in a further 42. Sensitivity and specificity of each test were calculated using the white cell scan result as the 'gold standard'. ACT had the highest specificity (1.0), but the lowest sensitivity (0.27) of the three markers. CRP (using specified limits) had the lowest specificity (0.67) and the highest sensitivity (0.79). The corresponding values for AGP are 0.87 and 0.48. The low sensitivity of ACT and AGP preclude them from being useful referral criteria. CRP (using specified limits) is the most sensitive marker, but not sensitive enough to be useful as a referral indicator. However, by lowering the upper limit of normal to 5 mg.l-1, the sensitivity of the test increases to 0.96. Using this threshold to select the patients, 30% would not have been scanned and only one patient out of the 22 with IBD would have been missed. Where there is high demand for white cell scans this may provide a useful strategy for rationalizing the requests with minimal consequence on clinical management.

Topics: Adolescent; Adult; Aged; Bacterial Proteins; Biomarkers; C-Reactive Protein; Child; Female; Glycoproteins; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Referral and Consultation; Reproducibility of Results; Sensitivity and Specificity; Serpins; Statistics as Topic; Technetium Tc 99m Exametazime

Seventeen cases (11 patients) of inflammatory bowel disease (IBD) were studied to define the intensity and extent of disease by 99mTc-HMPAO-labeled leukocytes scintigraphy (TLLS), and 10 cases underwent CT examination to evaluate the bowel wall, lymph-nodes, and mesenteric surroundings. Serial TLLS were obtained up to 4 hours and CT was carried out within one week before or after TLLS. The sensitivities of early (1 hour) and delayed (4 hours) TLLS were 91% and 100%, respectively. The respective specificities were 100% and 33%. However, it appeared that mild IBD may yield false negative results in early TLLS while non-specific bowel activity and migration of white cells may cause false positive results in delayed imaging. By setting the diagnostic criteria for labeled leukocyte accumulation on visualization of the small bowel regardless of uptake or activity of the large bowel similar to or greater than lumbar bone marrow, the sensitivity and specificity of delayed TLLS changed to 91% and 83%, respectively. On CT examination, mesenteric lymph-node swelling, periintestinal blurring and dilatation of mesenteric vasa recta were observed in all five patients with active Crohn's disease, while wall thickening and enhancement were seen in four of them. None of the other three cases of inflammatory disease showed positive findings of dilatation of the mesenteric vasa recta, and they revealed relatively low uptake of labeled leukocytes in TLLS. A "scintigram score" was calculated by comparing uptake of tracer in five bowel segments with lumbar bone marrow activity, and a "CT score" was calculated by adding abnormalities of the intestine and mesenteric surroundings. The scintigram score correlated closely with CT score and clinical disease activity. Combined use of CT and TLLS for the evaluation of patients with IBD was an excellent means to obtain the findings of intensity and extent of disease of the bowel wall and mesenteric surroundings and provided useful information in determining the patient management.

Topics: Adolescent; Adult; Child; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

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 HMPAO labelled white cell scanning is now an accepted method for assessing the activity of inflammatory bowel disease. However, false positive results have been demonstrated. This study was conducted to assess the significance of low grade uptake on 99Tcm-HMPAO labelled white cell scans in the right iliac fossa (RIF) in the context of possible inflammatory bowel disease (IBD). 32 patients over a period of 1 year had low grade RIF uptake as the predominant abnormality. 20 of these had no prior diagnosis of inflammatory bowel disease. Only one case in this group was subsequently diagnosed as having Crohn's disease. Nodular lymphoid hyperplasia (NLHP) and non-steroidal anti-inflammatory drugs (NSAIDs) were also associated with low grade RIF uptake. Possible explanations for these findings are discussed.

Topics: Adolescent; Adult; Aged; False Positive Reactions; Female; Humans; Ileum; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Enema is the primary imaging method in the diagnosis of Crohn's disease in the small bowel, with clinical follow-up examinations performed by gastroenterologists as the gold standard. The information provided by small bowel enema, in addition to endoscopic findings, is usually sufficient for the gastroenterologist to make the definitive diagnosis and to plan the whole treatment. Scintigraphy with leukocytes labelled with HMPAO-Tc99m has several unique characteristics favoring its use as a diagnostic imaging method in Crohn's disease and ulcerative colitis. It is a noninvasive method requiring no bowel preparation and it is safe in severely ill patients in whom such conventional imaging methods as barium enema or colonscopy might be hazardous. In this study, the authors report the results of their experience with diagnostic small bowel enema and leukocyte scintigraphy with HMPAO-Tc99m in 28 patients with inflammatory bowel disease (Crohn's disease in 18 patients, ulcerative colitis in 7 and radiation-induced inflammatory stenosis of the sigma-rectum, bowel inflammation after appendicectomy and bladder surgery, respectively, in 1 patient each). Scintigraphy with autologous granulocytes with HMPAO-Tc99m was positive in 26 patients and negative in 2. Twenty-five patients were true positives and 1 was a false positive. Fifteen patients were also submitted to small bowel enema: 12 of them were positive (true positive) and 3 negative (1 false negative and 2 true negative). The results of granulocytes scintigraphy were compared with those of small bowel enema: the radionuclide study appeared superior in the assessment of bowel inflammation associated with Crohn's disease and ulcerative colitis. Indeed, scintigraphy depicted granulocyte uptake in the colon where enema had shown no major findings in 4 patients with Crohn's disease. In the author's opinion, the overall sensitivity, specificity and positive predictive value of combined leukocyte scintigraphy and small bowel enema play a major role in the early diagnosis of Crohn's disease and ulcerative colitis and in the assessment of disease extent and activity.

