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Pethidine-augmented white cell scintigraphy in inflammatory bowel disease
J Davidson1, F W Poon, R G Bessent
1Department of Nuclear Medicine, Glasgow Royal Infirmary, Alexander Parade, UK. jdavidson65@hotmail.com
European Journal of Nuclear Medicine
|July 20, 2000
Summary
Pethidine reduces non-diagnostic results in Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) white cell scintigraphy for inflammatory bowel disease. This improves image interpretation by minimizing tracer excretion into the bowel.
Area of Science:
- Nuclear Medicine
- Gastroenterology
- Radiopharmacology
Background:
- Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) white cell scintigraphy is crucial for diagnosing inflammatory bowel disease (IBD).
- Image interpretation can be hindered by physiological tracer excretion into the bowel via the biliary system.
Purpose of the Study:
- To evaluate the efficacy of intravenous pethidine in reducing enterohepatic circulation of 99mTc-HMPAO.
- To improve the diagnostic accuracy of white cell scintigraphy in IBD patients.
Main Methods:
- Ninety-one patients with suspected or confirmed IBD underwent 99mTc-HMPAO scintigraphy.
- A control group (n=50) received standard imaging; an intervention group (n=41) received intravenous pethidine (0.3 mg/kg) with tracer re-injection.
- Images were assessed at 1 and 2.5 hours for diagnostic category and gallbladder visualization.
Main Results:
- The pethidine group showed significantly fewer non-diagnostic scans compared to the control group (P=0.003).
- Gallbladder visualization was significantly higher in the pethidine group (P=0.001).
- Pethidine administration correlated with reduced biliary excretion of the tracer.
Conclusions:
- Intravenous pethidine effectively reduces biliary excretion of 99mTc-HMPAO during scintigraphy.
- This intervention enhances confidence in interpreting early and delayed images, potentially decreasing the number of non-diagnostic scans in IBD assessment.