1. 99mTc-HMPAO labelled leucocyte scintigraphy in the diagnosis of pelvic inflammatory disease
- Author
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Mustafa Yildirim, Hatice Uslu, Erhan Varoglu, Ayten Kadanali, Rezzan Bayrakdar, and Sedat Kadanali
- Subjects
Adult ,medicine.medical_specialty ,Peritonitis ,Disease ,Scintigraphy ,Sensitivity and Specificity ,Sepsis ,Technetium Tc 99m Exametazime ,Pelvic inflammatory disease ,Leukocytes ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radionuclide Imaging ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Abdominal Abscess ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Female ,Radiology ,Radiopharmaceuticals ,business ,Pelvic Inflammatory Disease - Abstract
Background Scintigraphy using leucocytes labelled with 99m Tc hexamethylpropyleneamine oxime ( 99m Tc-HMPAO) is widely used for the localization of inflammatory foci and abscesses in cases of acute pelvic inflammatory disease, which is one of the serious health problems of women of child-bearing age. Early diagnosis and effective management of this condition can preserve fertility and prevent serious complications, such as peritonitis and sepsis. Aim To evaluate the importance of scintigraphy using 99m Tc-HMPAO labelled leucocytes in the early diagnosis of patients with pelvic inflammatory disease. Methods Fifteen women (mean age 29.2 ± 8 years, range 25-46 years) with suspicion of pyogenic pelvic inflammatory disease based on gynaecological examinations, clinical findings and blood tests were included in this study. The patients received 555 MBq 99m Tc-HMPAO labelled leucocytes, by injection, and were scanned by scintigraphy 0.5-1, 3 and 24 h later in the anterior abdominal projection. Ten of the patients were then evaluated by abdominal or transvaginal ultrasonography, four by computed tomography and two by both ultrasound and computed tomography. The final diagnosis was made by surgical intervention. Results Scintigraphy detected pelvic inflammatory disease in five of the patients. In three of them the disease was apparent on the scans taken at 0.5-1 h, and in the other two it was apparent at 3 h. There were no false negative results, and one false positive result. The scan accurately reflected the absence of pelvic inflammatory disease in nine patients showing non-pathological tracer uptake in the lower abdominal region. Conclusion We showed that scintigraphy with 99m Tc-HMPAO labelled leucocytes had a sensitivity of 100%, specificity of 90%, overall accuracy of 93%, positive predictive value of 83%, and negative predictive value of 100%. Therefore, we conclude that 99m Tc-HMPAO labelled leucocyte scans provide a rapid and highly accurate method for diagnosing pelvic inflammatory disease in women of child-bearing age. This adds an important contribution to the diagnosis of infection and helps determine further operative or conservative treatment.
- Published
- 2006