Topics: Adolescent; Adult; Aged; Barium Sulfate; Enema; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Oximes; Radiography; Radionuclide Imaging; Reproducibility of Results; 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

Abdominal pain is a common complaint in children and its differential diagnosis includes inflammatory bowel disease (IBD). The aim of the study was to assess the diagnostic accuracy of scintigraphy with 99mTechnetium Hexamethylpropyleneamine Oxime (99mTc-HMPAO) labeled leukocytes in children with suspected IBD.. Eighty-five children (age 12.4 ± 4.3 years, 47% boys) with suspected IBD based on clinical presentation, laboratory and ultrasound findings underwent scintigraphy with 99mTc-HMPAO labeled leukocytes. Abdominal scintigrams were acquired 40 min and 90 min post injection, and whole body scintigrams at 180 min. Scintigraphy was evaluated by two specialists in nuclear medicine. The results were compared with the final diagnosis established by endoscopy, histology, other imaging methods, and follow-up evaluated by an expert in pediatric gastroenterology.. Scintigraphy results corresponded with the final diagnosis in 78 (91%) patients resulting in a sensitivity of 89% (95%CI 72 to 98%), specificity of 91% (95% CI 82 to 98%), and accuracy of 91% (95% CI 83 to 96%). The interobserver agreement was 0.82 (95% CI 0.75 to 0.88) and the radiation dose estimate was 4.2 ± 1.5 mSv. In 28 children (25 positives and 3 negatives on scintigraphy), the diagnosis of IBD was established by endoscopy, histology, MR enterography, or fluoroscopy. Five positive findings on scintigraphy were not confirmed by other methods or during follow-up.. Scintigraphy with 99mTc-HMPAO labeled leukocytes in children with suspected IBD has high accuracy and offers a non-invasive option for detecting the presence of gastrointestinal inflammation. Scintigraphy is a powerful non-invasive decision-making tool in the management of suspected IBD that may spare a greater proportion of children of more invasive and demanding examinations.

Topics: Child; Female; Humans; Inflammatory Bowel Diseases; Isotope Labeling; Leukocytes; Male; Radionuclide Imaging; Technetium Tc 99m Exametazime

Inflammatory bowel diseases (IBDs) are defined as chronic relapsing immune-mediated disorders of the gastrointestinal tract. IBD exacerbations are characterized by recruitment of mainly CXCL8 receptor-expressing activated neutrophils into the intestinal wall, leading to severe damage. Considering its chronic relapsing character, accurate and timely diagnosis of an exacerbation is pivotal for early adaptation of the treatment and reduction of the disease burden. However, endoscopic evaluation is invasive and associated with an increased risk of perforation. We previously developed a (99m)Tc-labeled CXCL8 preparation in preclinical models including colitis and clinical studies.. In this study, we investigate the accuracy of (99m)Tc-CXCL8 SPECT to detect and localize disease activity in a prospective series of patients with IBD. Thirty patients (15 Crohns disease, 15 ulcerative colitis) participated, and 92 segmental pairs of histology and (99m)Tc-CXCL8 scans were studied. Imaging was performed after injection of 400 MBq of (99m)Tc-CXCL8. Planar and SPECT images of the abdomen were acquired at 30 min and 4 h after the injection.. The overall sensitivity and specificity on a per-patient basis for the detection of active disease were 95% and 44% for (99m)Tc-CXCL8 scan and 71% and 70% for endoscopy. The degree of (99m)Tc-CXCL8 accumulation correlated to the degree of neutrophilic influx in affected mucosa. Sensitivity and specificity on a per-segment basis, calculated from the 92 segmental pairs, were 82% and 72%, negative predictive value was 81%, and overall positive predictive value was 74%. Specificity could be increased at the expense of sensitivity using different cutoffs. In 74 segmental pairs, overall sensitivity and specificity for endoscopy were 74% and 85%, positive predictive value was 81%, and negative predictive value was 79%.. (99m)Tc-CXCL8 SPECT provides a novel imaging technique to target neutrophil recruitment to the intestinal wall, especially in moderate to severe exacerbations of IBD. Further validation studies are warranted to potentiate (99m)Tc-CXCL8 SPECT as a biomarker to scale up or step down treatment with immune-modulating drugs in a personalized fashion.

Topics: Abdomen; Adolescent; Adult; Aged; Bone Marrow; Endoscopy, Gastrointestinal; Female; Humans; Inflammatory Bowel Diseases; Intestinal Mucosa; Male; Middle Aged; Monitoring, Physiologic; Neutrophil Infiltration; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Young Adult

Although endoscopy with biopsy is the gold standard for the diagnosis of inflammatory bowel disease (IBD), this procedure is invasive and its repetition is stressful, especially in children. The purpose of this study was to evaluate prospectively the role of (99m)Tc-HMPAO-labeled granulocyte scintigraphy in the diagnosis and follow-up of pediatric IBD and its possible use as an alternative to colonoscopy to determine the disease extent and severity beyond its ability to differentiate ulcerative colitis from Crohn's disease. During a 10-year period, 52 children, aging between 2 and 17 years (median, 11.09 years), were subjected to (99m)Tc-HMPAO granulocyte scan 7-28 days from conventional diagnostic tests, and the results were compared with endoscopic and bioptic results. Disease severity was graded by the focal uptake intensity versus iliac bone uptake (Scan Activity Index) and compared with Endoscopy Mayo Score. In 15 out of 16 patients, IBD diagnosis was obtained with a full correspondence of location and severity of lesions, respectively, in 14 out of 16 and 13 out of 16, while in 31 out of 36 patients, IBD was correctly excluded (sensitivity of 93.7%, specificity of 86.1%, and negative predictive value of 96.4%). During the follow-up, all relapses (24) and remissions (13) were correctly recognized (sensibility and specificity of 100%). In conclusion, (99m)Tc-HMPAO granulocyte scan is an accurate minimally invasive technique with very good accuracy, able to diagnose and to grade the intensity and extent of the disease; it is also a useful tool in the follow-up of pediatric IBD where it could reliably replace the invasive endoscopic assessment in most cases.

Topics: Adolescent; Biopsy; Child; Child, Preschool; Chronic Disease; Diagnosis, Differential; Endoscopes, Gastrointestinal; Female; Follow-Up Studies; Granulocytes; Humans; Inflammatory Bowel Diseases; Intestines; Male; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime

The aims of this study are: (a) to evaluate the reliability of Multidetector Computed Tomography Enteroclysis (MDCT-E) and (99m)Tc-HMPAO labeled leukocyte scintigraphy (TLLS), in inflammatory bowel disease, (b) to test the accuracy of the two techniques with regard to their histological results, (c) to define how each technique can influence the natural course of inflammatory bowel disease (IBD), (d) to assess the potential value of the two techniques combined.. Thirty-seven patients with suspected IBD underwent MDCT-E and TLLS. We made a separate assessment of the results shown by the two methods and then compared and contrasted the histological results of the two. The latter, however, were either disappointing or not available in 15 patients who, for this reason, had to be dismissed from the study. As result, the number of participants eventually dropped to 22 subjects: 12 women, 10 men with an average age of 44 years.. MDCT-E and TLLS were successful in all patients. Sensitivity, specificity, and efficiency values have been reported as follows: MDCT-E: 62%, 100%, 64%,100%, 11%, respectively. TLLS: 90%, 100%, 91%, 100%, 33%, respectively. The two methods combined: 95%, 100%, 95%, 100%, 50%, respectively.. The two techniques can be employed in different stages of the natural course of the disease. In our experience, TLLS proved itself to be useful in the diagnosis of the disease and the assessment of its development. Conversely, MDCT-E proved itself to be more reliable in identifying the seat and the extent of the disease inside and outside the bowel wall as well as potential intra-peritoneal and extra-intestinal complications. The combined use of the two methods represents the Criterion Standard for diagnosing IBD with imaging.

