Gastric and small bowel Crohn's disease assessed with leukocytes-Tc(99m) scintigraphy.
We reviewed 312 (99m)Tc leukocyte (99m)Tc-WBC studies to evaluate the sensitivity and specificity of (99m)Tc-WBC for identifying small-bowel and gastric inflammation in children with Crohn's disease. The (99m)Tc-WBC scans were interpreted blindly and compared to the results of colonoscopy with biopsies and surgical specimens. In 46 children, total colonoscopy was done within a few days of a (99m)Tc- WBC scan and in 13 others surgical specimens were available. Of the 37 children in whom the terminal ileum was visualized endoscopically (24) or surgically (13), the WBC-Tc(99m) scan showed a similar degree of inflammation in 33. The sensitivity of (99m)Tc-WBC scanning was 91% and the specificity 96%. The scans allowed evaluation of inflammation in the terminal ileum in 22 children in whom the endoscopist did not cannulate it; the scans were abnormal in 10 of these 22 children. In the children with no ileoscopy the results of the (99m)Tc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment, and long-term clinical follow-up. Finally, the scans of 46 controls did not reveal any false-positive findings in the terminal ileum. Five children with gastritis documented by gastroscopy had normal (99m)Tc-WBC scans and upper gastrointestinal barium studies. This study demonstrates in a large number of normal and abnormal children with different pre-test probabilities of having inflammatory bowel disease that scintigraphy is reliable in identifying small-bowel inflammation.
Charron
M
M
Department of Radiology, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Di Lorenzo
C
C
Kocoshis
S
S
D000293:Adolescent; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D005756:Gastritis / Q000000981:diagnostic imaging; D006801:Humans; D007962:Leukocytes; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000000981:diagnostic imaging*; D019690:Technetium Tc 99m Exametazime
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime