Association between technetium-99 m albumin scintigraphy-based severity of protein-losing enteropathy and patient...

This study aimed to demonstrate the differences in Technetium-99 m albumin scintigraphy findings for patients with protein-losing enteropathy (PLE) associated with their characteristics and laboratory data.

Eighteen patients with PLE were grouped into two based on two mechanisms: direct mucosal damage and failed lymph drainage. Scintigraphy images were divided based on the timing of acquisition: images obtained at 1, 2, 4, 6, and 24 h after starting the examination. The intensity of tracer uptake was graded as follows: 3 (marked uptake equal to or greater than the liver level), 2 (moderate uptake less than liver and greater than kidney levels), 1 (mild uptake less than kidney level), and 0 (negative). The grades at each timepoint for the two groups were compared using the Mann-Whitney U test. The associations between the grades and fecal alpha-1-antitrypsin and serum total protein concentrations were evaluated using Pearson correlation coefficients.

Of 18 patients, 7 had PLE due to failed lymph drainage. The direct mucosal damage and failed lymph drainage groups had significantly different fecal alpha-1-antitrypsin concentrations [43.5 ± 29.6 (range 11-115) vs. 208.7 ± 66.0 (range 124-311), respectively; P < 0.001] and scintigraphy-based severity at 24 h [1.2 ± 0.8 (range 1-3) vs. 2.8 ± 0.4 (range 2-3), respectively; P = 0.007]. The fecal alpha-1-antitrypsin concentration was positively correlated with the scintigraphy-based severity at 6 h (r = 0.499, P = 0.049) and 24 h (r = 0.747, P = 0.002). However, the serum protein concentration was negatively correlated with the scintigraphy-based severity at 6 h (r = - 0.587, P = 0.017).

The scintigraphy-based severity at 6 and 24 h and the fecal alpha-1-antitrypsin concentrations were higher for patients with PLE due to failed lymph drainage mechanisms than for those with PLE due to direct mucosal damage. Scintigraphy can help localize the leakage point and determine disease severity to guide PLE management.