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Investigating inflammatory bowel disease--white cell scanning, radiology, and colonoscopy
J C Jobling1, K J Lindley, Y Yousef
1Great Ormond Street Hospital for Children, NHS Trust, London.
Insights
Technetium-99m-HMPAO labelled white cell scan (Tc-WCS) is a sensitive, specific, and non-invasive method for diagnosing inflammatory bowel disease in children. Barium follow-through (Ba-FT) has low sensitivity and high radiation, while colonoscopy is effective when expertise is available.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Inflammatory Bowel Disease
Background:
- Inflammatory bowel disease (IBD) diagnosis in children requires accurate and minimally invasive methods.
- Evaluating the efficacy of various diagnostic modalities is crucial for optimal patient management.
Purpose of the Study:
- To compare the diagnostic performance of technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow-through (Ba-FT), and colonoscopy in children with suspected IBD.
Main Methods:
- A prospective study involving 39 children with suspected IBD over three years.
- Investigated diagnostic methods included Tc-WCS, Ba-FT, and colonoscopy with biopsy.
- Histological confirmation was used as the gold standard.
Main Results:
- Tc-WCS demonstrated high sensitivity (90%) in diagnosing IBD.
- Colonoscopy showed 87% sensitivity, while Ba-FT had a lower sensitivity (42%).
- Tc-WCS was found to be non-invasive with high accuracy.
Conclusions:
- Tc-WCS is recommended as a sensitive, specific, and non-invasive first-line investigation for suspected pediatric IBD.
- The role of Ba-FT needs re-evaluation due to its high radiation burden and lower sensitivity.
- Colonoscopy with biopsy is effective but requires appropriate facilities and expertise.
Objective:
To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease.
Design:
Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken.
Setting:
Great Ormond Street Hospital for Children, London.
Subjects:
39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years).
Main Outcome Measures:
There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%).
Conclusion:
The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.