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Unlabelled: To evaluate whether scintigraphy with (99m)Tc-labeled white blood cells (WBC) can assess the intensity of bowel inflammation, a large dataset of laboratory values and clinical activity indices was correlated with (99m)Tc-WBC scintigraphy in children with Crohn's disease (CD), ulcerative colitis (UC), and miscellaneous colitis (MC). Also evaluated was whether stratification of children with CD as ileitis versus colitis results in different correlation coefficients for laboratory values versus (99m)Tc-WBC scintigraphy., Methods: Over a 6-y period, 313 (99m)Tc-WBC studies were performed. A dataset of 2,714 laboratory values is available for analysis., Results: There is a positive correlation between the erythrocyte sedimentation rate (ESR) and large bowel uptake of (99m)Tc-WBC (P < 0.05) and a negative trend with small bowel uptake of (99m)Tc-WBC in children with CD. Similarly, there is a correlation between WBC counts and scintigraphy in most segments of the large bowel and a negative correlation with the small bowel (R = -0.32, P = 0.01) in children with CD. There is a correlation between platelets and (99m)Tc-WBC in children with CD or UC. There is no correlation between the ESR and (99m)Tc-WBC in children with UC or MC. Many clinical activity indices correlate (P < 0.001) with (99m)Tc-WBC in children with CD, but none correlates in children with UC. Numerous laboratory values correlate with each other. There is a negative correlation between protein, albumin, hemoglobin, and hematocrit versus (99m)Tc-WBC scintigraphy in children with CD. In children with UC, there is a negative correlation between hemoglobin and hematocrit versus (99m)Tc-WBC., Conclusion: (99m)Tc-WBC scintigraphy, ESR, and WBC counts are good indicators of the inflammatory activity in CD if the inflammation is limited to the large bowel. There is a trend toward an inverse relationship when the inflammation is limited to the small bowel; thus, scintigraphy and the aforementioned markers may be of limited value. This report also demonstrates that (99m)Tc-WBC scintigraphy correlates with clinical activity indices in CD and with numerous biologic markers. In children with UC, scintigraphy with (99m)Tc-WBC and most laboratory markers are of limited value in assessing disease activity.

Studies have suggested that Tc-99m white blood cell (WBC) imaging is superior to contrast radiology for assessing the extent and activity of inflammatory bowel disease (IBD). The Tc-99m WBC scan seems ideally suited to obtain, in only one examination, a precise temporal snapshot of the distribution and intensity of inflammation, whereas radiographic methods of investigation tend to represent changes that are more chronic. The test is useful in children with inconspicuous signs suggesting IBD in whom laboratory test results are either normal or slightly abnormal. In those cases, a negative Tc-99m WBC study will obviate endoscopic investigations. The author's current experience, in more than 500 patients, indicates that the Tc-99m WBC scan is a virtual gold standard to establish, or exclude, the diagnosis of IBD. The minimal invasiveness of the Tc-99m WBC scan makes it an especially attractive method for evaluating children with IBD. It is economical compared with endoscopy, and its diagnostic sensitivity is excellent. The ability to evaluate the small and large bowel simultaneously is an important advantage for the patient. In conclusion, the Tc-99m WBC scan is a useful tool to evaluate IBD and should be added to the clinician's investigative armamentarium.

Objective: The goal of this retrospective study was to assess whether 99mTc-white blood cell (WBC) scintigraphy and upper gastrointestinal small bowel follow-through (UGI-SBFT) could exclude inflammation in children suspected of having inflammatory bowel disease (IBD)., Methods: Of a population of 313 children who had a 99mTc-WBC scan, 130 children were studied exclusively to rule out IBD. Sixty-nine colonoscopies with biopsies were done within a short time interval of the 99mTc-WBC scans. There were also 51 controls studied with 99mTc-WBC scintigraphy., Results: Of the 130 children studied to exclude IBD, the final diagnosis was Crohn's disease in 27, ulcerative colitis in nine, miscellaneous colitis in 13, probably normal in 42, and normal in 39. The 99mTc-WBC scans were positive in all but three newly diagnosed Crohn's disease, ulcerative colitis, or miscellaneous colitis children. The false-negative 99mTc-WBC studies were seen in children with mild inflammation on biopsies and normal UGI-SBFT studies. In the 46 children with a true-positive 99mTc-WBC scan, 81% (17/21) of UGI-SBFT studies were normal. In five children with equivocal UGI-SBFT studies, the 99mTc-WBC scan correctly predicted if inflammation was present in the terminal ileum., Conclusions: Our results suggest that 99mTc-WBC is useful as an initial screening modality to exclude IBD, and is more sensitive than UGI-SBFT studies.

Technetium-99m white blood cell ((99m)Tc-WBC) imaging has been part of the initial evaluation and follow-up of more than 400 children presenting with inflammatory bowel disease (IBD) at Children's Hospital of Pittsburgh. Studies have suggested that (99m)Tc-WBC imaging is superior to contrast radiology in assessing the extent and activity of IBD. With only one examination, (99m)Tc-WBC imaging is ideally suited to obtain a precise temporal snapshot of the distribution and intensity of inflammation, whereas radiography tends to detect more chronic changes. There is a high correlation between (99m)Tc-WBC imaging findings and those of endoscopy. When total colonoscopy cannot be completed satisfactorily or when contrast radiography findings are negative or equivocal, scintigraphy can confirm the presence of ileitis or right-sided colitis. Occasionally, (99m)Tc-WBC imaging is useful in differentiating Crohn's disease from ulcerative colitis. Some studies have suggested that (99m)Tc-WBC imaging is useful as an initial screening modality to exclude IBD. Technetium-99m WBC imaging is noninvasive, practical, safe, requires no bowel preparation, and entails less radiation exposure than contrast radiology or computed tomography.

Background: Studies have suggested that scans with technetium-tagged white blood cells (WBC-Tc99m) may be equal to endoscopy in the assessment of extent and activity of inflammatory bowel disease (IBD)., Objective: We have retrospectively examined the accuracy of WBC-Tc99m scans in differentiating continuous from discontinuous colitis in pediatric IBD., Materials and Methods: There were 207 children in the study (96 boys, 111 girls, median age 13 years). This included 29 controls - children with no gastrointestinal disease (NL) who underwent WBC-Tc99m scans for other medical problems. Scans were obtained at 30 minutes and 2-4 hours following injection. Scans were interpreted as showing continuous colitis, discontinuous colitis, or no colitis., Results: In the 77 children with active Crohn's disease (CD) of the colon, the scans revealed discontinuous uptake in 63 children and continuous uptake in 14. In the 29 children with ulcerative colitis (UC), 23 scans showed continuous uptake and 6 revealed discontinuous uptake. Two of these 6 showed focal activity near the appendix, and subclinical appendicitis could not be excluded. Another child was bleeding and the scan could have been misinterpreted as showing small- bowel inflammation. In the last three patients, skip areas were clearly identifiable. In none of these last three patients were the biopsies typical of CD (i. e., no granuloma was identified) nor was inflammation patchy. In summary, of the 106 scans showing inflammation, 6 were classified into the wrong group., Conclusion: These data show that WBC-Tc99m scanning can be useful in distinguishing discontinuous from continuous colitis.

The difference in sensitivity of early imaging at 30 minutes after injection of Tc-99m HMPAO WBC versus delayed imaging at 2 or 3 hours for depiction of active inflammation in children with inflammatory bowel disease was established. The charts of 220 children who had early (30-minute) and delayed (2 or 3 hours) imaging performed for evaluation of inflammatory bowel disease were reviewed. There were 107 boys and 113 girls (average age, 12 years; median, 13 years). The bowel was divided into eight segments (with the total for all patients being 3,520) graded on a scale of 0 to 6 (with reference points in the iliac crest and liver). Any grade > or = 1 was abnormal. The uptake in each segment was summed. One hundred and twenty-two studies were abnormal (55%). The average uptake in the early images was 5.1 +/- 0.41 and that in the late images was 9.3 +/- 0.64. The Friedman nonparametric test of comparison of rank was significant at the 0.001 level. One hundred and five patients had abnormal studies at 30 minutes (88%). An additional 12% of patients had abnormal studies only on the late images. There were 245 abnormal segments at 30 minutes and 413 abnormal segments at 2 or 3 hours. When the uptake was analyzed segment by segment, 62 patients (52%) had abnormal segments at 30 minutes but also had additional abnormal segments at 3 hours. Sensitivity of Tc-99m HMPAO WBC imaging was significantly improved when late imaging was performed.

