Non-invasive diagnosis and grading of postsurgical endoscopic recurrence in Crohn's disease: usefulness of abdominal ultrasonography and (99m)Tc-hexamethylpropylene amineoxime-labelled leucocyte scintigraphy.
Non-invasive techniques aim to be an alternative to endoscopy in the assessment of postsurgical recurrence of Crohn's disease (CD). The object of this study was to evaluate the accuracy of abdominal ultrasonography (AUS) and (99m)Tc-hexamethylpropylene amineoxime ((99m)Tc-HMPAO)-labelled leucocyte scintigraphy (LLS) compared with endoscopy in the diagnosis and grading of postsurgical recurrence of CD. Between January 2006 and May 2007, all patients with CD and resection with ileocolic anastomosis were included prospectively. Within three days they underwent an ileocolonoscopy, AUS with evaluation of bowel wall thickness and the presence of Doppler flow, and LLS. Forty patients who met the study conditions were included; 5 patients did not agree to have the ileocolonoscopy and it was not possible to assess the anastomosis in 2 patients. Endoscopic recurrence was detected in 26 patients (78.8%), in 15 of whom it was moderate-severe. For the diagnosis of recurrence, both AUS and LLS showed acceptable sensitivity and positive predictive value, with an accuracy of 72.7% and 78.1%, respectively. The results of the AUS and LLS for diagnosing moderate-severe recurrence were better, with an accuracy of 78.8% and 81.3%, respectively. The best assessment of the severity of the recurrence was obtained with the combination of both techniques (sensitivity, specificity, positive and negative predictive values, accuracy and kappa index were, respectively: 93.3%, 72.2%, 73.7%, 92.9%, 81.8% and 0.64). The variables evaluated, both sonographic and scintigraphic, had areas under the curve that were similar and significantly different from 0.5.


CONCLUSIONS
Abdominal ultrasonography and (99m)Tc-HMPAO-labelled leucocyte scintigraphy are two useful non-invasive techniques for the assessment of postsurgical recurrence of Crohn's disease.
Servicios de Medicina Digestiva, Hospital Universitario Dr Peset de Valencia, Universidad de Valencia, Spain. paredes_jos@gva.es
José María
JM
Paredes
Tomás
T
Ripollés
Xavier
X
Cortés
María Dolores
MD
Reyes
Antonio
A
López
María Jesús
MJ
Martínez
Eduardo
E
Moreno-Osset
D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging* / Q000473:pathology; D007962:Leukocytes; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D055502:Secondary Prevention; D012720:Severity of Illness Index; D019690:Technetium Tc 99m Exametazime; D018608:Ultrasonography, Doppler
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime