The value of 99mTc-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation

Abstract

Various imaging studies can be performed in the evaluation of patients with a clinical presentation equivocal for acute appendicitis. One of these studies is technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled white blood cell (WBC) scintigraphy. The aim of this study was to evaluate the accuracy and clinical value of 99mTc-HMPAO WBC scintigraphy in the aforementioned group of patients. Forty-one patients who had acute right lower quadrant abdominal pain with a clinical presentation equivocal for acute appendicitis were included in the study. The anterior abdomen and pelvis were imaged up to 4 h after the injection of 125-300 MBq 99mTc-HMPAO WBCs and the results were immediately reported to the surgeon before a decision was taken on whether to perform laparotomy. Diagnostic accuracy was established by the intra-operative findings and the histopathology in operated patients. In non-operated patients, absence of abdominal symptoms 1 month after scintigraphy and/or identification of another cause of abdominal pain was used to rule out acute appendicitis. There were 16 patients with positive scintigraphy and 81% of these patients were positive within 2 h post injection. There were no false-positive or false-negative results. We operated on 17 (41.4%) patients, and only one patient (5.9%) underwent unnecessary laparotomy. We conclude that 99mTc-HMPAO WBC scintigraphy is a rapid, highly accurate method for the exclusion of acute appendicitis and that its use can lower the unnecessarily high laparotomy rate in patients with an equivocal clinical presentation.

Nuclear medicine imaging of inflammatory/infective disorders of the abdomen

“…Nevertheless, a WBC scan is time consuming and requires the handling of blood. No significant difference emerges concerning the protocol to be used (up to 2 h or to 4 h), but in one of the few comparative studies, the 4 h acquisition shows a 100% sensitivity versus 80% for the early acquisition only [61]. The use of MoAbs, although more expensive, should be considered as the first option.…”

Tc-99m Labeled HMPAO white Blood Cell Scintigraphy in Pediatric Patients

“…The rate of complications, including death, is directly correlated with delay in diagnosis and surgery (32). The fact that no single laboratory test is 100% accurate for diagnosing appendicitis exacerbates the problem.…”

A review of the studies about appendicitis of the Turkish Pediatric Surgical Centers and a preliminary study to form a publishing index for pediatric appendicitis.

“…Yirmi sekiz merkezin 69 çalışma-sında 16.102 apandisit tanısından 1185'inin (%7) kuş olduğu hesaplanmıştır (10,18,24,41,50-54,60-62,64,68,70-74,77-80,87,88 ,94,95,104,105,111,112,117,176,177,182,186,187,190,191,195,197,198,200,202,205,222, 223,227-230,251-253,258,260-262,266,294,309,334-337,342-344,358) . Bildirilen en düşük sıklık %1 (202) , en yüksek sıklık %17 (104,105) olup, 28 merkezin 11'inde sıklık ortalama değer olan %7'nin altında, 14'ünde ise bu rakamın üzerindedir. (351,352) dren kullanma/kullanmama, 1'inde ise (205) radyolojik inceleme maliyetleri incelenmiştir.…”

“…Sintigrafi: Şüpheli olgularda gereksiz apandektomi sıklığını azaltmada yararlı olabileceği (104) , diğer yön-temlerle tanı hala şüpheli ise kullanılabileceği (284) öne sürülmüş ve deneysel çalışma ile apandisit olguları için 99mTc sitrat'ın DMSA ve 67Ga sitrattan daha üstün olduğu bildirilmiştir (282,283) .…”