Charron M, del Rosario J F, Kocoshis S A
Department of Radiology, Children's Hospital of Pittsburgh, PA 15213, USA.
Nucl Med Commun. 1998 Aug;19(8):753-9. doi: 10.1097/00006231-199808000-00005.
We retrospectively evaluated the incidence of late accumulation of 99Tcm-HMPAO leukocytes (99Tcm-WBC) in the right lower quadrant of a large population of children and characterized some predictive patterns that would enable differentiation of active inflammation from this late occasional accumulation of 99Tcm-WBC. We reviewed the charts of 211 children. The first group evaluated consisted of 79 controls: 30 normal children with no gastrointestinal disease, but who underwent 99Tcm-WBC scanning for other medical problems, and 49 children who had non-specific gastrointestinal (GI) complaints, but had no demonstrable inflammatory bowel disease by conventional diagnostic methods. The second group consisted of 132 children with inflammatory bowel disease: 80 children with Crohn's disease (CD), 34 with ulcerative colitis (UC) and 18 with indeterminate colitis (IC). Children were imaged at 30 min and 3 h. Fifteen (19%) of the 79 controls scanned showed accumulation of 99Tcm-WBC in the right lower quadrant at 3 h and none at 30 min. Of those 15, 8 were from the control population and 7 from the group with non-specific GI complaints and negative work-ups. There was no uptake in other segments of the bowel. The accumulation was faint, of lesser intensity than in the iliac wing, and diffuse, such that identification of a specific loop of involved bowel was not possible. Migration of the 99Tcm-WBC distal to the terminal ileum was demonstrated. The other 64 children in the control group showed no accumulation of 99Tcm-WBC at any time during their scans. All 79 scans were blindly interpreted as normal studies. There were no false-positive readings encountered in the 132 children with inflammatory bowel disease (80 CD, 34 UC, 18 IC) when the aforementioned characteristics of the late accumulation of 99Tcm were used to differentiate inflammation from this physiological excretion. In conclusion, the late accumulation of 99Tcm-WBC in the right lower quadrant is characterized by (1) accumulation at no less that 3 h, (2) no accumulation in other segments of the bowel, (3) faint accumulation of lesser intensity than in the iliac wing, (4) a diffuse accumulation pattern and (5) migration of the 99Tcm-WBC into the caecum and ascending colon over time. Recognition of this excretion pattern enables differentiation of active Crohn's disease of the small bowel from migration and accumulation of 99Tcm-WBC in the right lower quadrant of the abdomen.
我们回顾性评估了大量儿童右下象限99锝-六甲基丙二胺肟白细胞（99锝-白细胞）晚期聚集的发生率，并确定了一些预测模式，以便能够区分活动性炎症与99锝-白细胞这种偶尔出现的晚期聚集。我们查阅了211名儿童的病历。第一组评估对象为79名对照者：30名无胃肠道疾病但因其他医疗问题接受99锝-白细胞扫描的正常儿童，以及49名有非特异性胃肠道（GI）主诉但通过传统诊断方法未发现炎症性肠病的儿童。第二组由132名炎症性肠病儿童组成：80名克罗恩病（CD）患儿、34名溃疡性结肠炎（UC）患儿和18名不确定性结肠炎（IC）患儿。儿童在30分钟和3小时时进行成像。79名接受扫描的对照者中，有15名（19%）在3小时时右下象限出现99锝-白细胞聚集，30分钟时无聚集。在这15名中，8名来自对照人群，7名来自非特异性GI主诉且检查结果为阴性的组。肠道其他节段无摄取。聚集较淡，强度低于髂骨翼，且呈弥漫性，无法识别特定的受累肠袢。显示99锝-白细胞向回肠末端远端迁移。对照组的其他64名儿童在扫描过程中的任何时候均未出现99锝-白细胞聚集。所有79次扫描均被盲目解读为正常检查。当利用99锝晚期聚集的上述特征将炎症与这种生理性排泄区分开来时，132名炎症性肠病儿童（80名CD、34名UC、18名IC）中未遇到假阳性读数。总之，右下象限99锝-白细胞晚期聚集的特征为：（1）至少在3小时时出现聚集；（2）肠道其他节段无聚集；（3）聚集较淡，强度低于髂骨翼；（4）呈弥漫性聚集模式；（5）随着时间推移99锝-白细胞迁移至盲肠和升结肠。认识到这种排泄模式有助于区分小肠活动性克罗恩病与99锝-白细胞在右下象限的迁移和聚集。
