COMPUTED-TOMOGRAPHY AND GRANULOCYTE SCINTIGRAPHY IN ACTIVE INFLAMMATORY BOWEL-DISEASE - COMPARISON WITH ENDOSCOPY AND OPERATIVE FINDINGS

The accuracy of computed tomography (CT) and [Tc-99m]HMPAO granulocyte scintigraphy (GS) for detection of bowel localization, inflammatory a ctivity, and complications in acute inflammatory bowel disease (IBD) w as prospectively studied in 32 patients. Of each bowel segment, findin gs on CT and GS were scored by one blinded observer. Findings on opera tion or endoscopy served as the gold standard. In Crohn's disease (CD, 17 patients), CT detected bowel pathology (sensitivity 71%, specifici ty 98%), abscesses (sensitivity and specificity 100%), and fistulas (s ensitivity 80%, specificity 100%). In CD, GS had a sensitivity of 79% and a specificity of 98% for detection of inflammatory activity. The d etection of complications with GS was poor. Segmental inflammatory act ivity correlated with endoscopy-operative findings for CT (r = 0.86, P < 0.0001) and GS (r = 0.86, P < 0.0001), In ulcerative colitis (UC, 1 5 patients), GS predicted proximal extension of bowel involvement bett er than CT. In CD, CT is superior to GS for localization of both activ e and fibrostenotic bowel disease, and in detection of abscesses and f istulas. In UC, GS showed proximal extension more accurately than CT.