We retrospectively evaluated the incidence of late accumulation of 99Tcm-HMPAO leukocytes (99Tcm-WBC) in the right lower quadrant of a large population of children and characterized some predictive patterns that would enable differentiation of active inflammation from this late occasional accumulation of 99Tcm-WBC. We reviewed the charts of 211 children. The first group evaluated consisted of 79 controls: 30 normal children with no gastrointestinal disease, but who underwent 99Tcm-WBC scanning for other medical problems, and 49 children who had non-specific gastrointestinal (GI) complaints, but had no demonstrable inflammatory bowel disease by conventional diagnostic methods. The second group consisted of 132 children with inflammatory bowel disease: 80 children with Crohn's disease (CD), 34 with ulcerative colitis (UC) and 18 with indeterminate colitis (IC). Children were imaged at 30 min and 3 h. Fifteen (19%) of the 79 controls scanned showed accumulation of 99Tcm-WBC in the right lower quadrant at 3 h and none at 30 min. Of those 15, 8 were from the control population and 7 from the group with non-specific GI complaints and negative work-ups. There was no uptake in other segments of the bowel. The accumulation was faint, of lesser intensity than in the iliac wing, and diffuse, such that identification of a specific loop of involved bowel was not possible. Migration of the 99Tcm-WBC distal to the terminal ileum was demonstrated. The other 64 children in the control group showed no accumulation of 99Tcm-WBC at any time during their scans. All 79 scans were blindly interpreted as normal studies. There were no false-positive readings encountered in the 132 children with inflammatory bowel disease (80 CD, 34 UC, 18 IC) when the aforementioned characteristics of the late accumulation of 99Tcm were used to differentiate inflammation from this physiological excretion. In conclusion, the late accumulation of 99Tcm-WBC in the right lower quadrant is characterized by (1) accumulation at no less that 3 h, (2) no accumulation in other segments of the bowel, (3) faint accumulation of lesser intensity than in the iliac wing, (4) a diffuse accumulation pattern and (5) migration of the 99Tcm-WBC into the caecum and ascending colon over time. Recognition of this excretion pattern enables differentiation of active Crohn's disease of the small bowel from migration and accumulation of 99Tcm-WBC in the right lower quadrant of the abdomen.

Knowledge of the distribution of disease in patients with inflammatory bowel disease is important because it has diagnostic, prognostic, and therapeutic implications. We studied 215 patients with 99mTc-HMPAO-white blood cell scans, of whom 80 had Crohn's disease (CD), 34 had active ulcerative colitis (UC), and 31 were controls. In our 77 cases of active CD, uptake was seen exclusively in the small bowel in 18% of patients, only the large bowel in 44%, and both the large and small bowel in 38% of patients. Discontinuous colitis was seen in 63 of these patients. In the 29 cases of active UC, the uptake involved the entire colon in 50% of patients, extended farther than the sigmoid in 27% of patients, and was limited to the rectosigmoid in 23%. In the 29 cases of active UC, four of the scans incorrectly revealed discontinuous accumulation of 99mTc-HMPAO-WBC. In 31 controls, no significant colonic uptake was seen. Isolated small bowel involvement with CD is observed less frequently in children undergoing 99mTc-HMPAO-WBC scanning than in adults. In children, the segmental distribution of inflammation as depicted with 99mTc-HMPAO-WBC is similar to the radiologic distribution.

Technetium Tc 99m-labeled hexamethylpropyleneamine-oxime (Tc-HMPAO) scintigraphy has been evaluated in adults with inflammatory bowel diseases and has shown promising ability to define intensity and extent of disease. To evaluate the method's utility in children, we studied 27 pediatric patients-23 with inflammatory bowel diseases and 4 control subjects without abdominal inflammation. Autologous leukocytes labeled with Tc-HMPAO were reinjected into each patient and serial scans were obtained up to 4 hours later. None of the control subjects had any uptake of Tc-HMPAO by the bowel. Disease localization as defined by the scan correlated well with that visualized in surgical specimens from five patients, at endoscopy in three patients, with barium studies of two patients, and with computed tomography scanning of the abdomen in one patient. A "scan score" was calculated by comparing uptake of tracer in five bowel segments with iliac crest bone marrow activity. Scan score correlated much better with clinical disease activity (correlation coefficient = 0.62) than did the erythrocyte sedimentation rate (correlation coefficient = 0.24). Scintigraphy with Tc-HMPAO appears to be useful in evaluation of disease localization and intensity in children with inflammatory bowel disease.

Unlabelled: Technetium-99m-HMPAO-labeled leukocyte imaging is now an accepted technique in the assessment of adult patients with inflammatory bowel disease (IBD), but its role in pediatric patients has not been studied., Methods: We evaluated the efficacy of 99mTc-HMPAO-labeled leukocyte imaging in 21 children. We studied 16 children with active IBD (4 ulcerative colitis, 10 Crohn's disease, 1 indeterminate colitis, 1 C-difficile) and 5 controls., Results: The sensitivity and specificity for active bowel inflammation were excellent. The intensity of uptake noted in most patients rendered image interpretation easy and straightforward. The inclusion of a tail on detector (TOD) view and anterior standing view of the abdomen is important. All patients with ulcerative colitis showed rectosigmoid disease and no small bowel activity, whereas, all patients with Crohn's disease showed discontinuous uptake and often small bowel activity. It was therefore possible to differentiate ulcerative colitis from Crohn's disease on the basis of location and distribution., Conclusion: The 99mTc-HMPAO-labeled leukocyte scan is an excellent technique for the detection, localization and characterization of IBD in children.