锝-99m HMPAO标记白细胞闪烁扫描术作为疑似炎症性肠病患者初始筛查试验的价值。

Value of technetium-99m HMPAO-labelled leucocyte scintigraphy as an initial screening test in patients suspected of having inflammatory bowel disease.

作者信息

Giaffer M H, Tindale W B, Holdsworth D

机构信息

Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.

出版信息

Eur J Gastroenterol Hepatol. 1996 Dec;8(12):1195-200. doi: 10.1097/00042737-199612000-00012.

DOI:10.1097/00042737-199612000-00012

PMID:8980940

Abstract

OBJECTIVE

This study was designed to evaluate the role of technetium-99m (99mTc) hexamethyl propylene amine oxime (HMPAO)-labelled leucocyte imaging as an initial screening test in patients suspected of having inflammatory bowel disease (IBD).

PATIENTS AND METHODS

Thirty-one patients in whom a final diagnosis of irritable bowel syndrome (IBS) was made (group 1) and another 33 patients with established Crohn's disease (group 2) were studied. All patients had 99mTc HMPAO-labelled leucocyte scan with imaging at 40 and 120 min. Scans with abnormal bowel uptake were considered positive and this uptake was quantified by visual grading and computer-based methods (scan score). Group 1 patients with positive 99mTc HMPAO scan underwent an indium-111 (111In)-labelled leucocyte scan (imaging at 180 min) followed by endoscopy and barium radiology as deemed necessary in order to verify the 99m Tc HMPAO result.

RESULTS

Three scan patterns were seen: well localized and unequivocally positive scans at both 40 min and 2 h were obtained from 28 patients. All but one had established Crohn's disease. Diffuse bowel uptake was seen in 14 scans. Ten of these (false positive) were obtained from symptomatic patients with IBS and four (false negative) from patients with asymptomatic Crohn's disease. No bowel uptake at 40 min and 2 h was seen in 22 scans. All but two of these (who had quiescent Crohn's disease) were obtained from patients with IBS. Active Crohn's disease is associated with significantly higher scan score (mean +/- SEM, 82.1 +/- 13.6) than the false positive scans (12.5 +/- 3.1, P > or = 0.001). Patients with false positive 99mTc HMPAO scans had negative 111In scans, endoscopy and barium radiology.

CONCLUSION

Bowel scanning using either 111In or 99mTc HMPAO is useful in excluding active IBD. Because of radiation dose, image quality and availability 99mTc may be preferred to 111In.

摘要

目的

本研究旨在评估锝-99m（99mTc）六甲基丙烯胺肟（HMPAO）标记的白细胞显像作为疑似炎症性肠病（IBD）患者初步筛查试验的作用。

患者与方法

研究了31例最终诊断为肠易激综合征（IBS）的患者（第1组）和另外33例确诊为克罗恩病的患者（第2组）。所有患者均进行了99mTc HMPAO标记的白细胞扫描，并在40分钟和120分钟时进行显像。肠道摄取异常的扫描被视为阳性，并通过视觉分级和基于计算机的方法（扫描评分）对这种摄取进行量化。第1组中99mTc HMPAO扫描阳性的患者接受了铟-111（111In）标记的白细胞扫描（180分钟时显像），随后根据需要进行内镜检查和钡剂放射学检查，以验证99mTc HMPAO的结果。

结果

观察到三种扫描模式：28例患者在40分钟和2小时时均获得了定位良好且明确阳性的扫描结果。除1例患者外，其余均为确诊的克罗恩病患者。14次扫描中可见弥漫性肠道摄取。其中10次（假阳性）来自有症状的IBS患者，4次（假阴性）来自无症状的克罗恩病患者。22次扫描在40分钟和2小时时未见肠道摄取。除2例（患有静止期克罗恩病）外，其余均来自IBS患者。活动期克罗恩病的扫描评分（均值±标准误，82.1±13.6）显著高于假阳性扫描（12.5±3.1，P≥0.001）。99mTc HMPAO扫描假阳性的患者111In扫描、内镜检查和钡剂放射学检查均为阴性。