Topics: Adult; Biopsy; Chi-Square Distribution; Contrast Media; Female; Humans; Inflammatory Bowel Diseases; Iopamidol; Leukocytes; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

Topics: Blood Transfusion, Autologous; Colon; Diagnosis, Differential; Female; Gardner Syndrome; Humans; Inflammatory Bowel Diseases; Leukocyte Count; Leukocyte Transfusion; Leukocytes; Middle Aged; Proctitis; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed; Urinary Bladder

Evaluation and comparison between pentavalent 99mTc dimercaptosuccinic acid (99mTc(V)-DMSA) and 99mTc-hexamethylpropylene amine oxime white blood cell (99mTc-HMPAO WBC) scintigraphy in the detection and assessment of disease activity in patients with active inflammatory bowel disease (IBD).. 99mTc(V)-DMSA scintigraphy was performed in 23 patients with active IBD and true positive 99mTc-HMPAO WBC scintigraphy. Images were considered positive when an area of increased uptake was observed. To assess severity of IBD, semi-quantitative analysis was included with reference to the uptake in the iliac crest. Comparison with endoscopic, radiological and clinical data was performed.. The diagnostic accuracy of 99mTc-HMPAO WBC and 99mTc(V)-DMSA was 91% and 84%, respectively. A significant correlation between the findings of both radioisotopic methods and scintigraphy score was demonstrated. Endoscopic findings were significantly correlated with scintigraphic results. Kappa statistics showed a moderate to good agreement between the two scintigraphic methods. Two patients (8.8%) had negative findings with 99mTc(V)-DMSA scintigraphy (false negative results).. 99mTc(V)-DMSA compared to 99mTc-HMPAO WBC could provide a simple, non-invasive alternative method for the assessment of disease activity, although it is slightly inferior to 99mTc-HMPAO WBC scintigraphy especially in the evaluation of disease localization in IBD patients.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Exametazime

To assess the clinical value of 99mTc-HMPAO-leukocyte-labeled scintigraphy (LLS) in the detection and follow-up of inflammatory bowel disease (IBD) in the pediatric population, we retrospectively reviewed 33 patients (15 boys; mean age 10.7 +/- 2.2 years) with suspected IBD. A total of 58 examinations were performed: 29 for screening purposes, 23 for follow-up and 6 to detect relapses. LLS was compared with clinical symptoms (PCDAI index), biologic markers of inflammation, barium contrast radiology (BCR; n = 22), sonography (n = 22), colonoscopy (n = 16), and biopsy (n = 13). The final diagnosis was Crohn's disease in 12, ulcerative colitis in 4, and no IBD in 17. In the 17 patients without IBD, LLS was always negative. Among the 16 patients with IBD, LLS showed concordant results with BCR in 7/10 patients, with sonography in 6/11, with colonoscopy in 9/12 and with biopsy in 8/9. The severity of LLS increased with the PCDAI index (p < 0.001), with a positive correlation between the scintigraphic activity index/PCDAI r = 0.76. An increase in the PCDAI index with the severity of LLS (p < 0.001) was also observed in the follow-up, and a weak correlation (r = 0.50) between erythrocyte sedimentation rate/scintigraphic activity index was obtained. In 5 patients with normal biologic markers, LLS detected inflammation. All 6 patients with relapses were symptomatic; 5 had inflammation on LLS and 5 had abnormal biologic markers. In conclusion, LLS can be a useful screening tool in the detection of IBD in children to assess the grade of inflammation and extension of IBD. This technique can detect the presence of inflammation during follow-up and should be performed when relapses are suspected.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Exametazime

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Bone Neoplasms; Crohn Disease; Diagnosis, Differential; False Positive Reactions; Humans; Ileum; Inflammatory Bowel Diseases; Leukocytes; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Topics: Diagnosis, Differential; Female; Humans; Hypertrophy; Inflammatory Bowel Diseases; Leukocytes; Liver; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Whole-Body Counting

Topics: Adult; Child; Humans; Inflammatory Bowel Diseases; Leukocytes; Organometallic Compounds; Oxyquinoline; 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 aim of this study was to retrospectively compare the diagnostic accuracy of (99m)Tc hexamethylpropyleneamine oxime (HMPAO) white blood cell scintigraphy in patients with a suspicion of active inflammatory bowel disease by using two different cell suspension media: leukocyte poor plasma (LPP) and Hanks' balanced salt solution (HBSS). Leukocytes from 30 patients were labelled using LPP and in 28 cases using HBSS. In the LPP method the leukocytes were resuspended in 0.5 ml cell-free plasma while in the HBSS method the cells were resuspended in 0.5 ml HBSS. Scintigraphic images were obtained at 30 min and 2 h after injection of 185-200 MBq (99m)Tc-HMPAO leukocytes. The leukocyte labelling efficiency was 65.5% and 89.0%, respectively, for the LPP and HBSS methods. There were 22 true positive, seven true negative and one false negative result in the LPP group, while in the HBSS group results were 18, nine and one, respectively. Diagnostic accuracy was similar with both methods although sensitivity was slightly higher in the HBSS group. In summary, these date indicate that leukocyte scintigraphy labelling using HBSS as the resuspension medium should be used as a first option for white blood cell labelling and diagnosis of inflammatory bowel disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cell-Free System; False Negative Reactions; False Positive Reactions; Female; Humans; Inflammatory Bowel Diseases; Isotonic Solutions; Isotope Labeling; Leukocyte Count; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Adult; Child; Humans; Inflammatory Bowel Diseases; Leukocytes; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

To assess the potential benefits of technetium Tc 99m hexylmethylpropylene amine oxime (Tc 99m HMPAO)-labeled leukocyte scintigraphy in a group of patients with spondyloarthropathies (SpAs), overt gastrointestinal symptoms, and negative extensive endoscopic/radiologic test results.. Ten patients with SpAs and overt gastrointestinal symptoms were included in this study. All patients underwent colonoscopy and small bowel barium studies, and results were negative. Abdominal scintigraphy with Tc 99m HMPAO-labeled leukocytes was performed in all the patients. Clinical and laboratory data and response to treatment was recorded.. The Tc 99m HMPAO-labeled leukocyte scintigraphy was positive in 5 of 10 patients, demonstrating uptake at the terminal ileum which is very suggestive of Crohn disease. The 5 scintigraphically positive patients were treated with sulfasalazine (SSZ). Four patients responded to SSZ with significant improvement of both gastrointestinal and joint symptoms.. In 5 of 10 patients with SpA and suspected inflammatory bowel disease on clinical grounds, evidence of inflammatory bowel disease was shown by scintigraphic studies in which conventional invasive procedures failed. Tc 99m HMPAO-labeled leukocyte scintigraphy should be considered in the evaluation of patients with SpA.

