Bennink R, Peeters M, D'Haens G, Rutgeerts P, Mortelmans L
Department of Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.
Clin Nucl Med. 2001 Feb;26(2):99-104. doi: 10.1097/00003072-200102000-00001.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease with frequent exacerbations, including the risk for toxic megacolon and severe complications. In very active disease, colonoscopy should not be performed to assess the severity and the extent of the disease. The aim of the current study was to determine whether Tc-99m HMPAO-labeled white blood cell (WBC) scintigraphy can be used as an alternative to colonoscopy to determine the extent and the severity of the disease in critically ill patients.
Twenty consecutive patients (7 women, 13 men; age 38.1 +/- 13.1 years) who had a severe attack of UC underwent scintigraphy on the day of admission. Leukocytes were labeled with 200 MBq (5.35 mCi) Tc-99m HMPAO. Planar anterior and posterior imaging of the abdomen was performed 45 and 120 minutes after WBC reinjection. The tracer uptake in the different colon segments was scored visually compared with bone marrow uptake. A symptom score was made and C-reactive protein was measured as a serologic marker of inflammation. Rectosigmoidoscopy with biopsy was performed within 24 hours of scintigraphy. Scintigraphic, endoscopic, and histologic results were compared for disease activity.
The mean symptom score was 12.7 (+/-0.7) on a scale of 21, and mean the C-reactive protein level was 6.8 (+/-1.2) mg/l. No significant difference was found between the scintigraphic score of the rectum and the endoscopic or the histologic score. The best correlation was found with the latter (r = 0.66, P < 0.01). Based on the results of scintigraphy, disease involved the left side of the colon up to the splenic flexure in 10 patients. The other patients had pancolitis.
Disease severity can be determined adequately by planar WBC scintigraphy in patients with severe attacks of UC. Because the presence and severity of disease correlates well with endoscopic and histologic findings, WBC scintigraphy can assess disease extent without the need for colonoscopy. This decreases the number and severity of complications that can occur in already critically ill patients.
溃疡性结肠炎（UC）是一种慢性炎症性肠病，常频繁发作，包括发生中毒性巨结肠和严重并发症的风险。在疾病非常活跃时，不应进行结肠镜检查以评估疾病的严重程度和范围。本研究的目的是确定锝-99m六甲基丙烯胺肟（Tc-99m HMPAO）标记的白细胞（WBC）闪烁扫描是否可作为结肠镜检查的替代方法，用于确定危重症患者疾病的范围和严重程度。
连续20例（7例女性，13例男性；年龄38.1±13.1岁）重度UC发作患者在入院当天接受闪烁扫描。白细胞用200 MBq（5.35 mCi）Tc-99m HMPAO标记。白细胞回注后45分钟和120分钟进行腹部前后位平面显像。将不同结肠段的示踪剂摄取与骨髓摄取进行视觉评分。进行症状评分，并测定C反应蛋白作为炎症的血清学标志物。在闪烁扫描后24小时内进行直肠乙状结肠镜检查及活检。比较闪烁扫描、内镜检查和组织学检查结果以评估疾病活动度。
症状评分平均为12.7（±0.7）（满分21分），C反应蛋白平均水平为6.8（±1.2）mg/l。直肠闪烁扫描评分与内镜或组织学评分之间未发现显著差异。与后者相关性最佳（r = 0.66，P < 0.01）。根据闪烁扫描结果，10例患者疾病累及结肠左侧直至脾曲。其他患者为全结肠炎。
平面WBC闪烁扫描可充分确定重度UC发作患者的疾病严重程度。由于疾病的存在和严重程度与内镜及组织学检查结果相关性良好，WBC闪烁扫描无需结肠镜检查即可评估疾病范围。这减少了已处于危重症患者中可能发生的并发症的数量和严重程度。
