Download PDF
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)

    Permissions and Reprints

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
 

  • References

  • 1 Addiss DG, Shaffer N, Fowler BS. et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132: 910-25.
    CrossrefPubMedGoogle Scholar
  • 2 Babior BM, Cohen HF. Measurement of neutrophil function: phagocytosis, degranulation, the respiratory burst and bacterial killing. In: Cline MJ. (ed) Leukocyte function. New York: Churchill-Livingstone; 1981: 1-38.
    Google Scholar
  • 3 Biersack HJ, Overbeck B, Ott G. et al. Tc-99m labeled monoclonal antibodies against granulocytes (BW 250/183) in the detection of appendicitis. Clin Nucl Med 1993; 18: 371-6.
    CrossrefPubMedGoogle Scholar
  • 4 Bolton JP, Craven ER, Croft RJ. et al. An assessment of the value of the white cell count in the management of suspected acute appendicitis. Br J Surg 1975; 62: 906-8.
    CrossrefPubMedGoogle Scholar
  • 5 Brown JJ. Acute appendicitis: the radiologist’s role. Radiology 1991; 180: 13-4.
    CrossrefPubMedGoogle Scholar
  • 6 Chen SC, Wang SM. C-reactive protein in the diagnosis of acute appendicitis. Am J Emerg Med 1996; 14: 101-3.
    CrossrefPubMedGoogle Scholar
  • 7 Dueholm S, Bagi P, Bud M. Laboratory aid in the diagnosis of acute appendicitis. Dis Colon Rectum 1989; 32: 855-9.
    CrossrefPubMedGoogle Scholar
  • 8 el Ferzli G, Ozuner G, Davidson PG. et al. Barium enema in the diagnosis of acute appendicitis. Surg Gynecol Obstet 1990; 171: 40-2.
    PubMedGoogle Scholar
  • 9 Eriksson S, Granstrom L, Bark S. Laboratory tests in patients with suspected acute appendicitis. Acta Chir Scand 1989; 155: 117-20.
    PubMedGoogle Scholar
  • 10 Evetts BK, Foley CR, Latimer RG. et al. Tc-99 hexamethylpropyleneamineoxide scanning for the detection of acute appendicitis. J Am Coll Surg 1994; 179: 197-201.
    PubMedGoogle Scholar
  • 11 Foley CR, Latimer RG, Rimkus DS. Detection of acute appendicitis by technetium 99 HMPAO scanning. Am Surg 1992; 58: 761-5.
    Google Scholar
  • 12 Henneman PL, Marcus CS, Butler JA. et al. Evaluation of women with possible appendicitis using technetium-99m leukocyte scan. Am J Emerg Med 1990; 8: 373-8.
    PubMedGoogle Scholar
  • 13 Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am J Surg 1990; 160: 291-3.
    CrossrefPubMedGoogle Scholar
  • 14 Jeffrey Jr RB, Laing FC, Lewis FR. Acute appendicitis: high-resolution real-time US findings. Radiology 1987; 163: 11-4.
    CrossrefPubMedGoogle Scholar
  • 15 Kao CH, Lin HT, Wang YL. et al. Tc-99m HMPAO-labeled WBC scans to detect appendicitis in women. Clin Nucl Med 1996; 21: 768-71.
    CrossrefPubMedGoogle Scholar
  • 16 Kao CH, Wang YL, Liao SQ. et al. Tc-99m HMPAO label w1 WBCs in the detection of occult sepsis in the intensive care unit. Intensive Care Med 1992; 18: 15-9.
    CrossrefPubMedGoogle Scholar
  • 17 Kipper SL. The role of radiolabeled leukocyte imaging in the management of patents of patients with acute appendicitis. Q J Nucl Med 1999; 43: 83-91.
    PubMedGoogle Scholar
  • 18 Kottmeier PK. Appendicitis. In: Welch KJ, Randolph JG, Ravitch MM. (eds.) Pediatric Surgery. Chicago: Year Book Medical Publishers; 1986: 991-2.
    Google Scholar
  • 19 Mountford PJ, Kettle HG, O’Doherty MJ. et al. Comparsion of Technetium-99m-HMPAO leukocytes with Indium-111-oxine leukocytes for localizing intra-abdominal sepsis. J Nucl Med 1990; 31: 311-5.
    PubMedGoogle Scholar
  • 20 Overbeck B, Briele B, Hotze A. et al. 99mTc-anti-granulocyte antibodies (BW 250/183) in the detection of appendicitis. Nuklearmedizin 1992; 31: 24-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Peters AM, Danpure HG, Osman S. et al. Clinical experience with 99m-Tc-hexamethylpropylene-amineoxime for labelling leukocytes and imaging inflammation. Lancet 1986; 25: 946-9.
    Google Scholar
  • 22 Peters AM, Saverymuttu SH, Bell RN. et al. Quantification of the distribution of the margination granulocyte pool in man. Scan J Haematol 1985; 34: 111-20.
    PubMedGoogle Scholar
  • 23 Putnam TC, Gagliano N, Emmens RW. Appendicitis in children. Surg Gynecol Obstet 1990; 170: 527-32.
    PubMedGoogle Scholar
  • 24 Puylaert JB, Rutgers PH, Lalisang RI. et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med 1987; 317: 666-9.
    CrossrefPubMedGoogle Scholar
  • 25 Puylaert JBCM. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158: 355-60.
    CrossrefPubMedGoogle Scholar
  • 26 Roddie ME, Peters AM, Danpure HJ. et al. Inflammation: imaging with Tc-99m HMPAO labelled leucocytes. Radiology 1988; 166: 762-7.
    Google Scholar
  • 27 Rypins EB, Evans DG, Hinrichs W. et al. Tc-99m-HMPAO white blood cell scan for diagnosis of acute appendicitis in patients with equivocal clinical presentation. Ann Surg 1997; 226: 58-65.
    CrossrefPubMedGoogle Scholar
  • 28 Schwerk WB, Wichtrup B, Rothmund M. et al. Ultrasonography in the diagnosis of acute appendicitis: a prospective study. Gastroenterology 1989; 97: 630-9.
    CrossrefPubMedGoogle Scholar
  • 29 Sfakianakis GN, Al-Sheikh W, Heal A. et al. Comparison of scintigraphy with In-111 leukocytes and Ga-67 in the diagnosis of occult sepsis. J Nucl Med 1982; 23: 618-26.
    PubMedGoogle Scholar
  • 30 Thakur ML, Coleman RE, Welch MS. Indium-111 labeled leukocytes for the localization of abscesses: preparation analysis, tissue distribution and comparison with gallium-67 citrate in dogs. J Lab Clin Med 1977; 89: 217-28.
    PubMedGoogle Scholar
  • 31 Thakur ML, Lavender P, Arnot RN. et al. Indium-111-labeled autologous leukocytes in man. J Nucl Med 1977; 18: 1009-12.
    Google Scholar
  • 32 Thompson MM, Underwood MJ, Dookeran KA. et al. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg 1992; 79: 822-4.
    CrossrefPubMedGoogle Scholar