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Nuklearmedizin 2002; 41(01): 37-41
DOI: 10.1055/s-0038-1623994
Originalarbeiten – Original Articles
Schattauer GmbH

Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

Verbesserung der Diagnose akute Appendizitis in atypischen Fällen durch Leukozytenscan mit Tc-99m-HMPAO
S. Shung-Shung
1   Department of Nuclear Medicine
,
S. Yu-Chien
3   Department of Nuclear Medicine, Far Eastern Memorial Hospital and Institute of Biomedical Engineering, College of Electrical Engineering, National Taiwan University, Taipei, Taiwan
,
Y. Mei-Due
2   Department of Surgery, China Medical College Hospital, Taichung
,
W. Hwei-Chung
2   Department of Surgery, China Medical College Hospital, Taichung
,
A. Kao
1   Department of Nuclear Medicine
› Author Affiliations
Further Information

Publication History

Received: 20 August 2001

in revised form: 03 September 2001

Publication Date:
10 January 2018 (online)

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Summary

Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

Zusammenfassung

Ziel: Trotz sorgfältiger Beobachtung liegt die Gesamtrate falsch positiver Laparotomien bei Verdacht auf akute Appendizitis um 10-15%. Deshalb wurde der klinische Nutzen des Tc-99m-HMPAO-Leukozytenscans (TC-WBC) zur Diagnose der akuten Appendizitis bei Patienten mit untypischen Befunden überprüft. Patienten und Methoden: Achtzig Patienten mit akutem Abdomen und Verdacht auf akute Appendizitis wurden in diese Studie eingeschlossen. Nach i. v. Injektion von TC-WBC wurde der Abdomen-Becken-Bereich nach 30, 60, 120 und 240 min mit einer Gammakamera mit 800 kCounts aufgenommen. Jede abnormale Anreicherung von Aktivität im rechten unteren Quadranten des Abdomens, die gleich oder größer war als die Knochenmarkaktivität, wurde als positiver Scan gewertet. Ergebnisse: 36 von 49 Patienten mit positivem TC-WBC-Scan wurde operativ der Appendix vermiformis entfernt. Sie alle zeigten ein positives pathologisches Ergebnis. Fünf positive TC-WBC-Scans wurden nicht mit akuter Appendizitis in Zusammenhang gebracht, da andere pathologische Läsionen vorlagen. Acht Patienten wurden nicht operiert und hatten bei der klinischen Nachuntersuchung nach einem Monat keine abdominellen Beschwerden. Drei von 31 Patienten mit negativem TC-WBC-Scan wurden einer Appendektomie unterzogen. Auch bei ihnen war der pathologische Befund positiv. Die restlichen 28 Patienten wurden nicht operiert und zumindest bei der Nachuntersuchung nach einem Monat gab es bei ihnen keinen Hinweis auf Appendizitis. Insgesamt ergaben sich hinsichtlich der Diagnose akute Appendizitis folgende Werte für Sensitivität, Spezifität, Genauigkeit, positive und negative Voraussagen: 92, 78, 86, 82 und 90%. Schlussfolgerung: Der TC-WBC-Scan erwies sich als schnelle und sehr akkurate Methode zur Diagnose der akuten Appendizitis bei Patienten mit fragwürdigem klinischen Untersuchungsergebnis. Er reduziert die falschpositive Laparotomierate und verkürzt die zur klinischen Beobachtung nötige Zeit.

Keywords

Technetium-99m hexamethylpropyleneamineoxide - HMPAO - leukocytes - appendicitis

Schlüsselwörter

Tc-99m-Hexamethylpropylenaminoxid - HMPAO - Leukozyten - Appendizitis
 

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