Celentano L, Cirillo L C, D'Arienzo A, De Santis D A
Diapartimento Assistenziale di Diagnostica per Immagini e Radioterapia, Istituto di Scienze Radiologiche, Università degli Studi di Napoli, Federico II.
Radiol Med. 1996 Oct;92(4):398-404.
Enema is the primary imaging method in the diagnosis of Crohn's disease in the small bowel, with clinical follow-up examinations performed by gastroenterologists as the gold standard. The information provided by small bowel enema, in addition to endoscopic findings, is usually sufficient for the gastroenterologist to make the definitive diagnosis and to plan the whole treatment. Scintigraphy with leukocytes labelled with HMPAO-Tc99m has several unique characteristics favoring its use as a diagnostic imaging method in Crohn's disease and ulcerative colitis. It is a noninvasive method requiring no bowel preparation and it is safe in severely ill patients in whom such conventional imaging methods as barium enema or colonscopy might be hazardous. In this study, the authors report the results of their experience with diagnostic small bowel enema and leukocyte scintigraphy with HMPAO-Tc99m in 28 patients with inflammatory bowel disease (Crohn's disease in 18 patients, ulcerative colitis in 7 and radiation-induced inflammatory stenosis of the sigma-rectum, bowel inflammation after appendicectomy and bladder surgery, respectively, in 1 patient each). Scintigraphy with autologous granulocytes with HMPAO-Tc99m was positive in 26 patients and negative in 2. Twenty-five patients were true positives and 1 was a false positive. Fifteen patients were also submitted to small bowel enema: 12 of them were positive (true positive) and 3 negative (1 false negative and 2 true negative). The results of granulocytes scintigraphy were compared with those of small bowel enema: the radionuclide study appeared superior in the assessment of bowel inflammation associated with Crohn's disease and ulcerative colitis. Indeed, scintigraphy depicted granulocyte uptake in the colon where enema had shown no major findings in 4 patients with Crohn's disease. In the author's opinion, the overall sensitivity, specificity and positive predictive value of combined leukocyte scintigraphy and small bowel enema play a major role in the early diagnosis of Crohn's disease and ulcerative colitis and in the assessment of disease extent and activity.
小肠灌肠是诊断小肠克罗恩病的主要影像学方法，胃肠病学家进行的临床随访检查是金标准。除内镜检查结果外，小肠灌肠提供的信息通常足以让胃肠病学家做出明确诊断并规划整个治疗方案。用锝-99m标记的六甲基丙烯胺肟（HMPAO）标记白细胞的闪烁扫描法有几个独特的特点，使其适合用作克罗恩病和溃疡性结肠炎的诊断成像方法。它是一种非侵入性方法，无需肠道准备，对于病情严重的患者是安全的，而钡剂灌肠或结肠镜检查等传统成像方法对这些患者可能有风险。在本研究中，作者报告了他们对28例炎症性肠病患者（18例克罗恩病、7例溃疡性结肠炎、1例分别为乙状结肠-直肠放射性炎症狭窄、阑尾切除术后肠道炎症和膀胱手术后肠道炎症）进行诊断性小肠灌肠和用锝-99m标记的六甲基丙烯胺肟（HMPAO）白细胞闪烁扫描的经验结果。用锝-99m标记的六甲基丙烯胺肟（HMPAO）自体粒细胞闪烁扫描在26例患者中呈阳性，2例呈阴性。25例为真阳性，1例为假阳性。15例患者还接受了小肠灌肠：其中12例阳性（真阳性），3例阴性（1例假阴性和2例真阴性）。将粒细胞闪烁扫描结果与小肠灌肠结果进行比较：放射性核素研究在评估与克罗恩病和溃疡性结肠炎相关的肠道炎症方面似乎更具优势。事实上，闪烁扫描显示4例克罗恩病患者的结肠有粒细胞摄取，而灌肠未显示主要异常。作者认为，联合白细胞闪烁扫描和小肠灌肠的总体敏感性、特异性和阳性预测值在克罗恩病和溃疡性结肠炎的早期诊断以及疾病范围和活动度评估中起主要作用。
