99mTc-HMPAO Granulocyte Scintigraphy in the Early Detection of Postoperative Asymptomatic Recurrence in Crohn's Disease
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The usefulness of 99mTc-HMPAOscintigraphy in the early detection of postoperativerecurrence of Crohn's disease was evaluated in 17patients undergoing ileocecal resection andprospectively followed up for one year. Scintigraphy was performed 6 and12 months after surgery and recurrence assessed bycolonoscopy within two weeks. As controls, four patientswith ileocecal resection for cecal carcinoma were studied. To perform scintigraphy, autologousgranulocytes were labeled with 99mTc-HMPAO,injected, and tau-camera images acquired after 30 minand 3 hr. Six months after surgery, 4/8 Crohn's diseasepatients showed endoscopic recurrence, and 30-minscintigraphy was positive only in these four patients(four true positives, four true negatives). At 12months, endoscopic recurrence was detected in 10/14Crohn's disease patients, and 30-min scintigraphy waspositive in 9/14 patients (eight true positives, threetrue negatives, two false negatives, one falsepositive). Scintigraphy at 3 hr showed a lowerspecificity in detecting CD recurrence both at 6 and 12months. The endoscopic and 30-min scintigraphic scorewere significantly correlated both at 6 and 12 months (P = 0.007; P = 0.04). Scintigraphy was negative in 4/4 controls at 30 min (four true negatives) andpositive in 1/4 (one false positive) at 3 hr. Weconclude that 99mTc-HMPAO scintigraphy at 30min is a sensitive technique for the early detection ofCrohn's disease recurrence in patients under regularfollow-up after surgery.
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