title: Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in female patients with an atypical clinical presentation.
abstract: OBJECTIVE
  Acute appendicitis is a clinically challenging surgical disease which is particularly difficult to diagnosis in women. An atypical presentation is a major obstacle to quickly diagnose acute appendicitis.
  
  
  METHODS
  Fifty female patients with acute abdomen pain who were suspected of having appendicitis, but who had atypical findings were included in this study. After an intravenous injection of technetium-99m hexamethylpropyleneamineoxide (Tc-99m HMPAO) labeled white blood cells, serial anterior abdomen-pelvis images at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images.
  
  
  RESULTS
  Thirty-two patients received a laparotomy for surgical and pathological diagnoses. The remaining 18 patients did not receive operations and showed no evidence of appendicitis after at least a one-month follow-up period. Two patients had false-positive white blood cell scan findings and 2 patients had false-negative white blood cell scan findings. The overall sensitivity, specificity, and accuracy for white blood cell scans in diagnosing appendicitis was 93.3%, 90.0%, 92.0%, respectively. One patient had false-positive abdominal sonographic finding and 5 patients had false-negative abdominal sonographic findings. The overall sensitivity, specificity, and accuracy for abdominal sonography scans in diagnosing appendicitis were 83.3%, 95.0%, and 88.0%, respectively.
  
  
  CONCLUSIONS
  The Tc-99m HMPAO white blood cell scan provides a more sensitive and accurate method for the diagnosis of appendicitis in female patients with equivocal clinical presentation when compared with abdominal sonography.
authors.affiliation: Division of Gastroenterology, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
authors.forename: Ken-Sheng
authors.initials: KS
authors.lastname: Cheng
authors.forename: Yu-Chien
authors.initials: YC
authors.lastname: Shiau
authors.forename: Cheng-Cheih
authors.initials: CC
authors.lastname: Lin
authors.forename: Cheng-Chun
authors.initials: CC
authors.lastname: Lee
authors.forename: Albert
authors.initials: A
authors.lastname: Kao
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010091:Oximes; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012737:Sex Factors; D014463:Ultrasonography
chemical_list: D010091:Oximes; C068296:hexamethylpropyleneamine oxime