open access

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

Tihana Klarica Gembić1, Domagoj Kustić1, Josipa Vukšić2, Dražen Huić3
DOI: 10.5603/NMR.a2020.0002
·
Pubmed: 32779169
·
Nucl. Med. Rev 2020;23(1):15-20.
Affiliations
  1. University Hospital Centre Rijeka, Kresimirova 42, 51000 Rijeka, Croatia
  2. General Hospital Šibenik, Šibenik, Croatia
  3. University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia

open access

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

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)

Article type

Research paper

Pages

15-20

Published online

2020-01-15

Page views

594

Article views/downloads

563

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

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