Topics: Abdomen; Adolescent; Adult; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Serologic Tests; Spondylarthropathies; Technetium Tc 99m Exametazime

Topics: Child; Female; Humans; Inflammatory Bowel Diseases; Intestinal Polyps; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; 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

The concept that gut inflammation is implicated in the pathogenesis of spondyloarthropathies (SpA) has long been considered. Subclinical intestinal inflammation has been reported in adult patients with SpA by histological examination of intestinal biopsies. We assessed the presence of gut inflammation by abdominal 99mTc-hexamethyl propylene amine oxime (99mTc-HMPAO) labeled leukocyte scintigraphy in a group of children and adolescents with HLA-B27 positive SpA without gastrointestinal (GI) symptoms, and correlated the scintigraphic results to disease activity.. Abdominal scintigraphy with 99mTc-HMPAO labeled leukocytes was performed in 27 HLA-B27 positive children and adolescents with SpA without GI symptoms. Patients were divided into 2 groups according to the presence of active or inactive joint disease: Group A, 17 patients with active disease, and Group B, 10 patients with inactive disease. Patients with positive abdominal scintigraphy underwent complete bowel investigation by means of small bowel barium follow-through, abdominal ultrasound scan, and ileocolonoscopy with mucosal biopsies.. Thirteen of 27 patients (48%) had scintigraphy indicating the presence of bowel inflammation. All patients with abnormal scan had active joint disease, whereas no patient with inactive disease had a positive intestinal uptake of labeled leukocytes. Bowel investigation revealed the presence of aspecific mucosal inflammatory changes in the majority of patients with positive scintigraphy.. The presence of intestinal leukocyte uptake only in patients with active joint disease, even if intestinal inflammatory changes were minimal and clinical gut manifestations were absent, supports the role of gut inflammation in the pathogenesis of joint disease in HLA-B27 positive patients with SpA.

Topics: Adolescent; Adult; Age of Onset; Child; Female; HLA-B27 Antigen; Humans; Ileum; Inflammatory Bowel Diseases; Leukocytes; Male; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rheumatic Diseases; Spinal Diseases; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) white cell scintigraphy is invaluable for assessing the presence and extent of disease activity in patients with inflammatory bowel disease. Interpretation of images can be compromised by physiological excretion of tracer into the bowel via the biliary tree. This study assesses the effect of intravenous pethidine administered with the labelled white cells in an attempt to reduce the enterohepatic circulation of the tracer. Ninety-one subjects with proven or suspected inflammatory bowel disease were included in this study, all of whom underwent 99mTc-HMPAO white cell scintigraphy. The control group of 50 subjects underwent the standard protocol for this study performed in our department. The other 41 subjects received an intravenous injection of 0.3 mg/kg of pethidine at the same time as re-injection of the labelled white cells. Images were graded using a five-point scale at both 1 and 2.5 h and categorised as positive, negative or non-diagnostic. Each scan was also assessed for the presence of a visible gall-bladder. The pethidine group had significantly fewer non-diagnostic scans than the control group (P=0.003), and significantly (P=0.001) more studies in which the gall-bladder was visualised. It is concluded that the use of pethidine appears to reduce biliary excretion of tracer during 99mTc-HMPAO white cell scintigraphy. This may allow the delayed images, and early images with low-grade tracer uptake in the bowel, to be interpreted with greater confidence and thereby reduce the number of scans classified as non-diagnostic.

Topics: Adolescent; Adult; Aged; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Meperidine; Middle Aged; Narcotics; Radionuclide Imaging; Technetium Tc 99m Exametazime

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

Labeled leukocyte imaging is a helpful diagnostic tool in the detection of inflammation and sepsis. The technetium Tc 99m hexamethyl propylene amine oxime (99mTc HMPAO)-labeled leukocyte scan has been found to be more sensitive than the Indium-111 labeled leukocyte scan in detecting inflammatory bowel disease, with reported sensitivities of 95% to 100%. Experience with the 99mTc HMPAO-labeled leukocyte scan was examined and its clinical applications evaluated in the immediate treatment of patients with inflammatory bowel disease.. A retrospective chart review was undertaken that included pediatric patients who underwent 99mTc HMPAO-labeled leukocyte scan at the James Whitcomb Riley Hospital for Children. The disease activity of patients with inflammatory bowel disease was assessed. The leukocyte scan was performed according to the manufacturer's specifications, and images were obtained 30 minutes and 2 hours after administration of the radiopharmaceutical.. During the period of July 1996 through November 1997, 41 scans were performed in 35 patients. Twenty-nine patients had histologically proven inflammatory bowel disease: 24 with Crohn's disease, 4 with ulcerative colitis, and 1 with indeterminate colitis. Active inflammatory bowel disease was suspected in 24 patients when the leukocyte scan was performed. Twenty of the 24 patients (83% sensitivity) had abnormal findings in leukocyte scans that prompted more aggressive management in 15 (75%). Six of the 15 who were receiving maximum medical therapy underwent surgical resection of severely affected bowel segments, and medical treatment was intensified in the other 9. The remaining 5 patients were receiving optimal medical therapy, instituted at their recent visit, and did not require further medication adjustments. Four of the 24 patients with active inflammatory bowel disease had normal leukocyte scans (17% false-negative rate), 3 of whom were receiving corticosteroid therapy at the time the scans were performed. All of the 11 patients in whom inflammatory bowel disease was in remission and 6 patients who did not have inflammatory bowel disease had normal findings in leukocyte scans (100% specificity).. Although a tissue diagnosis is still recommended, obtained during upper and lower gastrointestinal endoscopic examinations, and contrast radiography of the small bowel for the initial work-up of patients with suspected inflammatory bowel disease, the 99mTc HMPAO-labeled leukocyte scan is a safe and useful diagnostic adjunct for subsequent evaluation of patients known to have inflammatory bowel disease. The results of 99mTc HMPAO-labeled leukocyte scans directly influenced treatment of 75% of the study patients with active inflammatory bowel disease, which included the decision to refer patients for surgical intervention.

