TC-99M-HMPAO GRANULOCYTE SCINTIGRAPHY IN THE EARLY DETECTION OF POSTOPERATIVE ASYMPTOMATIC RECURRENCE IN CROHNS-DISEASE

The usefulness of Tc-99m-HMPAO scintigraphy in the early detection of postoperative recurrence of Crohn's disease was evaluated in 17 patien ts undergoing ileocecal resection and prospectively followed up for on e year. Scintigraphy was performed 6 and 12 months after surgery and r ecurrence assessed by colonoscopy within two weeks. As controls, four patients with ileocecal resection for cecal carcinoma were studied. To perform scintigraphy, autologous granulocytes were labeled with Tc-99 m-HMPAO, injected, and tau-camera images acquired after 30 min and 3 h r. Six months after surgery, 4/8 Crohn's disease patients showed endos copic recurrence, and 30-min scintigraphy was positive only in these f our patients (four true positives, four true negatives). At 12 months, endoscopic recurrence was detected in 10/14 Crohn's disease patients, and 30-min scintigraphy was positive in 9/14 patients (eight true pos itives, three true negatives, two false negatives, one false positive) . Scintigraphy at 3 hr showed a lower specificity in detecting CD recu rrence both at 6 and 12 months. The endoscopic and 30-min scintigraphi c score were significantly correlated both at 6 and 12 months (P = 0.0 07; P = 0.04). Scintigraphy was negative in 4/4 controls at 30 min (fo ur true negatives) and positive in 1/4 (one false positive) at 3 hr. W e conclude that Tc-99m-HMPAO scintigraphy at 30 min is a sensitive tec hnique for the early detection of Crohn's disease recurrence in patien ts under regular follow-up after surgery.