open access

Vol 23, No 1 (2020)
Original articles
Published online: 2020-01-15
Submitted: 2019-07-26
Accepted: 2019-09-26
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Can inflammatory markers and clinical indices serve as useful referral criteria for leukocyte scan with inflammatory bowel disease?

Tihana Klarica Gembić, Domagoj Kustić, Josipa Vukšić, Dražen Huić
DOI: 10.5603/NMR.a2020.0002
·
Pubmed: 32779169
·
Nucl. Med. Rev 2020;23(1):15-20.

open access

Vol 23, No 1 (2020)
Original articles
Published online: 2020-01-15
Submitted: 2019-07-26
Accepted: 2019-09-26

Abstract

Background: In the follow-up of patients with inflammatory bowel disease (IBD), Tc-99m-HMPAO labelled leukocytes scintigraphy (leukocyte scan; LS) has long been established as a valuable diagnostic tool. The aim of this study was to estimate the relationship between scintigraphic results, inflammatory markers (IM) (including white blood cells (WBCs) and C-reactive protein (CRP)), clinical parameters and clinical indices of the disease activity (CI), in order to determine clinical settings in which LS is indicated. Materials and methods: A total of 147 patients who underwent LS, (79 males, 68 females, median age 36), were examined from April 2010 until December 2017 at the University Hospital Centre Zagreb, Croatia. Among these, 126 (86%) had Crohn's disease (CD) and 21 (14%) had ulcerative colitis (UC). Either increased IM (either WBCs ≥10x109/L and/or CRP ≥7.4 mg/L) and/or CI, Crohn's disease activity index (CDAI) score ≥220 points, Harvey-Bradshaw index (HBI) score ≥8 points, and severe colitis defined according to Truelove and Witts' criteria (TWC) for UC, respectively, were considered consistent with active disease. Results: Eighty-two patients (56%) had negative scans, while in 65 (44%) the scans were positive. Positive correlations were found between LS and all of the 3 parameters, WBCs, CRP and CI. When combined, the 3 parameters demonstrated even stronger positive correlation with the LS results with the correlation coefficient 0.76 (p<0.0001, 95% CI [0.68-0.82]). Using endoscopy and histological study findings of the obtained specimens as a composite reference standard, the overall sensitivity, specificity, positive predictive value and negative predictive value of IM and CI for LS were determined, being 91%, 85%, 83%, and 92%, respectively. IM and CI were both negative in 76 (52%) out of the total subjects. Of these, 70 had negative LS as well. Conclusion: In the presence of normal IM with CI pointing to no active or mildly active disease, LS is not necessarily indicated,

Abstract

Background: In the follow-up of patients with inflammatory bowel disease (IBD), Tc-99m-HMPAO labelled leukocytes scintigraphy (leukocyte scan; LS) has long been established as a valuable diagnostic tool. The aim of this study was to estimate the relationship between scintigraphic results, inflammatory markers (IM) (including white blood cells (WBCs) and C-reactive protein (CRP)), clinical parameters and clinical indices of the disease activity (CI), in order to determine clinical settings in which LS is indicated. Materials and methods: A total of 147 patients who underwent LS, (79 males, 68 females, median age 36), were examined from April 2010 until December 2017 at the University Hospital Centre Zagreb, Croatia. Among these, 126 (86%) had Crohn's disease (CD) and 21 (14%) had ulcerative colitis (UC). Either increased IM (either WBCs ≥10x109/L and/or CRP ≥7.4 mg/L) and/or CI, Crohn's disease activity index (CDAI) score ≥220 points, Harvey-Bradshaw index (HBI) score ≥8 points, and severe colitis defined according to Truelove and Witts' criteria (TWC) for UC, respectively, were considered consistent with active disease. Results: Eighty-two patients (56%) had negative scans, while in 65 (44%) the scans were positive. Positive correlations were found between LS and all of the 3 parameters, WBCs, CRP and CI. When combined, the 3 parameters demonstrated even stronger positive correlation with the LS results with the correlation coefficient 0.76 (p<0.0001, 95% CI [0.68-0.82]). Using endoscopy and histological study findings of the obtained specimens as a composite reference standard, the overall sensitivity, specificity, positive predictive value and negative predictive value of IM and CI for LS were determined, being 91%, 85%, 83%, and 92%, respectively. IM and CI were both negative in 76 (52%) out of the total subjects. Of these, 70 had negative LS as well. Conclusion: In the presence of normal IM with CI pointing to no active or mildly active disease, LS is not necessarily indicated,

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Keywords

inflammatory bowel disease; Crohn' s disease; Ulcerative colitis; leukocyte scan; white blood cells scintigraphy; inflammatory markers

About this article
Title

Can inflammatory markers and clinical indices serve as useful referral criteria for leukocyte scan with inflammatory bowel disease?

Journal

Nuclear Medicine Review

Issue

Vol 23, No 1 (2020)

Pages

15-20

Published online

2020-01-15

DOI

10.5603/NMR.a2020.0002

Pubmed

32779169

Bibliographic record

Nucl. Med. Rev 2020;23(1):15-20.

Keywords

inflammatory bowel disease
Crohn's disease
Ulcerative colitis
leukocyte scan
white blood cells scintigraphy
inflammatory markers

Authors

Tihana Klarica Gembić
Domagoj Kustić
Josipa Vukšić
Dražen Huić

References (20)
  1. Viscido A, Aratari A, Maccioni F, et al. Inflammatory bowel diseases: clinical update of practical guidelines. Nucl Med Commun. 2005; 26(7): 649–655.
  2. Karlinger K, Györke T, Makö E, et al. The epidemiology and the pathogenesis of inflammatory bowel disease. European Journal of Radiology. 2000; 35(3): 154–167.
  3. Hommes DW, van Deventer SJH. Endoscopy in inflammatory bowel diseases. Gastroenterology. 2004; 126(6): 1561–1573.
  4. Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology. 2007; 133(5): 1670–1689.
  5. Bernklev T, Jahnsen J, Lygren I, et al. Health-related quality of life in patients with inflammatory bowel disease measured with the short form-36: psychometric assessments and a comparison with general population norms. Inflamm Bowel Dis. 2005; 11(10): 909–918.
  6. Becker HM, Grigat D, Ghosh S, et al. Living with inflammatory bowel disease: A Crohn's and Colitis Canada survey. Can J Gastroenterol Hepatol. 2015; 29(2): 77–84.
  7. Golovics PA, Mandel MD, Lovasz BD, et al. Inflammatory bowel disease course in Crohn's disease: is the natural history changing? World J Gastroenterol. 2014; 20(12): 3198–3207.
  8. Stathaki MI, Koukouraki SI, Karkavitsas NS, et al. Role of scintigraphy in inflammatory bowel disease. World J Gastroenterol. 2009; 15(22): 2693–2700.
  9. Annovazzi A, Bagni B, Burroni L, et al. Nuclear medicine imaging of inflammatory/infective disorders of the abdomen. Nucl Med Commun. 2005; 26(7): 657–664.
  10. Peyrin-Biroulet L, Panés J, Sandborn WJ, et al. Defining Disease Severity in Inflammatory Bowel Diseases: Current and Future Directions. Clin Gastroenterol Hepatol. 2016; 14(3): 348–354.e17.
  11. Magro F, Gionchetti P, Eliakim R, et al. European Crohn’s and Colitis Organisation [ECCO]. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017; 11(6): 649–670.
  12. de Vries EFJ, Roca M, Jamar F, et al. Guidelines for the labelling of leucocytes with (99m)Tc-HMPAO. Inflammation/Infection Taskgroup of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2010; 37(4): 842–848.
  13. Moran CP, Neary B, Doherty GA. Endoscopic evaluation in diagnosis and management of inflammatory bowel disease. World J Gastrointest Endosc. 2016; 8(20): 723–732.
  14. Viennois E, Zhao Y, Merlin D. Biomarkers of Inflammatory Bowel Disease: From Classical Laboratory Tools to Personalized Medicine. Inflamm Bowel Dis. 2015; 21(10): 2467–2474.
  15. Fengming Yi, Jianbing Wu. Biomarkers of inflammatory bowel disease. Dis Markers. 2014; 2014: 710915.
  16. Haas K, Rubesova E, Bass D. Role of imaging in the evaluation of inflammatory bowel disease: How much is too much? World J Radiol. 2016; 8(2): 124–131.
  17. Becker W, Fischbach W, Weppler M, et al. Radiolabelled granulocytes in inflammatory bowel disease: diagnostic possibilities and clinical indications. Nucl Med Commun. 1988; 9(10): 693–701.
  18. Panes J, Bouhnik Y, Reinisch W, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 2013; 7(7): 556–585.
  19. Cappello M, Morreale GC. The Role of Laboratory Tests in Crohn's Disease. Clin Med Insights Gastroenterol. 2016; 9: 51–62.
  20. Rispo A, Imbriaco M, Celentano L, et al. Noninvasive diagnosis of small bowel Crohn's disease: combined use of bowel sonography and Tc-99m-HMPAO leukocyte scintigraphy. Inflamm Bowel Dis. 2005; 11(4): 376–382.

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