Topics: Adolescent; Child; Female; Humans; Inflammatory Bowel Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

To study the concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes (ASTLL) and ileocolonoscopy in patients with spondyloarthropathies (SpA) and without clinical evidence of inflammatory bowel disease (IBD).. Fifteen patients with SpA (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD were studied prospectively with ASTLL and ileocolonoscopy.. This cohort consisted of seven men and eight women aged 31.8+/-10.5 yr (18-47) [mean age +/- S.D. (range)] and with a disease duration of 6.0+/-4.4 yr (0.4-15). ASTLL showed abnormal uptake in four patients. Ileocolonoscopy was abnormal in five patients, showing acute inflammatory lesions in one patient with reactive arthritis, undifferentiated chronic inflammatory lesions in two cases, and features indistinguishable from those of Crohn's disease in two cases. ASTLL was negative in two cases in which ileocolonoscopy showed inflammatory lesions and was positive (terminal ileum) in one case with normal ileocolonoscopy. The concordance between the two examinations was statistically significant (kappa = 0.53; P = 0.008).. ASTLL may be an interesting tool to detect subclinical gut inflammation in patients with SpA.

Topics: Abdomen; Adolescent; Adult; Colonoscopy; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

Topics: Communicable Diseases; Humans; Inflammation; Inflammatory Bowel Diseases; Leukocytes; Practice Guidelines as Topic; Quality Assurance, Health Care; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Gut inflammation is frequent among patients with seronegative spondyloarthropathies (SSp). The purpose of this study was to evaluate the presence of positive abdominal findings in patients with SSp who did not have clinical symptoms or signs of inflammatory bowel disease (IBD). This represents a new indication for abdominal 99mTc-HMPAO-labeled leukocyte scintigraphy.. Eighty-six patients (59 with SSp and 27 controls) were prospectively imaged with 99mTc-HMPAO-labeled leukocytes.. Leukocyte imaging was positive in 33 patients with SSp (56%), 27 of these patients scored between 2+ and 4+ (51%). Four (15%) control patients also had positive findings.. These findings provide evidence linking SSp with intestinal inflammation. SSp may be an important new indication for 99mTc-HMPAO-labeled autologous leukocyte scintigraphy.

Topics: Adult; Arthritis; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; 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

The difference in sensitivity of early imaging at 30 minutes after injection of Tc-99m HMPAO WBC versus delayed imaging at 2 or 3 hours for depiction of active inflammation in children with inflammatory bowel disease was established. The charts of 220 children who had early (30-minute) and delayed (2 or 3 hours) imaging performed for evaluation of inflammatory bowel disease were reviewed. There were 107 boys and 113 girls (average age, 12 years; median, 13 years). The bowel was divided into eight segments (with the total for all patients being 3,520) graded on a scale of 0 to 6 (with reference points in the iliac crest and liver). Any grade > or = 1 was abnormal. The uptake in each segment was summed. One hundred and twenty-two studies were abnormal (55%). The average uptake in the early images was 5.1 +/- 0.41 and that in the late images was 9.3 +/- 0.64. The Friedman nonparametric test of comparison of rank was significant at the 0.001 level. One hundred and five patients had abnormal studies at 30 minutes (88%). An additional 12% of patients had abnormal studies only on the late images. There were 245 abnormal segments at 30 minutes and 413 abnormal segments at 2 or 3 hours. When the uptake was analyzed segment by segment, 62 patients (52%) had abnormal segments at 30 minutes but also had additional abnormal segments at 3 hours. Sensitivity of Tc-99m HMPAO WBC imaging was significantly improved when late imaging was performed.

Topics: Adolescent; Child; Humans; Inflammatory Bowel Diseases; Intestines; Leukocytes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

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

The lungs are an important site of granulocyte pooling. The aim of the study is to quantify pulmonary vascular granulocyte transit time using deconvolution analysis, as has previously been performed to measure pulmonary red cell transit time. Granulocyte and red cell studies were performed in separate groups of patients. Both cell types were labelled with Tc-99m, which for granulocyte labelling was complexed with hexamethylpropyleneamine oxime (HMPAO). The red cell impulse response function (IRF) was monoexponential with a median transit time of 4.3 s. The granulocyte IRF was biexponential in 19 of 22 subjects, 18 of whom had systemic inflammation (inflammatory bowel disease, systemic vasculitis or graft-vs-host disease) and four were controls without inflammatory disease. The median transit time of the fast component ranged from 20 to 25 s and of the slow component 120-138 s in the four patient groups. The fraction of cells undergoing slow transit correlated significantly with (a) mean granulocyte transit time and (b) the fraction showing shape change in vitro. We conclude that granulocyte transit time through the pulmonary circulation is bimodal and that shape-changed (activated) cells transit more slowly that non-activated cells. The size of the fraction undergoing slow transit is closely related to mean granulocyte transit time and is an important determinant of the size of the pulmonary vascular granulocyte pool.

Topics: Cell Movement; Cell Size; Erythrocytes; Graft vs Host Disease; Granulocytes; Humans; Inflammatory Bowel Diseases; Pulmonary Circulation; Statistics, Nonparametric; Technetium Tc 99m Exametazime; Time Factors; Vasculitis

Noninvasive leukocyte scintigraphy for assessment of localization, extent, and degree of active inflammation in acute colonic inflammatory bowel disease have been shown to correlate well with endoscopy. This study compared findings of mucosal leukocyte migration assessed histologically with those of technetium 99m hexamethylpropylene-amineoxime-labeled leukocyte scintigraphy.. Twenty-one patients hospitalized because of a first attack or a relapse of known inflammatory bowel disease were investigated using leukocyte scintigraphy followed by total colonoscopy with multiple biopsies within 24 h. Histological interpretation focused on the degree of segmental mucosal leukocyte infiltration.. Fourteen patients with ulcerative colitis (UC) and seven with colonic Crohn's disease (CD) were included. With the use of histology as the reference method, maximal proximal disease extent was correctly assessed by the leukocyte scan in 11 patients (8 with UC, 3 with CD), although the rectal involvement was not visualized in 5. In seven patients, the extent assessments almost matched (+/- one segment), and in the remaining three patients (two UC, one CD) the scan grossly misinterpreted active histological inflammation (> or = +/- two segments). In patients with UC, the sensitivity, specificity, and diagnostic accuracy concerning the extent of inflammation were 0.84, 0.79, and 0.83, respectively. In patients with CD, the sensitivity was 0.79, and the diagnostic accuracy was 0.78. The relative leukocyte scan activity score was less concordant with the degree of mucosal leukocyte infiltration but still significantly correlated (r = 0.616, p < 0.0001 in UC patients and r = 0.441, p < 0.003 in CD patients).. Images created by the technetium 99m hexamethylpropylene-amineoxime-labeled leukocyte scan in acute colonic inflammatory bowel disease correlate to mucosal leukocyte migration in terms of proximal disease extent and, to a lesser degree, also to the intensity of mucosal inflammatory infiltration.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Cell Migration Inhibition; Colon; Colonoscopy; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Aim of the study was to evaluate [99mTc]hexamethyl-propylamine-oxime (HMPAO) leukocyte scintigraphy for the assessment of disease activity and extent in inflammatory bowel disease patients. Results and scores of scintigraphy using [99mTc]HMPAO-labeled leukocytes were retrospectively compared with the activity index of van Hees, laboratory parameters, and gastroenterologists' assessment of disease using endoscopy, radiology, and histology plus clinical parameters in 136 patients with Crohn's disease (115) and ulcerative colitis (21) and in 29 controls. There were 114 positive and 22 negative [99mTc]HMPAO leukocyte scintigrams. Sensitivities for active disease at 1 and 3 hr were 98% and 98% and specificities were 100% and 83%, respectively. [99mTC]HMPAO leukocyte scintigraphy is superior to the activity index and the gastroenterologists' clinical assessment of active inflammation in IBD patients. Scintigraphy allows assessment of the existence, extent, and intensity of active inflammation in IBD patients in one examination with high accuracy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Inflammatory Bowel Diseases; Intestines; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Prognosis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The technetium white cell scan (WCS) may be a useful investigation for patients with inflammatory bowel disease (IBD). In a retrospective study we assessed the use of the WCS as an initial imaging investigation in evaluating children with suspected IBD.. Over a 3-year period, 60 WCS were performed on 55 patients (25 boys, median age 12.1 years, age range 1.5-18 years) with known or suspected IBD. There were two clinical groups: those with previously diagnosed IBD (histologically and radiologically) and in clinical relapse (13 patients), and newly presenting patients with suspected IBD (42 patients).. Eighteen scans were performed on the 13 patients presenting with relapse. Seventeen were positive and one patient, subsequently shown to have an inactive stricture, had a negative scan. Seven of the 42 newly presenting patients had abnormal scans, confirmed to be due to IBD by a combination of histology and barium examinations. Of the remaining 35 scans, three were abnormal and 32 were normal. None of these patients were subsequently proven to have IBD. These results show that in detecting active IBD, a positive WCS has a 100% sensitivity (24/24) and a 91% specificity (32/35) in the diagnosis of IBD.. Our results show that the WCS is very useful as an initial imaging investigation in evaluating patients with suspected IBD to select patients for further investigation.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Inflammatory Bowel Diseases; Isotope Labeling; Leukocytes; Male; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Exametazime

Topics: Humans; Inflammatory Bowel Diseases; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Topics: Crohn Disease; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sepsis; Technetium Tc 99m Exametazime

Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of 99mTc-HMPAO-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P<0.05) (64.7% vs 26.6%; odds ratio: 5). No control patient showed a positive scan. It is concluded that 99mTc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results.

Topics: Abdomen; Adult; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Serologic Tests; Spondylitis, Ankylosing; Technetium Tc 99m Exametazime

A prospective study was carried out on 13 patients with ulcerative colitis and 11 with Crohn's disease to compare the value of radioimmunoscintigraphy involving 99mTc-labeled antigranulocyte monoclonal antibody (BW 250/183) with that of hexamethylpropyleneamine-oxime-labeled leukocyte scintigraphy. The extent of the process (various segments of the small bowel; ascending, transverse, and descending colon; and rectosigmoideum) was determined in 115 segments by means of radioimmunoscintigraphy and leukocyte scintigraphy and compared with the results of enteroclysis and colonoscopy in 64 segments. The scintigraphic activity, calculated by summing the segment scores, was compared with clinical and laboratory parameters. During radioimmunoscintigraphy, the 24-hr fecal excretion of the antibody was measured. The two methods revealed a different extent of the process (P<0.01). The segmental sensitivity and specificity were 63% and 96% in radioimmunoscintigraphy, and 87% and 94% in leukocyte scintigraphy. Leukocyte scintigraphy proved to be superior in cases with small intestine involvement, but the methods are of similar value in cases with large bowel involvement. The scintigraphic activity determined by radioimmunoscintigraphy and the fecal excretion of monoclonal antibody correlated with seven parameters, while that determined by leukocyte scintigraphy did so with 12 variables. Both methods are of similar value for the detection of large bowel involvement, but leukocyte scintigraphy was the better method for determination of the involved segments in the small intestine. The scintigraphic activity proved a useful parameter, correlating well with the clinical and laboratory variables.

Topics: Adult; Aged; Evaluation Studies as Topic; Female; Granulocytes; Humans; Inflammatory Bowel Diseases; Isotope Labeling; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Prospective Studies; Radioimmunodetection; Technetium Tc 99m Exametazime

Topics: Adult; Child; Humans; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

The appearance of the gallbladder in images of patients undergoing 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) autologous white cell scans (AWCSs) was compared before and after the introduction of fasting in the white cell scan protocol in our department. Before February 1995, when fasting was not required as a condition of the test, gallbladders were identified in 10 and 13% of 128 patients at 1 and 3 h, respectively. After February 1995, when fasting was imposed for the duration of the AWCS procedure, gallbladders were identified in 44 and 58% of 139 patients undergoing an AWCS at 1 and 3 h, respectively (P < 0.01). While further studies are required to show that fasting affects the false-positive rate, the results suggest that the degradation products of 99Tcm-HMPAO may be retained in the biliary system longer during fasting. Fasting should therefore be included in the protocol for an AWCS, particularly in the evaluation of inflammatory bowel disease (IBD) when 99Tcm-HMPAO is the cell label used.

