Skip to main content
PMC home page
Gut logoLink to Gut
. 1995 Feb;36(2):243–250. doi: 10.1136/gut.36.2.243

Quantification of inflammatory bowel disease activity using technetium-99m HMPAO labelled leucocyte single photon emission computerised tomography (SPECT).

M J Weldon 1, A M Masoomi 1, A J Britten 1, J Gane 1, C J Finlayson 1, A E Joseph 1, J D Maxwell 1
PMCID: PMC1382411  PMID: 7883224

Abstract

Technetium-99m HMPAO labelled white cell bowel uptake was quantified in 23 patients with suspected colitis by means of the novel technique of single photon emission computerised tomography (SPECT) using a standard gamma-camera. Uptake in colon segments was quantified on transaxial images and expressed as a fraction of marrow uptake (SPECT score). Segmental histological disease activity was assessed at colonoscopy (20) or at surgery (3). Segmental histology score correlated with SPECT score r = 0.79 (p < 0.001). Overall SPECT score for all affected segments correlated with Crohn's disease activity index (CDAI) r = 0.66, p = 0.001 and with laboratory activity indices; erythrocyte sedimentation rate r = 0.44, p = 0.03, C reactive protein r = 0.38, p = 0.05, and albumin r = -0.46, p = 0.03. Small bowel SPECT score in 13 patients correlated with CDAI r = 0.65, p < 0.01 but not with erythrocyte sedimentation rate or C reactive protein. Five patients with positive small bowel white cell uptake had normal C reactive protein and erythrocyte sedimentation rate. Overall SPECT score for disease at all sites correlated with both CDAI and with laboratory indices of inflammation. 99mTc HMPAO SPECT provides non-invasive and accurate quantification of inflammatory bowel disease activity in both large and small bowel and may be useful in the objective evaluation of treatment for inflammatory bowel disease.

