title: (99m)Tc antigranulocyte monoclonal antibody imaging for the detection and assessment of inflammatory bowel disease newly diagnosed by colonoscopy in children.
abstract: OBJECTIVE
  This prospective study evaluated a (99m)Tc antigranulocyte monoclonal antibody Fab' imaging agent (Sulesomab) in children with inflammatory bowel disease (IBD) newly diagnosed by colonoscopy.
  
  
  METHODS
  Ten children (4 boys, 6 girls; mean age 14 years) with newly diagnosed Crohn's disease (n = 6) or ulcerative colitis (n = 4) were studied. Colonoscopy was performed in all of these patients. Within 24 h after colonoscopy, they underwent scintigraphy with (99m)Tc-Sulesomab. Abdominal/pelvic images were acquired at 30 min (planar) and 2-4 h (planar and SPECT) after injection of Sulesomab. Eighty bowel segments were evaluated semi-quantitatively by the investigators, using these three sets of images. The Pediatric Disease Activity (PDA) was correlated with the erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, albumin, Kirschner's score, the Sulesomab bowel segment with maximum uptake, and the sum of Sulesomab score in each segment.
  
  
  RESULTS
  The median PDA score was 26 (range 12.5-40). Three children had normal ESR and six normal WBC counts. All patients had at least one positive mucosal biopsy for IBD. While using the Kirschner's scale, the maximal severity of colonoscopy findings was graded as none (n = 2), mild (n = 4), moderate (n = 3), or severe (n = 1). Of the 59 segments evaluated with endoscopy, 35 were found to be endoscopically abnormal. The planar images identified 17 of these abnormal segments and the SPECT images 20. Nine of these ten children had abnormal bowel uptake by scintigraphy. Thus, the sensitivity of Sulesomab per patient was 90 % and per bowel segment 57 %. The correlation coefficient between the scintigraphic score for the segment with the Sulesomab maximum activity and the PDA was 0.3 (P = 0.41).
  
  
  CONCLUSIONS
  In pediatric IBD assessment, planar imaging with Sulesomab did not prove very sensitive in detecting inflammation in each bowel segment. However, SPECT detected the presence of inflammation in the majority of patients. A trial comparing (99m)Tc-HmPAO-WBC with Sulesomab in a large number of patients is required.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104, USA. charron@email.chop.edu
authors.forename: M
authors.initials: M
authors.lastname: Charron
authors.forename: C
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: S A
authors.initials: SA
authors.lastname: Kocoshis
authors.forename: M P
authors.initials: MP
authors.lastname: Hickeson
authors.forename: S R
authors.initials: SR
authors.lastname: Orenstein
authors.forename: A
authors.initials: A
authors.lastname: Goyal
authors.forename: S
authors.initials: S
authors.lastname: Kahn
authors.forename: L
authors.initials: L
authors.lastname: Collins
mesh_terms: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D002648:Child; D003113:Colonoscopy; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C101172:Sulesomab