Polymorphonuclear leukocyte-elastase in Crohn's disease: correlation with 99mtechnetium hexamethyl propylene amine oxime leukocyte scintigraphy.

In Crohn's disease (CD), labeled leukocyte scintigraphy results are highly correlated with radioendoscopic findings and the degree of histologic inflammation. We evaluated the correlation between leukocyte activity measured by two complementary methods. polymorphonuclear leukocyte (PMN)-elastase concentration and leukocyte scintigraphy. In 20 patients with CD, labeled leukocytes, 99m technetium hexamethyl propylene amine oxime (99mTc-HMPAO) scintigraphy, and PMN-elastase concentration were evaluated on the same day. A good correlation was found between PMN-elastase concentrations and the scintigraphic scores (p = 0.005; rs = 0.60; 95% CI, 0.20-0.83). Scintigraphy results were significantly correlated with CD activity index (p = 0.023, rs = 0.50). In four patients, scintigraphic scores and clinical disease activity were not consistent due to the state of PMN leukocyte activation, measured by elastase concentration. In CD, PMN-elastase can provide information about the degree of activation of PMN leukocytes and may explain discrepancy between clinical and scintigraphic indexes.

Technetium Tc 99m hexamethyl propylene amine oxine leukocyte scintigraphy in patients with ulcerative colitis: correlation with clinical, biologic, endoscopic, and pathologic intensity, and local release of interleukin 8.

BACKGROUND: Technetium Tc 99m hexamethyl propylene amine oxine (99mTc-HMPAO) has been used to radiolabel leukocytes with promising results for its clinical use in inflammatory bowel disease. During active ulcerative colitis, colonoscopy is indicated to determine the extent and the intensity of the disease for proper management. The aim of this prospective study was to determine whether 99mTc-HMPAO-labeled leukocyte scintigraphy can give information similar to that obtained with colonoscopy during acute attacks of ulcerative colitis. METHODS: Thirty-three consecutive patients with 50 acute episodes of ulcerative colitis underwent 99mTc-HMPAO scintigraphy and colonoscopy with biopsies. Scintigraphic determination of disease extent and intensity were compared with those obtained by colonoscopy with biopsies and clinicobiologic markers. RESULTS: The scintigraphic index of disease intensity was correlated with endoscopic index, Truelove index, biologic markers, and local release of interleukin-8. The extent measured by scintigraphy was well correlated to the endoscopic and histologic extent. CONCLUSIONS: 99mTc-HMPAO scintigraphy accurately determines the extent and the intensity of acute ulcerative colitis lesions. This noninvasive method can specify the extent and the intensity of an acute attack in patients with previously known ulcerative colitis.

[Scintigraphy using leukocytes marked with 99m-Tc-HMPAO in Crohn's disease]. / Scintigraphie aux leucocytes marqués par l'HMPAO 99mTc au cours de la maladie de Crohn.

99mTc-HMPAO leukocyte scintigraphy was prospectively studied in 20 patients with Crohn's Disease and was compared with radio-endoscopy and with disease activity index (Crohn's Disease Activity Index, ESR, C-reactive protein). Disease localization as defined by the scan was well correlated with those visualized at endoscopy or radiography (rs = 0.90 - p = 0.0001). A scan score was calculated by evaluating uptake of the tracer in 6 bowel segments with lumbar bone marrow activity, correlation with endoscopic score was strong (rs = 0.96 - p < 0.0001). Scan score was well correlated with the Crohn's Disease Activity Index (rs = 0.63 - p = 0.0026), but no correlation was found between ESR, C-reactive protein and scan score. In four patients with ileal localization, scintigraphy was helpful to separate inflammatory from scared stenosis. Scintigraphy with 99mTc-HMPAO appeared to be useful in evaluation of Crohn's Disease activity, and for the diagnosis of complications as stenosis.