Topics: Eating; Fasting; Gallbladder; Humans; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

99mTc-HMPAO-leukocyte scintigrams were compared with the activity index (AI) of Van Hees in 145 inflammatory bowel disease (IBD) patients. Labelling of leukocytes with 99mTc-HMPAO was less time-consuming and less laborious than 111In-labelling of granulocytes; in addition, the radiation dose for the patient is lower and the shorter acquisition time allows multiple views. In a previous comparative study 99mTc-leukocytes proved superior to 111In-granulocytes in detecting active IBD. The present study shows that a positive AI (> 125) is associated with a positive 99mTc-leukocyte scintigram (40 pts); a negative 99mTc-leukocyte scintigram is only found in patients with a negative AI (27 pts). In 30 out of 78 patients with an AI < or = 125 and a positive scintigram these positive results were confirmed by radiological and/or endoscopic examinations, but in the remaining 48 patients verification of the scintigraphic result was prohibited due to the absence of other confirmative examinations within 1 month of scintigraphy. In our view 99mTc-leukocyte scintigraphy may well be the gold standard for functional assessment of inflammation intensity and localization in IBD patients.

Topics: Granulocytes; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

This study was designed to evaluate the role of technetium-99m (99mTc) hexamethyl propylene amine oxime (HMPAO)-labelled leucocyte imaging as an initial screening test in patients suspected of having inflammatory bowel disease (IBD).. Thirty-one patients in whom a final diagnosis of irritable bowel syndrome (IBS) was made (group 1) and another 33 patients with established Crohn's disease (group 2) were studied. All patients had 99mTc HMPAO-labelled leucocyte scan with imaging at 40 and 120 min. Scans with abnormal bowel uptake were considered positive and this uptake was quantified by visual grading and computer-based methods (scan score). Group 1 patients with positive 99mTc HMPAO scan underwent an indium-111 (111In)-labelled leucocyte scan (imaging at 180 min) followed by endoscopy and barium radiology as deemed necessary in order to verify the 99m Tc HMPAO result.. Three scan patterns were seen: well localized and unequivocally positive scans at both 40 min and 2 h were obtained from 28 patients. All but one had established Crohn's disease. Diffuse bowel uptake was seen in 14 scans. Ten of these (false positive) were obtained from symptomatic patients with IBS and four (false negative) from patients with asymptomatic Crohn's disease. No bowel uptake at 40 min and 2 h was seen in 22 scans. All but two of these (who had quiescent Crohn's disease) were obtained from patients with IBS. Active Crohn's disease is associated with significantly higher scan score (mean +/- SEM, 82.1 +/- 13.6) than the false positive scans (12.5 +/- 3.1, P > or = 0.001). Patients with false positive 99mTc HMPAO scans had negative 111In scans, endoscopy and barium radiology.. Bowel scanning using either 111In or 99mTc HMPAO is useful in excluding active IBD. Because of radiation dose, image quality and availability 99mTc may be preferred to 111In.

Topics: Adult; Case-Control Studies; Colonic Diseases, Functional; Crohn Disease; False Positive Reactions; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Intestines; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Leukocyte scintigraphy (LS) was performed in 20 pediatric patients with inflammatory bowel disease (IBD: 10 with ulcerative colitis, 2 with indeterminate colitis, and 8 with Crohn disease) in different stages of clinical activity. Leukocytes were separated from 15 to 60 ml venous blood and were labeled in vitro with [99mTc]HM-PAO. The segmental extent (small intestine; ascending, transverse, and descending colon; and recto-sigmoideum) of the process was determined by LS. The uptake of each bowel segment was scored in relation to the bone marrow uptake. The scintigraphic activity, calculated by summing the segment scores, was compared with laboratory parameters. The mean labeling efficacy was 76% (60-86%). The segmental extent of the process determined by LS was compared with the results of barium enema or colonoscopy with regard to 32 bowel segments. The sensitivity, specificity, and accuracy of LS were 93, 88, and 91%, respectively. Two extraintestinal manifestations (abdominal abscess and joint involvement) were also detected by LS. These lesions were verified by computed tomography (CT) (abscess) and on the basis of the clinical outcome (arthritis). The scintigraphic activity correlated with the C-reactive protein (CRP) level (r = 0.82, p < 0.001), the alpha 2-globulin level (r = 0.63, p < 0.02), the sedimentation rate (r = 0.51, p < 0.05), and the fS iron level (r = -0.66, p < 0.005). LS is applicable in pediatric patients. The method is an excellent technique for assessment of the extent of IBD in children. Extraintestinal manifestations of IBD can also be investigated by LS. The scintigraphic activity is a useful parameter for determination of the activity of IBD in children.

Topics: Adolescent; Barium Sulfate; Child; Child, Preschool; Colonoscopy; Enema; Female; Humans; Inflammatory Bowel Diseases; Isotope Labeling; Leukocytes; Male; Organotechnetium Compounds; Oximes; 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

The ideal imaging method in inflammatory bowel disease would reliably detect inflammation, identify the correct intestinal location, and assess the severity of the disease. The aim of this study was to compare scintigraphic methods of quantifying overall disease activity using both indium-111 (111In) and technetium-99M (99mTc) HMPAO labelled leucocyte scans. The four day faecal excretion of 111In was measured after 111In scintigraphy in 24 patients known to have inflammatory bowel disease. The same patients also underwent 99mTc HMPAO scanning. The scans were performed 10 days or less apart with no changes in treatment between scans. Bowel activity on the 99mTc HMPAO scans was assessed using a computer based method (scan score) and a visual grading method in a further 54 99mTc HMPAO. The results showed a close correlation between inflammatory activity defined by faecal 111In excretion and the scan score generated from the computer analysis of the 99mTc HMPAO image (Spearman rank correlation: rs = 0.78; p < 0.001). Accurate information to localise inflammatory activity could be obtained by simple visual assessment of both types of scan images, although image quality was superior with 99mTc HMPAO. Qualification of disease activity from 99mTc HMPAO images by visual grading was associated with a large variability, only 69% of scans had similar scores when graded by three observers. Computer generated image analysis was more reproducible. In conclusion, in inflammatory bowel disease 99mTc HMPAO scintigraphy and faecal 111In excretion correlated well. Either method can quantify and localise the inflammation. As 99mTc HMPAO scanning provides a quicker result, with a lower radiation dose, and avoids faecal collection, it may be the preferred method.

Topics: Adolescent; Adult; Aged; Feces; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Abscess; Granulocytes; Humans; Inflammatory Bowel Diseases; Intestinal Diseases; Intestinal Fistula; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes are well established for the investigation of inflammatory disease. Their kinetics and normal distribution are similar to those of indium-111-labeled leukocytes except for nonspecific activity in urine, kidneys, gall bladder, and bowel, which results from the elution of secondary 99mTc-labeled HMPAO complexes. The principal clinical indications for [99mTc]HMPAO-leukocytes include inflammatory bowel disease (IBD), osteomyelitis, soft tissue sepsis, and, to a lesser extent, occult fever. The superior resolution and count density of 99mTc places [99mTc]HMPAO-leukocytes at an advantage over 111In-leukocytes in IBD, especially for the identification of small bowel involvement in patients with Crohn's disease. However, quantification of disease activity is more difficult than with 111In. Technetium-99m HMPAO-leukocytes are indicated for most forms of acute soft tissue and abdominal sepsis, although when compared with 111In, it may be more difficult to demonstrate communication between an abdominal abscess and bowel lumen. Chronic osteomyelitis, including infected joint prostheses, are better approached with 111In-labeled leukocytes. Occult fever and fever of unknown origin (FUO) are more controversial. There is still a place for gallium-67 in FUO, of which there is a wide spectrum of causes. Occult fever implies a pyogenic cause for an undiagnosed fever and should probably be imaged with 111In-leukocytes. With the advances being made in other imaging modalities and in interventional radiology, there is a clear need for radionuclide agents that can be used for whole-body screening in patients with undiagnosed fever. Such agents may include fluorine-18-fluorodeoxy-glucose and radiolabeled monoclonal antibodies to endothelial adhesion molecules activated at the foci of inflammation.

Topics: Bone and Bones; Digestive System; Fever of Unknown Origin; Humans; Infections; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Thoracic Diseases

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

Forty-seven patients, 29 with chronic inflammatory bowel disease (IBD) and 18 with presumed irritable bowel syndrome, including one with uncomplicated diverticular disease, were studied with simultaneous technetium-99m hexamethylpropylene amine oxime and indium-111 oxine labelled leucocyte scans performed at 1, 3 and 24 h. Twenty-seven patients with IBD had active disease as judged by clinical and laboratory criteria and all of these had positive scans with both agents. No false positive studies were obtained. The 1-h 99mTc-HMPAO WBC scans showed the same distribution to disease as the 3-h 111-In WBC scans, with no difference in intensity (P < 0.92); they showed more extensive disease (P < 0.02) and more intense uptake (P < 0.001) than did the 1-h 111-In scans. The 3-h 99mTc-HMPAO WBC scans showed more extensive disease (P < 0.002), with greater intensity (P < 0.0005), than did the 3-h 111In WBC scans. Physiological bowel activity on 3-h 99mTc-HMPAO WBC scans was present in 12 patients but was faint and did not interfere with assessment of disease extent and activity. It is concluded that in terms of isotope availability, radiation dosimetry and image quality, 99mTc-HMPAO is the agent of choice in detecting active IBD, with localization of disease possible at 1-h after re-injection and optimal resolution and definition of disease extent at 3 h. A negative scan reliably excludes active disease.

Topics: Adult; Colonic Diseases, Functional; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Intestines; Leukocytes; Male; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

A comparative study of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) and 111In leucocyte scintigraphy was performed in inflammatory bowel disease. Two hundred and thirty-four patients were studied, 146 had 99Tcm-HMPAO, 82 had 111In and six had both. The sensitivity, specificity and accuracy of the 99Tcm leucocyte scan were 96, 97 and 97%, respectively, and 96, 97 and 97%, respectively, for the 111In leucocyte scan. 99Tcm-HMPAO leucocytes demonstrated similar diagnostic accuracy to 111In-labelled leucocytes with improved image quality and reduced radiation dose.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; England; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; 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

Topics: Antibodies, Monoclonal; Humans; Indium Radioisotopes; Inflammation; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sternum; Surgical Wound Infection; Technetium; Technetium Tc 99m Exametazime

The diagnostic value of early 99mTc-HMPAO-leukocyte images (2 min, 0.5 hr, 2 hr and 4 hr) was studied in 87 prospectively performed investigations in 80 patients with a suspicion of abdominal inflammation or infection. Sensitivity, specificity and accuracy were 74%, 85% and 77% in the 2-min scans, 88%, 81% and 86% in the 0.5-hr scans, 95%, 85% and 92% in the 2-hr scans, and 96%, 92% and 95% in the 4-hr scans. Nonspecific bowel accumulation was seen in 7% of patients at 2 hr and in 28% at 4 hr but was easily distinguishable from pathologic activity. The uptake in early images represents an active accumulation of granulocytes at the site of inflammation rather than nonspecific blood-pool activity judged by results of 99mTc-HMPAO-RBC imaging. We found that imaging within 2 hr from injection has a high diagnostic value, and that the activity accumulates in areas of infection and inflammation faster than in the intestinal background.

Topics: Abdomen; Abscess; Diverticulitis; Erythrocytes; Evaluation Studies as Topic; Female; Humans; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Time Factors

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Colon; Female; Humans; Ileum; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Adult; Antibodies, Monoclonal; Antigen-Antibody Reactions; Female; Granulocytes; Humans; Indium Radioisotopes; Infections; Inflammatory Bowel Diseases; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tissue Distribution

One hundred patients with suspected acute abdominal inflammation were imaged at 0.5, 2-3, 4-6, and 24 hours after the administration of Tc-99m HMPAO labeled autologous leukocytes. Scan findings were retrospectively compared with final diagnosis, serum C-reactive protein (CRP), and antibiotic treatment. Clinical findings were confirmed with surgery, barium enema, or sigmoidoscopy in 61 patients, and diagnosis was based only on clinical findings in 13 patients. In 26 patients, symptoms subsided before a final diagnosis was made. Tc-99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis, including all patients with acute cholecystitis (N = 4) and inflammatory bowel disease (N = 8). They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra-abdominal abscesses. Abnormal activity was found in patients with colonic carcinoma, small bowel infarction, and acute appendicitis. Abnormal activity was visualized in 0.5-hour images in all but one of the positive cases. With the exception of two postoperative cases, malignant lymphoma, and a liver abscess, a CRP level of greater than 75 mg/L was associated with positive image findings. Antibiotic treatment did not affect imaging findings. Imaging with Tc-99m labeled leukocytes appears to be valuable for detecting and localizing abdominal inflammation, and three-phase imaging during the first 4-6 hours is recommended. In some cases, 24-hour images may be useful for distinguishing small bowel from large bowel inflammation.

Topics: Abscess; Acute Disease; C-Reactive Protein; Cholecystitis; Diverticulitis, Colonic; Humans; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

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