Mansfield J C, Giaffer M H, Tindale W B, Holdsworth C D
Gastroenterology Unit, Royal Hallamshire Hospital, Sheffield.
Gut. 1995 Nov;37(5):679-83. doi: 10.1136/gut.37.5.679.
The ideal imaging method in inflammatory bowel disease would reliably detect inflammation, identify the correct intestinal location, and assess the severity of the disease. The aim of this study was to compare scintigraphic methods of quantifying overall disease activity using both indium-111 (111In) and technetium-99M (99mTc) HMPAO labelled leucocyte scans. The four day faecal excretion of 111In was measured after 111In scintigraphy in 24 patients known to have inflammatory bowel disease. The same patients also underwent 99mTc HMPAO scanning. The scans were performed 10 days or less apart with no changes in treatment between scans. Bowel activity on the 99mTc HMPAO scans was assessed using a computer based method (scan score) and a visual grading method in a further 54 99mTc HMPAO. The results showed a close correlation between inflammatory activity defined by faecal 111In excretion and the scan score generated from the computer analysis of the 99mTc HMPAO image (Spearman rank correlation: rs = 0.78; p < 0.001). Accurate information to localise inflammatory activity could be obtained by simple visual assessment of both types of scan images, although image quality was superior with 99mTc HMPAO. Qualification of disease activity from 99mTc HMPAO images by visual grading was associated with a large variability, only 69% of scans had similar scores when graded by three observers. Computer generated image analysis was more reproducible. In conclusion, in inflammatory bowel disease 99mTc HMPAO scintigraphy and faecal 111In excretion correlated well. Either method can quantify and localise the inflammation. As 99mTc HMPAO scanning provides a quicker result, with a lower radiation dose, and avoids faecal collection, it may be the preferred method.
炎症性肠病的理想成像方法应能可靠地检测炎症、确定正确的肠道位置并评估疾病的严重程度。本研究的目的是比较使用铟 - 111（¹¹¹In）和锝 - 99m（⁹⁹ᵐTc）六甲基丙二胺肟（HMPAO）标记白细胞扫描来量化整体疾病活动的闪烁扫描方法。在24例已知患有炎症性肠病的患者进行¹¹¹In闪烁扫描后，测量¹¹¹In的四天粪便排泄量。这些患者同时也接受了⁹⁹ᵐTc HMPAO扫描。两次扫描间隔10天或更短时间，且扫描期间治疗无变化。在另外54例⁹⁹ᵐTc HMPAO扫描中，使用基于计算机的方法（扫描评分）和视觉分级方法评估⁹⁹ᵐTc HMPAO扫描上的肠道活动。结果显示，由粪便¹¹¹In排泄定义的炎症活动与通过对⁹⁹ᵐTc HMPAO图像进行计算机分析得出的扫描评分之间密切相关（Spearman等级相关性：rs = 0.78；p < 0.001）。通过对两种类型的扫描图像进行简单的视觉评估，可以获得定位炎症活动的准确信息，尽管⁹⁹ᵐTc HMPAO的图像质量更优。通过视觉分级对⁹⁹ᵐTc HMPAO图像进行疾病活动定性存在较大变异性，当由三名观察者分级时，只有69%的扫描具有相似的分数。计算机生成的图像分析更具可重复性。总之，在炎症性肠病中，⁹⁹ᵐTc HMPAO闪烁扫描与粪便¹¹¹In排泄相关性良好。两种方法均可对炎症进行量化和定位。由于⁹⁹ᵐTc HMPAO扫描结果更快、辐射剂量更低且无需收集粪便，它可能是首选方法。
