Schölmerich J, Schmidt E, Schümichen C, Billmann P, Schmidt H, Gerok W
Department of Internal Medicine, University of Freiburg, Federal Republic of Germany.
Gastroenterology. 1988 Nov;95(5):1287-93. doi: 10.1016/0016-5085(88)90363-0.
Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity. The viability of homologous labeled leukocytes was greater than 95%. Less than 5% of lymphocytes were found in the final preparation. It was found that 45% +/- 12% of the label was bound to granulocytes, and 98% of the unbound label was washed off before reinjection. The results of 99mTc scan revealed a good correlation with those of barium enema (r = 0.880, p less than 0.001), of endoscopy/surgery (r = 0.983, p less than 0.001), and of all combined reference methods (r = 0.981, p less than 0.001). Activity as determined by 99mTc scan was weakly correlated with the results of Crohn's disease activity index (r = 0.559, p less than 0.01), van Hees index (r = 0.606, p less than 0.01), and erythrocyte sedimentation rate (r = 0.456, p less than 0.05) in 24 patients with proven Crohn's disease. The correlation was improved when the 99mTc scan was compared with a combination of these activity parameters and C-reactive protein (r = 0.781, p less than 0.001). Extraintestinal manifestations (joints) and complications (cholecystitis) were also identified correctly by the 99mTc scan. The study demonstrates that leukocyte scanning with technetium 99m-hexamethyl propylene amine oxine as a label can reliably assess the location and, to a lesser degree, activity of Crohn's disease. This technique is more convenient and provides images far superior to those produced by indium 111-labeled leukocyte scanning.
我们使用一种新型的锝99m-六甲基丙烯胺肟标记技术，对29例已知或疑似克罗恩病的患者进行了研究。前瞻性地比较了锝99m-六甲基丙烯胺肟白细胞扫描（99mTc扫描）与独立进行的放射学、内镜和组织学检查结果，以及手术所见，以评估该技术在定位炎症性病变方面的临床实用性。此外，通过将肠道中锝99m-六甲基丙烯胺肟的摄取与肝脏和骨髓中的摄取进行比较，并将其与既定的疾病活动参数相关联，对肠道中锝99m-六甲基丙烯胺肟的摄取进行分级。同源标记白细胞的活力大于95%。在最终制剂中发现淋巴细胞少于5%。发现45%±12%的标记与粒细胞结合，在重新注射前98%的未结合标记被洗脱。99mTc扫描结果与钡剂灌肠结果（r = 0.880，p＜0.001）、内镜检查/手术结果（r = 0.983，p＜0.001）以及所有联合参考方法结果（r = 0.981，p＜0.001）显示出良好的相关性。在24例确诊为克罗恩病的患者中，99mTc扫描所确定的活动度与克罗恩病活动指数结果（r = 0.559，p＜0.01）、范赫斯指数（r = 0.606，p＜0.01）以及红细胞沉降率（r = 0.456，p＜0.05）呈弱相关。当99mTc扫描与这些活动参数和C反应蛋白的组合进行比较时，相关性得到改善（r = 0.781，p＜0.001）。99mTc扫描也能正确识别肠外表现（关节）和并发症（胆囊炎）。该研究表明，以锝99m-六甲基丙烯胺肟为标记的白细胞扫描能够可靠地评估克罗恩病的病变部位，在一定程度上还能评估其活动度。该技术更便捷，所提供的图像远优于铟111标记白细胞扫描所产生的图像。
