engleski

Is labelled leukocyte scan always necessary in patients with inflammatory bowel disease?

Aim: Leukocyte scan is a non-invasive procedure increasingly used in detection and follow-up of patients with inflammatory bowel disease (IBD), especially in order to decide whether the medical or surgical treatment should be undertaken. The aim of our study was to determine whether the inflammation markers (leukocyte count (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), along with clinical parameters, could prove effective in identifying patients with IBD appropriate for leukocyte scanning. Materials and methods: A total of 61 patients, 51 with Crohn's disease (CD) and 10 with ulcerous colitis (UC), (31 males, 30 females, mean age 36.26 years), were examined from April 2010 till November 2011. Out of total participants, 40 were tested for follow-up to detect suspected relapses, while in 21 surgery was considered due to intestinal stenosis, established by previous endoscopy and/or barium contrast radiology. Scintigraphy was performed using Tc-99m-HMPAO labelled leukocytes. Planar abdominal images were acquired at 1/2, 1, 2, 3, 4, and 24 h p.i. Scans with abnormal bowel uptake were considered positive in terms of active intestinal inflammation. The results were assessed qualitatively by experienced nuclear physicians and compared both with inflammation markers and with clinical parameters, according either to Crohn's disease activity index (CDAI) for CD or Truelove-Witt's score (TWS) for UC. Inflammation markers were considered to be elevated when WBC>10x109/L and/or CRP>10 mg/L, and ESR>20 mm/h. Active disease was defined as symptomatic with a CDAI score greater than 150 points and Truelove- Witts score greater than 6 points. Results: Out of 32 patients with normal inflammation markers, 27 (84%) had negative scans. In 29 patients with elevated markers scintigraphy was positive in 21 (72%). Among 27 patients with normal clinical scores, scans were negative in 23 (85%). Out of 34 participants with pathological clinical scores, 22 (65%) had positive scintigraphy. Significant correlations (p<0.05) were found both between positive scintigraphy and elevated inflammation markers, and between positive scintigraphy and pathological clinical scores. When laboratory and clinical parameters were both normal, only one patient had positive scintigraphy (5%). Only 3, out of 21 (14%) of those with elevated inflammation markers accompanied with pathological clinical scores had negative scans. Conclusion: Inflammatory markers (WBC, CRP, ESR) associated with CDAI/TWS scores can serve as valuable indicators to predict the leukocyte scintigraphy results in IBD. When inflammation markers and clinical scores are both normal, leukocyte scintigraphy is not necessarily indicated, not even preoperatively if surgery is considered due to IBD complications.

inflammatory bowel disease ; labelled leukocyte scan

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