In Crohn's disease (CD), labeled leukocyte scintigraphy results are highly correlated with radioendoscopic findings and the degree of histologic inflammation. We evaluated the correlation between leukocyte activity measured by two complementary methods, polymorphonuclear leukocyte (PMN)-elastase concentration and leukocyte scintigraphy. In 20 patients with CD, labeled leukocytes, (99m)technetium hexamethyl propylene amine oxime (Tc-99m-HMPAO) scintigraphy, and PMN-elastase concentration were evaluated on the same day. A good correlation was found between PMN-elastase concentrations and the scintigraphic scores (p = 0.005; r(s) = 0.60; 95% CI, 0.20-0.83). Scintigraphy results were significantly correlated with CD activity index (p = 0.023, r(s) = 0.50). In four patients, scintigraphic scores and clinical disease activity were not consistent due to the state of PMN leukocyte activation, measured by elastase concentration. In CD, PMN-elastase can provide information about the degree of activation of PMN leukocytes and may explain discrepancy between clinical and scintigraphic indexes.

Background: Technetium Tc 99m hexamethyl propylene amine oxine (99mTc-HMPAO) has been used to radiolabel leukocytes with promising results for its clinical use in inflammatory bowel disease. During active ulcerative colitis, colonoscopy is indicated to determine the extent and the intensity of the disease for proper management. The aim of this prospective study was to determine whether 99mTc-HMPAO–labeled leukocyte scintigraphy can give information similar to that obtained with colonoscopy during acute attacks of ulcerative colitis. Methods: Thirty-three consecutive patients with 50 acute episodes of ulcerative colitis underwent 99mTc-HMPAO scintigraphy and colonoscopy with biopsies. Scintigraphic determination of disease extent and intensity were compared with those obtained by colonoscopy with biopsies and clinico-biologic markers. Results: The scintigraphic index of disease intensity was correlated with endoscopic index, Truelove index, biologic markers, and local release of interleukin-8. The extent measured by scintigraphy was well correlated to the endoscopic and histologic extent. Conclusions: 99mTc-HMPAO scintigraphy accurately determines the extent and the intensity of acute ulcerative colitis lesions. This noninvasive method can specify the extent and the intensity of an acute attack in patients with previously known ulcerative colitis. (Gastrointest Endosc 1998;48:491-6.)

Les auteurs rapportent la technique de marquage des leucocytes par l'HMPAO technetie et analysent la qualite de ce marquage. Les donnees dosimetriques sont ensuite precisees. Les indications et les resultats de l'examen sont enfin passes en revue et la place de l'examen est discutee.

The authors report on the protocol and the technical aspects of the labelling of leukocytes by Tc-HMPAO and its quality. Dosimetric concerns are discussed. Indications and results of scintigraphy are reviewed and the role of the exploration is discussed.

99mTc-HMPAO leukocyte scintigraphy was prospectively studied in 20 patients with Crohn's Disease and was compared with radio-endoscopy and with disease activity index (Crohn's Disease Activity Index, ESR, C-reactive protein). Disease localization as defined by the scan was well correlated with those visualized at endoscopy or radiography (rs = 0.90 - p = 0.0001). A scan score was calculated by evaluating uptake of the tracer in 6 bowel segments with lumbar bone marrow activity, correlation with endoscopic score was strong (rs = 0.96 - p < 0.0001). Scan score was well correlated with the Crohn's Disease Activity Index (rs = 0.63 - p = 0.0026), but no correlation was found between ESR, C-reactive protein and scan score. In four patients with ileal localization, scintigraphy was helpful to separate inflammatory from scared stenosis. Scintigraphy with 99mTc-HMPAO appeared to be useful in evaluation of Crohn's Disease activity, and for the diagnosis of complications as stenosis.

Tc-99m-HMPAO leukocyte scintigraphy was prospectively studied in 20 patients with Crohn's Disease and was compared with radio-endoscopy and with disease activity index (Crohn's Disease Activity Index, ESR, C-reactive protein). Disease localization as defined by the scan was well correlated with those visualized at endoscopy or radiography (r(s) = 0,90 p = 0,0001). A scan score was calculated by evaluating uptake of the tracer in 6 bowel segments with lumbar bone marrow activity, correlation with endoscopic score was strong (r(s) = 0,96 - p < 0,0001). Scan score was well correlated with the Crohn's Disease Activity Index (r(s) = 0,63 - p = 0,0026), but no correlation was found between ESR, C-reactive protein and scan score. In four patients with ileal localization, scintigraphy was helpful to separate inflammatory from scared stenosis. Scintigraphy with (TC)-T-99m-HMPAO appeared to be useful in evaluation of Crohn's Disease activity, and for the diagnosis of complications as stenosis.

Le syndrome de colite grave observe dans le cadre des enterocolites cryptogenetiques est une urgence medico-chirurgicale necessitant un diagnostic precis. Jusqu'a present, seuls deux examens non denues de risque, le lavement baryte et la coloscopie, permettaient d'affirmer le diagnostic. Nous rapportons le cas d'un patient chez qui la scintigraphie aux polynucleaires marques par le 99m TG-HMPAO a permis de diagnostiquer une colite grave en visualisant au niveau du colon une image specifique de double contour«

Nous avons evalue, au cours d'une etude prospective portant sur 40 patients (45 examens), la place de la scintigraphie aux leucocytes marques a l'HMPAO 99m Tc chez des patients atteints de maladie de Crohn et de rectocolite hemorragique. L'extension intestinale de la maladie, appreciee sur les images scintigraphiques a 2 h 30, a ete comparee aux donnees du bilan radio-endoscopique. L'activite de la maladie a ete appreciee par le rapport fixation intestinale / fixation osseuse obtenu sur les images a 2 h 30 et comparee au CDAI (Crohn's disease activity index). La scintigraphie a parfaitement montre l'extension des lesions dans 40 cas. L'index isotopique d'activite (base sur la comparaison numerique de l'activite en zone intestinale pathologique avec une zone rachidienne de reference) etait significativement correle avec le CDAI