Full text

PDF
244

Images in this article

244Figure 1
on p.244
246Figure 3
on p.246
247Figure 4
on p.247

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almer S., Franzén L., Peters A. M., Tjädermo M., Ekberg S., Granerus G., Ström M. Do technetium-99m hexamethylpropylene amine oxime-labeled leukocytes truly reflect the mucosal inflammation in patients with ulcerative colitis? Scand J Gastroenterol. 1992 Dec;27(12):1031–1038. doi: 10.3109/00365529209028134. [DOI] [PubMed] [Google Scholar]
  2. Bartholomeusz F. D., Shearman D. J. Measurement of activity in Crohn's disease. J Gastroenterol Hepatol. 1989 Jan-Feb;4(1):81–94. doi: 10.1111/j.1440-1746.1989.tb00810.x. [DOI] [PubMed] [Google Scholar]
  3. Becker W., Fischbach W., Weppler M., Mosl B., Jacoby G., Börner W. Radiolabelled granulocytes in inflammatory bowel disease: diagnostic possibilities and clinical indications. Nucl Med Commun. 1988 Oct;9(10):693–701. doi: 10.1097/00006231-198810000-00004. [DOI] [PubMed] [Google Scholar]
  4. Best W. R., Becktel J. M., Singleton J. W., Kern F., Jr Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976 Mar;70(3):439–444. [PubMed] [Google Scholar]
  5. Carpani de Kaski M., Peters A. M., Knight D., Stuttle A. W., Lavender J. P., Hodgson H. J. Indium-111 whole-body retention: a method for quantification of disease activity in inflammatory bowel disease. J Nucl Med. 1992 May;33(5):756–762. [PubMed] [Google Scholar]
  6. Danpure H. J., Osman S., Carroll M. J. The development of a clinical protocol for the radiolabelling of mixed leucocytes with 99Tcm-hexamethylpropyleneamine oxime. Nucl Med Commun. 1988 Jun;9(6):465–475. doi: 10.1097/00006231-198806000-00010. [DOI] [PubMed] [Google Scholar]
  7. DeNardo G. L., Macey D. J., DeNardo S. J., Zhang C. G., Custer T. R. Quantitative SPECT of uptake of monoclonal antibodies. Semin Nucl Med. 1989 Jan;19(1):22–32. doi: 10.1016/s0001-2998(89)80033-9. [DOI] [PubMed] [Google Scholar]
  8. Giaffer M. H., Tindale W. B., Senior S., Barber D. C., Holdsworth C. D. Quantification of disease activity in Crohn's disease by computer analysis of Tc-99m hexamethyl propylene amine oxime (HMPAO) labelled leucocyte images. Gut. 1993 Jan;34(1):68–74. doi: 10.1136/gut.34.1.68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gibson P., Lichtenstein M., Salehi N., Hebbard G., Andrews J. Value of positive technetium-99m leucocyte scans in predicting intestinal inflammation. Gut. 1991 Dec;32(12):1502–1507. doi: 10.1136/gut.32.12.1502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Harvey R. F., Bradshaw J. M. A simple index of Crohn's-disease activity. Lancet. 1980 Mar 8;1(8167):514–514. doi: 10.1016/s0140-6736(80)92767-1. [DOI] [PubMed] [Google Scholar]
  11. Lantto E., Järvi K., Krekelä I., Lantto T., Taavitsainen M., Vedenkangas H., Vorne M. Technetium-99m hexamethyl propylene amine oxine leucocytes in the assessment of disease activity in inflammatory bowel disease. Eur J Nucl Med. 1992;19(1):14–18. doi: 10.1007/BF00178302. [DOI] [PubMed] [Google Scholar]
  13. Peters A. M., Danpure H. J., Osman S., Hawker R. J., Henderson B. L., Hodgson H. J., Kelly J. D., Neirinckx R. D., Lavender J. P. Clinical experience with 99mTc-hexamethylpropylene-amineoxime for labelling leucocytes and imaging inflammation. Lancet. 1986 Oct 25;2(8513):946–949. doi: 10.1016/s0140-6736(86)90601-x. [DOI] [PubMed] [Google Scholar]
  14. Peters A. M. Granulocyte kinetics and methods of evaluating cell performance. Nucl Med Commun. 1988 Oct;9(10):687–692. [PubMed] [Google Scholar]
  15. Peters A. M. Imaging inflammation: current role of labeled autologous leukocytes. J Nucl Med. 1992 Jan;33(1):65–67. [PubMed] [Google Scholar]
  16. Peters A. M., Roddie M. E., Danpure H. J., Osman S., Zacharopoulos G. P., George P., Stuttle A. W., Lavender J. P. 99Tcm-HMPAO labelled leucocytes: comparison with 111In-tropolonate labelled granulocytes. Nucl Med Commun. 1988 Jun;9(6):449–463. doi: 10.1097/00006231-198806000-00009. [DOI] [PubMed] [Google Scholar]
  17. Saverymuttu S. H., Camilleri M., Rees H., Lavender J. P., Hodgson H. J., Chadwick V. S. Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease. A comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion. Gastroenterology. 1986 May;90(5 Pt 1):1121–1128. doi: 10.1016/0016-5085(86)90376-8. [DOI] [PubMed] [Google Scholar]
  18. Saverymuttu S. H., Lavender J. P., Hodgson H. J., Chadwick V. S. Assessment of disease activity in inflammatory bowel disease: a new approach using 111In granulocyte scanning. Br Med J (Clin Res Ed) 1983 Dec 10;287(6407):1751–1753. doi: 10.1136/bmj.287.6407.1751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Saverymuttu S. H., Peters A. M., Lavender J. P., Pepys M. B., Hodgson H. J., Chadwick V. S. Quantitative fecal indium 111-labeled leukocyte excretion in the assessment of disease in Crohn's disease. Gastroenterology. 1983 Dec;85(6):1333–1339. [PubMed] [Google Scholar]
  20. Schölmerich J., Schmidt E., Schümichen C., Billmann P., Schmidt H., Gerok W. Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label. Gastroenterology. 1988 Nov;95(5):1287–1293. doi: 10.1016/0016-5085(88)90363-0. [DOI] [PubMed] [Google Scholar]
  21. Sciarretta G., Furno A., Mazzoni M., Basile C., Malaguti P. Technetium-99m hexamethyl propylene amine oxime granulocyte scintigraphy in Crohn's disease: diagnostic and clinical relevance. Gut. 1993 Oct;34(10):1364–1369. doi: 10.1136/gut.34.10.1364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Spinelli F., Milella M., Sara R., Banfi F., Vigorelli R., Possa M., Bianchi Porro G., Ardizzone S., Gallitelli L. The 99mTc-HMPAO leukocyte scan: an alternative to radiology and endoscopy in evaluating the extent and the activity of inflammatory bowel disease. J Nucl Biol Med. 1991 Apr-Jun;35(2):82–87. [PubMed] [Google Scholar]
  23. Stein D. T., Gray G. M., Gregory P. B., Anderson M., Goodwin D. A., McDougall I. R. Location and activity of ulcerative and Crohn's colitis by indium 111 leukocyte scan. A prospective comparison study. Gastroenterology. 1983 Feb;84(2):388–393. [PubMed] [Google Scholar]
  24. TRUELOVE S. C., WITTS L. J. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955 Oct 29;2(4947):1041–1048. doi: 10.1136/bmj.2.4947.1041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Teahon K., Bjarnason I. Comparison of leukocyte excretion and blood loss in inflammatory disease of the bowel. Gut. 1993 Nov;34(11):1535–1538. doi: 10.1136/gut.34.11.1535. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES