Localization and Activity of Inflammatory Bowel Disease Using ¹¹¹ln Leukocyte Imaging^[*]

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of ¹¹¹ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

Zusammenfassung

In einer prospektiven Studie wurden die klinisch gesicherten Ergebnisse bezüglich Lokalisation/Ausdehnung und Aktivität von entzündlichen Darmerkrankungen mit denen der ¹¹¹In-Oxin Leukozyten-Szintigraphie verglichen. Alle in die Studie einbezogenen Patienten waren mit Barium- Kontrast-Röntgen, klinischen und laborchemischen Befunden sowie Endoskopie mit Histopathologic vollständig untersucht. Insgesamt wurden 31 Scans bei 15 Patienten (12 mit M. Crohn, 3 mit Colitis ulcerosa) erstellt. Die Szintigramme wurden bewertet durch den Vergleich der Zell-Speicherung einer Läsion (wenn vorhanden) und einer Knochenmarkregion und Bildung einer Count ratio (CR). Die korrekte Lokalisation der entzündlichen Läsionen war bei 26 Szintigrammen möglich, die szintigra- phisch eingeschätzte Ausdehnung stimmte bei 21 Scans mit dem endoskopischen Befund überein. In 5 Fällen wurde die Befundausdehnung szintigraphisch unterschätzt, 4 Szintigramme bei Patienten mit Crohn-Rezidiv waren falsch-negativ, bei einem Patienten mit M. Crohn war das Verfahren richtig-negativ. Die szintigraphisch eingeschätzte Entzündungsaktivität stimmte in allen Fällen gut mit der klinischen Entzündungsaktivität, die auf histopathologischen Befunden basierte, überein. Wir folgern, daß mit Hilfe der Leukozytenszintigraphie brauchbare Informationen über Lokalisation und Aktivität entzündlicher Darmerkrankungen gewonnen werden können.

^* Dedicated to Prof. Dr. G. Hoffmann on the occasion of his 65th birthday.

