Accuracy of 99mTc [V]-dimercaptosuccinic acid scintigraphy and fecal calprotectin compared with colonoscopy in localizing active lesions in inflammatory bowel disease

Introduction: Due to limitation of colonoscopy in assessing the entire bowel and patients' intolerance in inflammatory bowel disease [IBD], in the current study, we aimed to prospectively compare the accuracy of [99m]Tc[V]-dimercaptosuccinic acid [DMSA] and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations

Methods: Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent [99m]Tc [V]-DMSA scintigraphy and colonoscopy. The accuracy of [99m]Tc [V]-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated

Results: A total of 22 patients with ulcerative colitis [UC] and 8 patients with Crohn's disease [CD] were evaluated in our study. Sensitivity, positive likelihood ratio [PLR], and positive predictive value [PPV] of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio [NLR]=0.41, PPV=84.21%, and negative predictive value [NPV]= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively

Conclusion: The [99m]Tc [V]-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC

diagnostic role of magnetic resonance enterography as a complementary test to colonoscopy in active Crohn's disease

Background: According to recent studies comparing magnetic resonance enterography [MRE] with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn's disease [CD], we aimed to compare the accuracy of these two diagnostic methods in Iranian population

Method: During 2013-2014 a follow-up study was done on 30 patients with active CD ina gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS [version 18] and P value<0.05 was considered as statistically significant

Results: Of the 30 patients with active CD, 11[36.7%] were men and 19 [63.3%] were women with mean age of 37.30 +/- 13.66 years [range: 19-67 years]. MRE had sensitivity and specificity of 50% and 90% with positive predictive value [PPV] and negative predictive value [NPV] of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively

Conclusion: While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease