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Can 99Tcm HMPAO leucocyte scintigraphy distinguish between Crohn's disease and ulcerative colitis?
1Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK.
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99Tcm HMPAO leucocyte scintigraphy accurately distinguishes Crohn
Area of Science:
- Nuclear Medicine
- Gastroenterology
- Diagnostic Imaging
Background:
- Differentiating Crohn's disease (CD) from ulcerative colitis (UC) is crucial for appropriate patient management.
- Conventional diagnostic methods may have limitations in distinguishing these inflammatory bowel diseases.
- 99Tcm HMPAO leucocyte scintigraphy offers a potential non-invasive imaging modality.
Purpose of the Study:
- To retrospectively analyze the efficacy of 99Tcm HMPAO leucocyte scintigraphy in differentiating CD from UC.
- To establish and validate diagnostic criteria for distinguishing CD and UC using this imaging technique.
Main Methods:
- Retrospective analysis of 99Tcm HMPAO leucocyte scintigrams in 123 patients with histologically confirmed CD (83) or UC (40).
- Development of diagnostic criteria based on scintigraphic findings (e.g., location and pattern of uptake).
- Validation of criteria in an additional 62 patients and comparison with barium radiology in 63 patients.
Main Results:
- Specific scintigraphic patterns strongly suggested Crohn's disease (e.g., right iliac fossa uptake, small bowel involvement, rectal sparing).
- Left-sided colitis pattern indicated ulcerative colitis.
- High diagnostic accuracy of 98% in the validation cohort; scintigraphy (93%) outperformed barium radiology (83%) in comparative analysis.
Conclusions:
- 99Tcm HMPAO leucocyte scintigraphy is a reliable and accurate method for distinguishing between Crohn's disease and ulcerative colitis.
- The established scintigraphic criteria demonstrate high performance in differentiating these conditions.
- This imaging technique appears superior to conventional radiology for differentiating CD and UC.
Abstract:
This paper has retrospectively analysed the ability of 99Tcm HMPAO leucocyte scintigraphy to distinguish Crohn's disease from ulcerative colitis. The diagnostic criteria were established by reviewing 99Tcm HMPAO leucocyte scintigrams in 123 patients with histologically proven Crohn's disease (83) or ulcerative colitis (40). Uptake in the right iliac fossa with or without other segments of colon, irregular bowel uptake, small bowel uptake or colonic activity with rectal sparing were all strongly suggestive of Crohn's disease. Left sided colitis was found to indicate ulcerative colitis. Total colitis occurred in both ulcerative colitis and Crohn's disease. The criteria were later tested in an additional 62 patients with excellent results (accuracy 98%). In 63 patients in whom the results of barium radiology were also available, the accuracy of scintigraphy was higher (93% and 83%, respectively). We conclude that 99Tcm HMPAO leucocyte scintigraphy can accurately distinguish between Crohn's disease and ulcerative colitis in a large proportion of cases and appears to be more reliable than conventional radiology.