TC-99M HEXAMETHYLPROPYLENE AMINE OXIME LEUKOCYTE SCINTIGRAPHY IN THE EARLY COURSE OF MILD ACUTE-PANCREATITIS FOLLOWING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

We evaluated the diagnostic accuracy of technetium-99m hexamethylpropy lene amine oxime (HMPAO) leucocyte scintigraphy in mild acute pancreat itis. A study design was chosen that gave us an opportunity to assess patients by leucocyte scintigraphy in the very early course of the dis ease. Thirty-two consecutive patients referred for endoscopic retrogra de cholangiopancreatography were followed according to a very rigid pr otocol with laboratory tests and clinical examination before and after the endoscopic procedure and leucocyte scintigraphy [including single -photon emission tomography (SPET)] performed within 24 h. Planar and SPET images were examined by two observers who were blinded to each ot her and to the clinical history and diagnosis. Eight (25%) of the 32 p atients developed mild acute pancreatitis, and only one of these patie nts had a positive scan, Sensitivity, specificity and accuracy of 13%, 79% and 63%, respectively, were achieved when both planar and SPET im ages were considered. When only planar images were considered the sens itivity, specificity and accuracy were 13%, 96% and 75%, respectively. No evidence of pathological leucocyte accumulation in mild acute panc reatitis was found despite the aforementioned very rigid protocol, all owing patients to be assessed by Tc-99m-HMPAO leucocyte scintigraphy i n the very early phase of the disease (this was true even when using S PET). From a clinical point of view we believe that leucocyte scintigr aphy should be used only when the disease is moderate or severe and se rious intraabdominal complications are suspected.