99mTc-HMPAO labelled leucocyte scintigraphy in the diagnosis of pelvic inflammatory disease

ACR Appropriateness Criteria® Sepsis

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis. In 2017, the global incidence of sepsis was estimated to be 48.9 million cases, with 11 million sepsis-related deaths (accounting for nearly 20% of all global deaths); therefore, understanding which imaging modalities and types of studies are acceptable or not acceptable is imperative. The 5 variants provided include the most commonly encountered scenarios in the setting of sepsis along with recommendations and data for each imaging study. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

99mTc-HMPAO labelled white blood cell scintigraphy in the diagnosis and monitoring of response of the therapy in patients with active bronchiectasis

AIM

The aim of this study was to assess the role of labelled leukocyte scintigraphy in the diagnosis and monitorization of response to therapy of patients with active bronchiectasis.

MATERIAL AND METHODS

Twenty patients underwent (99m)Technetium hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) labelled white blood cell (WBC) scintigraphy. A second scintigraphy was performed in 13 patients at 10 day of the treatment. Regional (99m)Tc-HMPAO WBC uptake and radiologic imaging findings (high resolution computed tomography or Chest X-Ray) in the lungs were classified into 3 categories in 6 lung areas. scintigraphic, radiological and clinical disease scores were calculated for all patients.

RESULTS

An abnormal accumulation was visually observed in 19 of 20 patients on the pre-treatment scans, the scintigraphy showing 95% sensitivity. A significant difference was found between early and late ratios (P=0.001) in the pre-treatment scans. The infected areas revealed a significant decrease in uptake ratios on the post-treatment scans compared to the pre-treatment scans (P=0.001). However, no significant correlation was determined between clinical and radiological scores, clinical and scintigraphic scores and also between scintigraphic and radiological scores (P ≥ 0.05).

CONCLUSIONS

(99m)Tc-HMPAO WBC scintigraphy may be a useful tool to evaluate response to therapy in patients with active bronchiectasis.

The labeled-leukocyte scan in the study of abdominal abscesses

AIM

The purpose of the present paper was to review the literature over the last 30 years to assess the value of radionuclide imaging, particularly labeled leukocyte scan, as compared to other imaging modalities in the management of abdominal abscesses.

METHODS

A systematic review of the published studies in humans cited in PubMed written in English, French, German, Italian, and Spanish was made.

RESULTS

Ultrasound (US) has lower sensitivity than leukocyte scan (LS), particularly in patients without localizing signs, while CT has higher sensitivity than US, but less than LS. On the other hand, CT had higher specificity than both LS and US.

DISCUSSION

LS is the more sensitive method to localize abdominal abscesses and may guide dedicated US and CT investigations to improve their diagnostic potential. Further diagnostic evolution is expected from the routine use of hybrid SPECT/CT systems.

Scintigraphic evaluation of acute pancreatitis patients with 99mTc-HMPAO-labelled leukocytes

OBJECTIVE

To demonstrate the localization of leukocytes in the pancreas during acute pancreatitis and to evaluate the potential use of 99mTc-HMPAO-labelled leukocytes in the diagnostic assessment of patients with acute pancreatitis.

METHODS

The study was performed with 20 patients (11 females, nine males; ranging in age from 26 to 86 years, mean 55 years). Labelled leukocyte scintigraphy using planar imaging was performed on all patients, seven of whom were also examined by single photon emission computed tomography (SPECT). According to Ranson criteria, 10 patients had mild pancreatitis (group A), six had severe pancreatitis (group B) and four had necrotic pancreatitis (group C). Twelve patients had biliary pancreatitis and the other eight patients had no obvious cause.

RESULTS

All patients of group C, four of group B, two of group A had a positive leukocyte scan. The positive leukocyte scintigraphy value for the detection of a lethal course of acute pancreatitis was 100%; of a severe course, 66.7%; and of a mild course, 20%. These findings are statistically significant (P=0.005 in chi-squared tests result). The results of leukocyte scintigraphy compared with those of CT were also statistically significant (P=0.001 in chi-squared tests). All the patients diagnosed with pancreatic necrosis by CT had a positive leukocyte scan, but only three of 13 patients without pancreatic necrosis that could be detected by computed tomography had a positive leukocyte scan.

CONCLUSIONS

There was a significant correlation between the severity of the disease and leukocyte infiltration. Considering these results, we believe that leukocyte infiltration in acute pancreatitis can be demonstrated rapidly and accurately and by noninvasive 99mTc-HMPAO labelled leukocyte scintigraphy.

Pelvic inflammatory disease in adolescents

PURPOSE OF REVIEW

We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents.

RECENT FINDINGS

Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples.

SUMMARY

Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.