title: Diagnostic accuracy of nuclear medicine imaging in protein losing enteropathy : systematic review and meta-analysis of the literature.
abstract: OBJECTIVE
  Scintigraphy using Tc-99m or In-111 labeled proteins is an important diagnostic modality for diagnosis of protein losing enteropathy (PLE). We systematically reviewed the available literature regarding the accuracy of scintigraphy using Tc-99m or In-111 labeled proteins for diagnosis of PLE.
  
  
  METHODS
  Medline and SCOPUS were searched using (("protein losing") AND ("scintigraphy" OR "Nuclear Medicine")) as keywords without any language or date limit. All studies on the accuracy of scintigraphy using Tc-99m or In-111 labeled proteins in PLE were included in the systematic review.
  
  
  RESULTS
  Overall 12 studies were included in our study. Pooled sensitivity and specificity were 87% [81-92%], and 62% [51-72%], respectively. Tc-99m labeled tracers had higher sensitivity but lower specificity compared to In-111 labeled ones. Delayed imaging could increase the sensitivity of imaging despite the lower specificity compared to the early images. Restriction of the analyses to larger studies (more than 10 patients) and to studies with the gold standard of fecal alphal-antitrypsin did not change the pooled indices.
  
  
  CONCLUSIONS
  Scintigraphy using Tc-99m or In-111 labeled proteins has high sensitivity for diagnosis and localization of PLE. Using Tc-99m labeled tracers and delayed imaging can further increase the sensitivity. Despite the high sensitivity, specificity of scintigraphy is suboptimal and false positive abdominal activities can limit the usefulness of this imaging method.
authors.affiliation: Departments of Pediatrics, Ghaem Medical Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Khalesi
authors.affiliation: Departments of Pediatrics, Ghaem Medical Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Alireza Ataei
authors.initials: AA
authors.lastname: Nakhaei
authors.affiliation: Department of Pediatric Gastroenterology, Ghaem Medical Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Ali Jafari
authors.initials: AJ
authors.lastname: Seyed
authors.affiliation: Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seyed Rasoul
authors.initials: SR
authors.lastname: Zakavi
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Sadeghi
authors.affiliation: Department of Pediatric Gastroenterology, Ghaem Medical Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Kianifar
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D009683:Nuclear Medicine / Q000379:methods*; D011504:Protein-Losing Enteropathies / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D015203:Reproducibility of Results