Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohnʼs disease

Abstract

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.

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by 18F-FDG PET/CT

“…This is in concordance with the findings of some authors (11,15) but not others (23,26). It is possible that the smaller range of CDAI scores in our patient population (60-304) was not large enough to show differences in 18 F-FDG uptake based on this parameter.…”

“…In 48 patients with CD, 31 of 34 bowel strictures were positive for inflammation on histopathology from laparotomy, and 25 (74%) of these were positive on leukocyte scintigraphy (11). In pathologic specimens collected at our institution, CD strictures had a mean inflammatory score of 2.3 (maximum inflammation score, 3), with 83% demonstrating at least moderate inflammation and 47% having severe inflammation (Theodore M. Bayless, unpublished data, 2006).…”

“…Numerous studies have demonstrated that increased leukocyte accumulation in active IBD correlates well with disease extent and severity in CD, compared with endoscopy, histology, and fecal excretion of 111 In-leukocytes (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). For inpatients with symptoms of small bowel obstruction (a population somewhat similar to ours, though probably with more severe active disease because 76% of our patients were outpatients) and positive enteroclysis, a negative 111 In-leukocyte scan was reported to be suggestive of chronic fibrostenotic stricture, not acute inflammatory disease, due to lack of response to medical therapy (18).…”

“…Noninvasive anatomic and functional imaging modalities, including CT enteroclysis (6)(7)(8)(9), CT enterography, ultrasound, magnetic resonance enterography, and radiolabeled white blood cell and granulocyte scintigraphy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), have shown some ability to measure the extent and severity of active inflammation in CD. Neither these techniques nor endoscopy allows complete assessment of transmural inflammation or extraluminal complications of CD.…”

The role of positron emission tomography in the evaluation of inflammatory bowel disease

“…PET/CT provides an opportunity to identify the presence or absence of significant inflammation within the wall of an obstructive segment of bowel preoperatively. Other noninvasive imaging modalities—including CT enteroclysis, CT enterograpy, ultrasound, magnetic resonance enterography, and radiolabeled white blood cell granulocyte scintigraphy—can identify the extent and severity of inflammation, but as a rule, these lack the ability to completely assess transmural inflammation or extraluminal complications of CD 16 , 22–27 …”