The value of Tc-99m-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation
EUROPEAN JOURNAL OF NUCLEAR MEDICINE, vol.28, no.5, pp.575-580, 2001 (SCI-Expanded, Scopus)
- 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.