Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease

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Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease

Almer, Sven, 1953- (author): Östergötlands Läns Landsting,Linköpings universitet,Hälsouniversitetet,Gastroenterologi och hepatologi,Endokrin- och magtarmmedicinska kliniken US

Granerus, Göran, 1939- (author): Östergötlands Läns Landsting,Linköpings universitet,Hälsouniversitetet,Klinisk fysiologi,Fysiologiska kliniken

Ström, Magnus, 1945- (author): Östergötlands Läns Landsting,Linköpings universitet,Hälsouniversitetet,Gastroenterologi och hepatologi,Endokrin- och magtarmmedicinska kliniken US

Olaison, Gunnar (author)

Bonnet, Joëlle (author)

Lémann, Marc (author)

Smedh, Kennet (author): Uppsala universitet,Centrum för klinisk forskning, Västerås

Franzén, Lennart (author)

Bertheau, Philippe (author)

Cattan, Pierre (author)

Rain, Jean-Didier (author)

Modigliani, Robert (author)

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(creator_code:org_t)

Oxford University Press (OUP), 2007
2007
English.
In: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 13:2, s. 164-174

Related links:: http://www.ncbi.nlm....; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; https://urn.kb.se/re...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background: Leukocyte scintigraphy is a noninvasive investigation to assess inflammation. We evaluated the utility of labeled leukocytes to detect small bowel inflammation and disease complications in Crohn's disease and compared it to whole small bowel enteroscopy and laparotomy findings.Methods: Scintigraphy with technetium-99m exametazime-labeled leukocytes was prospectively performed in 48 patients with Crohn's disease a few days before laparotomy; 41 also had an intraoperative small bowel enteroscopy. The same procedures were performed in 8 control patients. Independent grading of scans was compared with the results of enteroscopy and with surgical, histopathologic, and clinical data.Results: In the 8 control patients leukocyte scan, endoscopy, and histopathology were all negative for the small bowel. In patients with Crohn's disease and small bowel inflammation seen at enteroscopy and/or laparotomy (n = 39) the scan was positive in 33. In 8 patients without macroscopic small bowel inflammation, the scan was positive for the small bowel in 3 patients; at histology, 2 of 3 had inflammation. When combining results for patients and controls, the sensitivity of leukocyte scan for macroscopically evident small bowel inflammation was 0.85, specificity 0.81, accuracy 0.84, positive predictive value 0.92, and negative predictive value 0.68. Scintigraphy detected inflammatory lesions not known before laparotomy in 16 of 47 (34%) Crohn's disease patients and showed uptake in 25 of 35 (71%) bowel strictures. It was diagnostic regarding 4 of 8 abscesses and 9 of 15 fistulas. In 6 patients (13%) lesions first demonstrated by leukocyte scintigraphy were treated during the surgery performed.Conclusions: Leukocyte scintigraphy reliably detects small bowel inflammation in Crohn's disease. It gives additional information on the presence of inflammatory lesions in a fraction of patients planned for surgery.

Keyword

Adolescent
Adult
Aged
Crohn Disease/*diagnosis/radionuclide imaging/surgery
Endoscopy; Gastrointestinal
Female
Humans
Ileum/pathology/radionuclide imaging
Intestine; Small
Intraoperative Period
Jejunum/pathology/radionuclide imaging
Laparotomy
Leukocytes
Male
Middle Aged
Predictive Value of Tests
Radiopharmaceuticals/*diagnostic use
Sensitivity and Specificity
Technetium Tc 99m Exametazime/*diagnostic use
MEDICINE
MEDICIN

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By the author/editor: Almer, Sven, 195 ...; Granerus, Göran, ...; Ström, Magnus, 1 ...; Olaison, Gunnar; Bonnet, Joëlle; Lémann, Marc; show more...; Smedh, Kennet; Franzén, Lennart; Bertheau, Philip ...; Cattan, Pierre; Rain, Jean-Didie ...; Modigliani, Robe ...; show less...

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