Nuklearmedizin 1995; 34(06): 248-251
DOI: 10.1055/s-0038-1629722
Original Article
Schattauer GmbH

Falsely Negative 99mTc-Antigranulocyte Immunoscintigraphy and Positive 99mTc-HMPAO-La be I led Leukocyte Scan in Active Crohn’s Disease

Possible Effects of Immunosuppressive Therapy?
V. Ivančević
1   From the Department of Nuclear Medicine, the Berlin, Germany
4   Clinic and Policlinic for Nuclear Medicine, Charité, Humboldt-University, Berlin, Germany
,
H. Schwörer
2   Department of Gastroenterology and Endocrinology, the Berlin, Germany
,
D. Sandrock
1   From the Department of Nuclear Medicine, the Berlin, Germany
4   Clinic and Policlinic for Nuclear Medicine, Charité, Humboldt-University, Berlin, Germany
,
Cornelia Kaufmann
3   Department of Haema-tology and Oncology, Georg-August-Univer-sity, Gòttingen, and the Berlin, Germany
,
G. Ramadori
2   Department of Gastroenterology and Endocrinology, the Berlin, Germany
,
D. Emrich
1   From the Department of Nuclear Medicine, the Berlin, Germany
,
D. L. Munz
1   From the Department of Nuclear Medicine, the Berlin, Germany
4   Clinic and Policlinic for Nuclear Medicine, Charité, Humboldt-University, Berlin, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 19. Juli 1995

in revised form: 25. Juli 1995

Publikationsdatum:
05. Februar 2018 (online)

Summary

A 19-year-old woman with active Crohn’s disease under immunosuppressive therapy underwent scintigraphy with 99mTc-anti-NCA-95 antigranulocyte antibodies in order to determine the extent of inflammation. It turned out to be falsely negative whereas a 99mTc-HMPAO-labelled leukocyte scan revealed a marked terminal ileitis and pancolitis. It is assumed that immunosuppressive therapy was the main reason for the falsely negative antibody scan, possibly affecting the red bone marrow where most of the antibodies bind to granulocytes. Peripheral leukocytes labelled in vitro do not seem to be subject to these hypothetical effects on red bone marrow.

Zusammenfassung

Bei einer 19jährigen Frau mit aktivem M. Crohn unter immunsuppressiver Therapie wurde eine Immunentzündungsszintigraphie mit dem 99mTc-Anti-NCA-95-Antigranulozytenantikörper durchgeführt, um das Ausmaß der Entzündung zu erfassen. Die Immunentzündungsszintigraphie fiel falsch-negativ aus, während eine Szintigraphie mit 99mTc-HMPAO-markierten Leukozyten eine ausgeprägte terminale Ileitis und Pankolitis erkennen ließ. Es wird vermutet, daß die immun-suppressive Therapie die Hauptursache für die falsch-negative Antikörperszinti-graphie war, möglicherweise über eine Wirkung auf das rote Knochenmark, wo sich der größte Teil der Antikörper an die Granulozyten bindet. In vitro markierte periphere Leukozyten scheinen diesen hypothetischen Effekten auf das rote Knochenmark nicht zu unterliegen.

