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Gastric and small bowel Crohn's disease assessed with leukocytes-Tc(99m) scintigraphy
M Charron1, C Di Lorenzo, S Kocoshis
1Department of Radiology, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Insights
Technetium-99m leukocyte (99mTc-WBC) scintigraphy reliably identifies small-bowel inflammation in pediatric Crohn's disease. This imaging technique demonstrates high sensitivity and specificity for detecting inflammation in children.
Area of Science:
- Pediatric Gastroenterology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease affecting children.
- Accurate assessment of small-bowel inflammation is crucial for pediatric CD management.
- Limitations exist in conventional diagnostic methods for pediatric small-bowel evaluation.
Purpose of the Study:
- To evaluate the sensitivity and specificity of technetium-99m leukocyte (99mTc-WBC) scintigraphy.
- To assess the utility of 99mTc-WBC scans in identifying small-bowel and gastric inflammation in children with Crohn's disease.
Main Methods:
- A retrospective review of 312 (99m)Tc-WBC studies was conducted.
- Scans were interpreted blindly and compared with colonoscopy, biopsies, and surgical specimens.
- Study included children with Crohn's disease and a control group.
Main Results:
- The (99m)Tc-WBC scan demonstrated 91% sensitivity and 96% specificity for detecting small-bowel inflammation.
- The technique accurately assessed terminal ileum inflammation, even when not visualized endoscopically.
- Scans were consistent with clinical assessments and laboratory values in patients without ileoscopy.
Conclusions:
- Technetium-99m leukocyte scintigraphy is a reliable tool for identifying small-bowel inflammation in pediatric Crohn's disease.
- The imaging modality offers high diagnostic accuracy and can evaluate areas not accessible by endoscopy.
- This study supports the use of 99mTc-WBC scans in the diagnostic workup of pediatric inflammatory bowel disease.
Abstract:
We reviewed 312 (99m)Tc leukocyte (99m)Tc-WBC studies to evaluate the sensitivity and specificity of (99m)Tc-WBC for identifying small-bowel and gastric inflammation in children with Crohn's disease. The (99m)Tc-WBC scans were interpreted blindly and compared to the results of colonoscopy with biopsies and surgical specimens. In 46 children, total colonoscopy was done within a few days of a (99m)Tc- WBC scan and in 13 others surgical specimens were available. Of the 37 children in whom the terminal ileum was visualized endoscopically (24) or surgically (13), the WBC-Tc(99m) scan showed a similar degree of inflammation in 33. The sensitivity of (99m)Tc-WBC scanning was 91% and the specificity 96%. The scans allowed evaluation of inflammation in the terminal ileum in 22 children in whom the endoscopist did not cannulate it; the scans were abnormal in 10 of these 22 children. In the children with no ileoscopy the results of the (99m)Tc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment, and long-term clinical follow-up. Finally, the scans of 46 controls did not reveal any false-positive findings in the terminal ileum. Five children with gastritis documented by gastroscopy had normal (99m)Tc-WBC scans and upper gastrointestinal barium studies. This study demonstrates in a large number of normal and abnormal children with different pre-test probabilities of having inflammatory bowel disease that scintigraphy is reliable in identifying small-bowel inflammation.