^99mTc-HMPAO leucocyte scintigraphy fails to detect Crohn's disease in the proximal gastrointestinal tract

Abstract

Objective-To investigate the use of 99m Tc-HMPAO (hexamethyl propylene amine oxime) leucocyte scintigraphy as a noninvasive screening test for inflammatory bowel disease. Patients-10 children with suspected Crohn's disease, in whom routine investigation using barium contrast radiology, upper gastrointestinal endoscopy, colonoscopy, and mucosal biopsies had identified severe gastroduodenal and/or jejunal involvement. Design99mTc-HMPAO leucocyte scintigraphic studies performed in each of these cases were assessed by a radiologist who was blinded to the disease distribution. Results-In nine cases there was no scintigraphic evidence of inflammation in the proximal gastrointestinal tract. The 10th child had both gastroduodenal and jejunal involvement, but scintigraphy only revealed faint jejunal positivity. Conclusions- 99m

Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohnʼs disease

“…The results of this study, together with our previous results for the colon, 22 indicate that the exametazime scan can be used for the detection of bowel inflammation and also be used as a screening test for inflammatory bowel disease, 2,12 possibly with the exception for very proximal Crohn's disease both in adults (Table 3) 44 and in children. 43,45 Several studies in children have shown results comparable to those in adults. 10,11,46 A more widespread use of leukocyte scanning can be advocated inasmuch as the method is noninvasive, without the need for bowel preparation, and, in comparison to other explorations, preferred by patients.…”

Diagnostic methodologies: serology, endoscopy, and radiology

“…In contrast, in a study of 10 children with known severe gastroduodenal and/or jejunal CD, scintigraphy failed to detect inflammation in nine patients [44]. This was not due to technical failure because, in the eight patients with coexistent distal ileal or colonic disease, scintigraphy demonstrated inflammation in those areas.…”

“…This was not due to technical failure because, in the eight patients with coexistent distal ileal or colonic disease, scintigraphy demonstrated inflammation in those areas. The poor sensitivity of leukocyte scintigraphy in detecting CD of the proximal small bowel may be caused by a smaller mass of acute inflammatory cells infiltrating the proximal gut [44].…”

Role of molecular imaging in the management of patients affected by inflammatory bowel disease: State-of-the-art

“…While a study showed that 99m Tc-HMPAO-WBC scintigraphy is more sensitive than upper gastrointestinal small bowel follow-through (SBFT)[37], other authors stated that 99m Tc-HMPAO-WBC scintigraphy should not be depended upon as a screening test for CD, since its performance compares unfavourably with each of the conventional investigative techniques[38,39]. …”