title: Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease.
abstract: BACKGROUND
  Leukocyte scintigraphy is a noninvasive investigation to assess inflammation. We evaluated the utility of labeled leukocytes to detect small bowel inflammation and disease complications in Crohn's disease and compared it to whole small bowel enteroscopy and laparotomy findings.
  
  
  METHODS
  Scintigraphy with technetium-99m exametazime-labeled leukocytes was prospectively performed in 48 patients with Crohn's disease a few days before laparotomy; 41 also had an intraoperative small bowel enteroscopy. The same procedures were performed in 8 control patients. Independent grading of scans was compared with the results of enteroscopy and with surgical, histopathologic, and clinical data.
  
  
  RESULTS
  In the 8 control patients leukocyte scan, endoscopy, and histopathology were all negative for the small bowel. In patients with Crohn's disease and small bowel inflammation seen at enteroscopy and/or laparotomy (n = 39) the scan was positive in 33. In 8 patients without macroscopic small bowel inflammation, the scan was positive for the small bowel in 3 patients; at histology, 2 of 3 had inflammation. When combining results for patients and controls, the sensitivity of leukocyte scan for macroscopically evident small bowel inflammation was 0.85, specificity 0.81, accuracy 0.84, positive predictive value 0.92, and negative predictive value 0.68. Scintigraphy detected inflammatory lesions not known before laparotomy in 16 of 47 (34%) Crohn's disease patients and showed uptake in 25 of 35 (71%) bowel strictures. It was diagnostic regarding 4 of 8 abscesses and 9 of 15 fistulas. In 6 patients (13%) lesions first demonstrated by leukocyte scintigraphy were treated during the surgery performed.
  
  
  CONCLUSIONS
  Leukocyte scintigraphy reliably detects small bowel inflammation in Crohn's disease. It gives additional information on the presence of inflammatory lesions in a fraction of patients planned for surgery.
authors.affiliation: Division of Gastroenterology and Hepatology, IMK Linköpings Universitet, Linköping, Sweden. Sven.Almer@lio.se
authors.forename: Sven
authors.initials: S
authors.lastname: Almer
authors.forename: Göran
authors.initials: G
authors.lastname: Granerus
authors.forename: Magnus
authors.initials: M
authors.lastname: Ström
authors.forename: Gunnar
authors.initials: G
authors.lastname: Olaison
authors.forename: Joëlle
authors.initials: J
authors.lastname: Bonnet
authors.forename: Marc
authors.initials: M
authors.lastname: Lémann
authors.forename: Kennet
authors.initials: K
authors.lastname: Smedh
authors.forename: Lennart
authors.initials: L
authors.lastname: Franzén
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertheau
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Jean-Didier
authors.initials: JD
authors.lastname: Rain
authors.forename: Robert
authors.initials: R
authors.lastname: Modigliani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology; D007421:Intestine, Small; D007432:Intraoperative Period; D007583:Jejunum / Q000000981:diagnostic imaging / Q000473:pathology; D007813:Laparotomy; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime