Rapid detection of acute appendicitis with Tc-99m-labeled intact polyvalent human immune globulin.
BACKGROUND
Acute appendicitis remains problematic for emergency clinicians. A rapid and definitive test is needed for detecting acute appendicitis before surgical intervention. The purpose of this clinical trial was to determine the efficacy of Tc-99m-labeled intact polyvalent human immune globulin (Tc-99m IgG) in the evaluation of acute appendicitis.


METHODS
Thirty-five patients with clinically suspected acute appendicitis were evaluated with Tc-99m IgG. After the intravenous injection of 25 mCi (92.5 MBq) of Tc-99m IgG, anterior flow, single photon emission computerized tomography (SPECT) and planar delayed images of the abdomen were obtained. Any abnormal focal uptake of Tc-99m IgG in the right lower quadrant was considered to be a positive scan.


RESULTS
Twenty-one patients with a positive Tc-99m IgG scan underwent laparotomy and were found to have acute appendicitis. Of the 14 patients who had negative scans, 7 underwent surgery. In this series, Tc-99m IgG study yielded 21 true-positive, 12 true-negative, and 2 false-negative results with a sensitivity, specificity, and accuracy of 91%, 100%, and 94%, respectively. The positive and negative predictive values were 100% and 86%, respectively. There were no false-positive results.


CONCLUSIONS
Tc-99m IgG scintigraphy can provide the clinicians a simple, rapid, and definitive test for the diagnosis of acute appendicitis.
Wong
D W
DW
Department of Radiology, Los Angeles County-Martin Luther King Hospital, CA 90059, USA.
Vasinrapee
P
P
Spieth
M E
ME
Cook
R E
RE
Ansari
A N
AN
Jones
M
M
Mandal
A
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging*; D001065:Appendix / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage; D007136:Immunoglobulins / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D013667:Technetium / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods; D014463:Ultrasonography
D007074:Immunoglobulin G; D007136:Immunoglobulins; D019275:Radiopharmaceuticals; C065376:technetium Tc 99m immunoglobulin; D013667:Technetium