title: Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy in the early course of mild acute pancreatitis following endoscopic retrograde cholangiopancreatography.
abstract: We evaluated the diagnostic accuracy of technetium-99m hexamethylpropylene amine oxime (HMPAO) leucocyte scintigraphy in mild acute pancreatitis. A study design was chosen that gave us an opportunity to assess patients by leucocyte scintigraphy in the very early course of the disease. Thirty-two consecutive patients referred for endoscopic retrograde cholangiopancreatography were followed according to a very rigid protocol with laboratory tests and clinical examination before and after the endoscopic procedure and leucocyte scintigraphy [including single-photon emission tomography (SPET)] performed within 24 h. Planar and SPET images were examined by two observers who were blinded to each other and to the clinical history and diagnosis. Eight (25%) of the 32 patients developed mild acute pancreatitis, and only one of these patients had a positive scan. Sensitivity, specificity and accuracy of 13%, 79% and 63%, respectively, were achieved when both planar and SPET images were considered. When only planar images were considered the sensitivity, specificity and accuracy were 13%, 96% and 75%, respectively. No evidence of pathological leucocyte accumulation in mild acute pancreatitis was found despite the aforementioned very rigid protocol, allowing patients to be assessed by 99mTc-HMPAO leucocyte scintigraphy in the very early phase of the disease (this was true even when using SPET). From a clinical point of view, we believe that leucocyte scintigraphy should be used only when the disease is moderate or severe and serious intra-abdominal complications are suspected.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Herning Hospital, Herning, Denmark.
authors.forename: J C
authors.initials: JC
authors.lastname: Mortensen
authors.forename: J J
authors.initials: JJ
authors.lastname: Jensen
authors.forename: N
authors.initials: N
authors.lastname: Thorsgaard
mesh_terms: D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime