The value of Tc-99m-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation

Colak T., Gungor F., Ozugur S., Bozan H., Yildiz A., Boz A., ...More

EUROPEAN JOURNAL OF NUCLEAR MEDICINE, vol.28, no.5, pp.575-580, 2001 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 5
  • Publication Date: 2001
  • Doi Number: 10.1007/s002590100504
  • Journal Name: EUROPEAN JOURNAL OF NUCLEAR MEDICINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.575-580
  • Keywords: Tc-99m-HMPAO, white blood cells, acute appendicitis, HEXAMETHYLPROPYLENE AMINE OXIME, SUSPECTED ACUTE APPENDICITIS, LEUKOCYTE SCINTIGRAPHY, DIAGNOSTIC LAPAROSCOPY, APPENDECTOMY, DISEASE, WOMEN, MANAGEMENT, ACCURACY, CHILDREN
  • Akdeniz University Affiliated: Yes

Abstract

Various imaging studies can be performed in the evaluation of patients with a clinical presentation equivocal for acute appendicitis. One of these studies is technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled white blood cell (WBC) scintigraphy. The aim of this study was to evaluate the accuracy and clinical value of Tc-99m-HMPAO WBC scintigraphy in the aforementioned group of patients. Forty-one patients who had acute right lower quadrant abdominal pain with a clinical presentation equivocal for acute appendicitis were included in the study. The anterior abdomen and pelvis were imaged up to 4 h after the injection of 125-300 MBq Tc-99m-HMPAO WBCs and the results were immediately reported to the surgeon before a decision was taken on whether to perform laparotomy. Diagnostic accuracy was established by the intra-operative findings and the histopathology in operated patients. In non-operated patients, absence of abdominal symptoms 1 month after scintigraphy and/or identification of another cause of abdominal pain was used to rule out acute appendicitis. There were 16 patients with positive scintigraphy and 81% of these patients were positive within 2 h post injection. There were no false-positive or false-negative results. We operated on 17 (41.4%) patients, and only one patient (5.9%) underwent unnecessary laparotomy. We conclude that Tc-99m-HMPAO WBC scintigraphy is a rapid, highly accurate method for the exclusion of acute appendicitis and that its use can lower the unnecessarily high laparotomy rate in patients with an equivocal clinical presentation.