 
  • LITERATUR

  • 1 Allan RA, Sladen GE, Bassingham S. et al. Comparison of simultaneous Tc-99m HMPAO and In-111 oxine labelled white cell scans in the assessment of inflammatory bowel disease. Eur J Nucl Med 1993; 20: 195-200.
  • 2 Arndt J-W, Van der Sluys Veer A, Blok D. et al. Prospective comparative study of technetium-99m WBCs and indium-Ill granulocytes for the examination of patients with inflammatory bowel disease. J Nucl Med 1993; 34: 1052-7.
  • 3 Ascher NL, Ahrenholz DH, Simmons RL. et al. Indium-Ill autologous tagged leukocytes in the diagnosis of intraperitoneal sepsis. Arch Surg 1979; 114: 386-92.
  • 4 Becker W. Immunoscintigraphy of infectious lesions. In: Immunoscintigraphy - Facts and Fiction. Münz DL, Emrich D. eds. Proc Internat Symp on Immunoscintigraphy, Göttingen. Amsterdam: Excerpta Medica; 1990: 159-79.
  • 5 Becker W, Fleig W, Marienhagen J. et al. Diagnostische Bedeutung der intestinalen Aktivität bei der Immunszintigraphie mit 99mTc-NCA-95-Antikörpern. Nucl-Med 1990; 29: 47-8.
  • 6 Bosslet K, Lüben G, Schwarz A. et al. Immu-nohistochemical localisation and molecular characteristics of three monoclonal antibody-defined epitopes detectable on car-cinoembryonic antigen (CEA). Int J Cancer 1985; 36: 75-84.
  • 7 Crama-Bohbouth GE, Arndt JW, Peña AS. et al. Value of indium-Ill granulocyte scintigraphy in the assessment of Crohn’s disease of the small intestine: Prospective investigation. Digestion 1988; 40: 227-36.
  • 8 Datz FL, Thorne DA, Taylor A. Evaluation of factors that could potentially decrease the sensitivity of the In-Ill labelled leukocyte scan. J Nucl Med 1986; 27: 914.
  • 9 Fischbach W, Mössner J, Seyschab H. et al. Tissue carcinoembryonic antigen and DNA aneuploidy in precancerous and cancerous colorectal lesions. Cancer 1990; 65: 1820-4.
  • 10 Ivančević V, Münz DL. Nonspecific bowel activity in 99mTc-labelled monoclonal antigranulocyte antibody imaging. Nucl Med Commun 1992; 13: 899-900.
  • 11 Joseph K, Höffken H, Bosslet K, Schorlem-mer HU. In vivo labelling of granulocytes with 99mTc anti-NCA monoclonal antibodies for imaging inflammation. Eur J Nucl Med 1988; 14: 367-73.
  • 12 Kroiss A, Kölbl Ch, Weiss W, Neumayr A. Immunszintigraphie mit J-123- und Tc-99m-markierten Granulozytenantikörpern bei M. Crohn und Colitis ulcerosa. Nucl-Med 1989; 2: 72.
  • 13 Lantto E, Järvi K, Krekelä I. et al. Techne-tium-99m hexamethyl propylene amine oxine leucocytes in the assessment of disease activity in inflammatory bowel disease. Eur J Nucl Med 1992; 19: 14-8.
  • 14 Li DJ, Middleton SJ, Wraight EP. 99mTc and 111 In leucocyte scintigraphy in inflammatory bowel disease. Nucl Med Commun 1992; 13: 867-70.
  • 15 Lind P, Langsteger W, Kôltringer P. et al. Immunoscintigraphy of inflammatory processes with a technetium-99m-labeled monoclonal antigranulocyte antibody (MAb BW 250/183). J Nucl Med 1990; 31: 417-23.
  • 16 Mahida YR, Perkins AC, Frier M, Wastie ML, Hawkey CJ. Monoclonal antigranulocyte antibody imaging in inflammatory bowel disease: a preliminary report. Nucl Med Commun 1992; 13: 330-5.
  • 17 McAfee JG, Samin A. In-Ill labeled leukocytes: A review of problems in image interpretation. Radiology 1985; 155: 221-9.
  • 18 Munz DL. Reflections on the mechanisms of targeting bone marrow, spleen, and inflammatory foci with radiolabelled monoclonal anti-NCA-95 antibodies. Nuc-Com-pact 1990; 21: 90-1.
  • 19 Papós M, Nagy F, Láng J, Csernay L. Tech-netium-99mhexamethylpropylene amine oxime labelled leucocyte scintigraphy in ulcerative colitis and Crohn’s disease. Eur J Nucl Med 1993; 20: 766-9.
  • 20 Roddie ME, Peters AM, Danpure HJ. et al. Inflammation: Imaging with Tc-99m HMPAO-labeled leukocytes. Radiology 1988; 166: 767-72.
  • 21 Saverymuttu SH, Peters AM, Crofton ME. et al. Indium-lll-autologous granulocytes in the detection of inflammatory bowel disease. Gut 1985; 26: 955-60.
  • 22 Saverymuttu SH, Peters AM, Hodgson HJ. et al. Indium-Ill autologous leucocyte scanning: comparison with radiology for imaging the colon inflammatory bowel disease. Br Med J 1982; 285: 255-7.
  • 23 Scholmerich J, Schmidt E, Schumichen C. et al. Scintigraphic assessment of bowel involvement and disease activity in Crohn’s disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label. Gastroenterology 1988; 95: 1287-93.
  • 24 Sciarretta G, Furno A, Mazzoni M, Basile C, Malaguti P. Technetium-99m hexamethyl propylene amine oxime granulocyte scintigraphy in Crohn’s disease: diagnostic and clinical relevance. Gut 1993; 34: 1364-9.
  • 25 Segarra I, Roca M, Baliellas C. et al. Granu-locyte-specific monoclonal antibody techne-tium-99m BW 250/183 and indium-Ill oxin labelled leukocyte scintigraphy in inflammatory bowel disease. Eur J Nucl Med 1991; 18: 715-9.
  • 26 Stein DT, Gray GM, Gregory PB. et al. Location and activity of ulcerative and Crohn’s colitis by indium-lll-leukocyte scans. Gastroenterology 1983; 84: 388-93.