Colonoscopy and technetium-99m white cell scan in children with suspected inflammatory bowel disease

Objectives: To determine the utility of the technetium-labeled autologous w hite cell scintigraphy (Tc-WCS) for detecting intestinal;inflammation in ch ildren with suspected inflammatory bowel disease (IBD). Tc-WCS was compared with colonoscopy and histologic examination. Study design: Forty-eight children (26 boys; median age, 10 years; range, 2 -17 years) with symptoms and signs suggesting IBD had colonoscopy with expl oration of terminal ileum and mucosal biopsies. The scans were judged to be abnormal if activity was seen in the gut within the first hour. Results: Twenty-one patients had a diagnosis of IBD (Crohn's disease, 13; u lcerative colitis, 5; indeterminate colitis, 3); results of scintigraphy we re positive in 16 and negative in 5 (sensitivity, 76.2%); the latter had a moderate degree of intestinal inflammation. In 27 patients, IBD was ruled o ut. Results of scintigraphy were negative in children with non-specific col itis and in those with lymphoid hyperplasia of the terminal ileum, whereas results were positive in 6 of 12 patients with spondyloarthropathy. In chil dren with IBD, there was a significant correlation between results of scint igraphy and endoscopy for the intensity of inflammation (r = 0.70); however , there was a poor correlation regarding the number of involved segments (r = 0.30) because in 16 patients, endoscopy revealed additional diseased seg ments as compared with scintigraphy. Conclusions: A positive Tc-TNCS result indicates the presence of an inflamm atory process of the gut, whereas a negative test result does not rule out intestinal inflammation, especially when the latter is of moderate degree. Colonoscopy and biopsy are the investigations of choice to establish the di agnosis of IBD and are superior to Tc-WCS in assessing topographic extensio n of IBD.