• REFERENCES

• 1 Anstall H B, Coleman R F. Donor-leuko- cyte imaging in granulocytopenic patients with suspected abscesses. J Nucl Med 1982; 23: 319-21.
• 2 Ascher N L, Forstrom L, Simmons R L. Radiolabeled autologous leukocyte scanning in abscess detection. World J Surg 1980; 04: 395-402.
• 3 Buxton-Thomas M S, Dickinson R J, Maltby J N. et al. Evaluation of indium scintigraphy in patients with active inflammatory bowel disease. Gut 1984; 25: 1372.
• 4 Coleman R E, Black R E, Welch D M. et al. Indium-111 labelled leukocytes in the evaluation of suspected abdominal abscesses. Am J Surg 1980; 139: 99-104.
• 5 Coleman R E, Welsh D. Possible pitfalls with clinical imaging of indium-111 leukocytes. J Nucl Med 1980; 21: 122-5.
• 6 Crass J R, L’Heureux P L, Loken M. False- positive ¹¹¹In-labeled leukocyte scan in cystic fibrosis. Clin Nucl Med 1979; 04: 291-3.
• 7 Crystal R F, Palace F. Indium-111 oxine- labeled autologous leukocyte scans in the management of colorectal diseases. Dis Col Rect 1984; 27: 223-7.
• 8 Datz F L, Jakobs J, Baker W J. et al. Decreased sensitivity of early imaging with In-111 oxine-labeled leukocytes in detection of occult infection. J Nucl Med 1984; 25: 303-6.
• 9 Datz F L, Bedont R A, Baker W J. et al. No difference in sensitivity for occult infection between tropolone- and oxine-labeled in- dium-lll leukocytes. J Nucl Med 1985; 26: 469-73.
• 10 Datz F L, Thorne D A. Gastrointestinal tract radionuclide activity on In-111 labeled leukocyte imaging: clinical significance in patients with fever of unknown origin. Radiology 1986; 160: 635-9.
• 11 Dewanjee M K. Cardiac and vascular imaging with labeled platelets and leukocytes. Sem Nucl Med 1984; 14: 188.
• 12 Dutcher J P, Schiffer C A, Johnston G S. Rapid migration of 111-indium-labeled granulocytes to sites of infection. N Engl J Med 1981; 304: 586-9.
• 13 Fawwaz R A. Clinical utility of labeled cells for detection of allograft rejection and myocardial infarction. Sem Nucl Med 1984; 14: 198.
• 14 Fisher M F, Rudd T G. In-Ill-labeled leukocyte imaging: false positive study due to acute gastrointestinal bleeding. J Nucl Med 1983; 24: 803-4.
• 15 Gray H W, Gutbert I, Richards J R. Clinical imaging with indium-111 leukocytes: uptake in bowel infarction. J Nucl Med 1981; 22: 701-2.
• 16 Hotze A, Schneider M, Briele B. et al. Localisation and activity of Crohn’s disease estimated by In-111 leukocyte scanning. In: Emrich D, Schmidt H. eds. sClinical de-mands on nuclear medicine. Stuttgart: Schattauer; 1987: 252-4.
• 17 Keshavarzian A, Price Y E, Peters A M. et al. Specificity of In-111-granulocyte scanning and faecal excretion measurement. An autoradiographic study. Gut 1984; 25: A1145.
• 18 Knöchel J Q, Koehler P R, Lee T G. et al. Diagnosis of abdominal abscesses with computed tomography, ultrasound, and ¹¹¹Inleukocyte scans. Radiology 1980; 137: 425-32.
• 19 Mikhail S H, Loken M K, Forstrom L A. Abdominal localization of indium-111 labeled leukocytes in the study of consecutive patients with apparent abdominal sepsis. Minn Med. 1983: 607.
• 20 Mok Y P, Carney W H, Fernandez-Ulloa M. Skeletal photopenic lesions in In-111 WBC imaging. J Nucl Med 1984; 25: 1322.
• 21 Peters A M, Saverymuttu S H, Revay H J. et al. Imaging of inflammation with indium-¹¹¹tropolonate labeled leukocytes. J Nucl Med 1983; 24: 39-44.
• 22 Saverymuttu S H, Peters A M, Hodgson H J F. et al. ¹¹¹Indium autologous leukocyte scanning: comparison with radiology for imaging the colon in inflammatory bowel disease. Br Med J 1982; 285: 255-7.
• 23 Saverymuttu S H, Peters A M, Lavender J P. et al. In-111 autologous leukocytes in inflammatory bowel disease. Gut 1983; 24: 293-9.
• 24 Saverymuttu S H, Peters A M, Hodgson H J. et al. ¹¹¹Indium leukocyte scanning in small- bowel Crohn’s disease. Gastrointest Radiol 1983; 08: 157-61.
• 25 Saverymuttu S H, Peters A M, Hodgson H J. et al. Assessment of disease activity in ulcerative colitis using indium-111 labelled leukocyte faecal excretion. Scand J Gastroenterol 1983; 18: 907-12.
• 26 Saverymuttu S H, Peters A M, Lavender J P. et al. Quantitative fecal In-lll-labelled leukocyte excretion in the assessment of disease in Crohn’s disease. Gastroenterology 1983; 85: 1333-9.
• 27 Seabold J E, Wilson D G, Lieberman L M. et al. Unsuspected extra-abdominal sites of infection: scintigraphic detection with indium-ill-labeled leukocytes. Radiology 1984; 151: 213-7.
• 28 Segal A W, Ensell J, Munro J M. et al. ¹¹¹Indium-tagged leukocytes in the diagnosis of inflammatory bowel disease. Lancet 1981; ii: 230-2.
• 29 Stein D T, Gray G M, Gregory P B. et al. Location and activity of ulcerative and Crohn’s colitis by indium 111 leukocyte scan: a prospective comparison study. Gastroenterology 1983; 84: 388-98.
• 30 Stein D T, Paldi J H, Goodwin D A. In-111 leukocyte scan in “diversion” colitis. Clin Nucl Med 1983; 08: 1-2.
• 31 Thakur M L, Lavender J P, Arnot R W. et al. Indium-111 labelled autologous leukocytes in man. J Nucl Med 1977; 18: 1014-21.
• 32 Ybern A, Martin-Comin J, Gine J J. et al. ¹¹¹In-oxine-labelled autologous leukocytes in inflammatory bowel disease: New scintigraphic activity index. Eur J Nucl Med 1986; 11: 341-4.