Pediatric inflammatory bowel disease: Assessment with scintigraphy with Tc-99m white blood cells

PURPOSE: To evaluate the sensitivity and specificity of scintigraphy with t echnetium 9m white blood cells (WBC) for detection of colonic inflammation in children with and children without inflammatory bowel disease (IBD). MATERIALS AND METHODS: In 215 patients, uptake of Tc-99m WBC in 3,440 bowel segments was graded. In 137 of the 215 patients, the Tc-99m WBC scans were interpreted blindly and findings compared with results at colonoscopy and endoscopic biopsy. Planar, single photon emission computed tomographic, and maximum-activity-projection images were reviewed together. In 78 children without recent endoscopic biopsy results, Tc-99m WBC scan findings were com pared with laboratory values, the gastroenterologist's initial clinical ass essment, and findings at long-term clinical follow-up. RESULTS: In 128 of 137 children with recent biopsies, findings at histologi c examination and on Tc-99m WBC scans were correlated. There were seven fal se-negative and two false-positive studies. Sensitivity was 90%, specificit y 97%, positive predictive value 97%, negative predictive value 93%, preval ence of disease 53%, and overall accuracy 93%. In 75 of 78 (96%) children w ithout recent biopsies, Tc-99m WBC scan findings were consistent with the l aboratory values, gastroenterologist's clinical assessment, and long-term c linical follow-up findings. CONCLUSION: Scintigraphy with Tc-99m WBC is a useful noninvasive diagnostic test to determine the extent and distribution of inflammation in children with IBD.