Evaluation of 99mTc-HMPAO leukocyte scintigraphy in the investigation of pediatric inflammatory bowel disease.
OBJECTIVE
To evaluate (99m)Tc-HMPAO leukocyte scintigraphy as an investigation for inflammatory bowel disease (IBD).


METHODS
Scintigraphy was performed in 95 children undergoing investigation for IBD in a tertiary Gastroenterology Department. Diagnosis was based on conventional investigations including small bowel barium contrast radiology (BCR), upper gastrointestinal endoscopy (UGIE), colonoscopy, and endoscopic biopsy (the "gold standards"). IBD was confirmed in 73 (57 Crohn's disease; 10 ulcerative colitis; 6 indeterminate colitis) and excluded in 22 (controls). Scintigraphy was (1) evaluated as a screening test, (2) compared with individual conventional tests, (3) assessed for each gut segment.


RESULTS
Screening test: sensitivity 0.75 (95% CI, 0.63-0.85), specificity 0.82 (95% CI, 0.59-0.94), PPV 0.93, NPV 0.5. Comparison with BCR: sensitivity 0.87 (95% CI, 0.72-0.96), specificity 0.57 (95% CI, 0.39-0.73), PPV 0.69, NPV 0.2. Comparison with UGIE: specificity 0.9 (95% CI, 0.79-0.96), NPV 0.13 (sensitivity and PPV unavailable). Comparison with colonoscopy: sensitivity 0.57 (95% CI, 0.41-0.73), specificity 0.71 (95% CI, 0.54-0.85), PPV 0.71, NPV 0.42. Comparison with biopsies paralleled that with endoscopy. False negatives were especially common (NPV< or =0.2) in the proximal gut.


CONCLUSIONS
(99m)Tc-HMPAO leukocyte scintigraphy should not be relied on as a screening test for IBD because false negative results are common. This method is especially unreliable at detecting disease in the proximal gut.
Grahnquist
Lena
L
Institute of Child Health, University of Birmingham and Department of Gastroenterology, Birmingham Children's Hospital NHS Trust, Birmingham, United Kingdom.
Chapman
Stephen C
SC
Hvidsten
Sasha
S
Murphy
M Stephen
MS
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D004382:Duodenitis / Q000000981:diagnostic imaging*; D004751:Enteritis / Q000000981:diagnostic imaging*; D005260:Female; D005756:Gastritis / Q000000981:diagnostic imaging*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007962:Leukocytes / Q000000981:diagnostic imaging*; D008297:Male; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime