Labeled granulocyte scanning for the diagnosis of infected necrosis in acute pancreatitis : What kind of labelling should be used ?

• Published in: Pancreas Vol. 12; no. 4; pp. 381 - 387
• Main Authors: HERESBACH, D, DEVILLERS, A, RABOT, A, MOISAN, A, MALLEDANT, Y, BOURGUET, P, BRETAGNE, J. F, GOSSELIN, M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-05-1996
• Subjects: Acute Disease; Aged; Biological and medical sciences; Female; Gastroenterology. Liver. Pancreas. Abdomen; Granulocytes; Humans; Indium Radioisotopes; Isotope Labeling - methods; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Necrosis - complications; Necrosis - diagnostic imaging; Organometallic Compounds; Organotechnetium Compounds; Other diseases. Semiology; Oximes; Oxyquinoline - analogs & derivatives; Pancreatitis - diagnostic imaging; Pancreatitis - pathology; Radionuclide Imaging; Sensitivity and Specificity; Sepsis - complications; Sepsis - diagnostic imaging; Technetium Tc 99m Exametazime; Radionuclide study; Human; Radiolabelling; Acute; Granulocyte; Pancreatitis; Scintigraphy; Necrosis; Infection; Digestive diseases; Complication; Diagnosis; Pancreas; Pancreatic disease
• ISSN: 0885-3177; 1536-4828
• DOI: 10.1097/00006676-199605000-00010

Clinical and laboratory data or imaging results cannot provide a positive diagnosis of septic complications of pancreatic and peripancreatic necrosis in patients with acute pancreatitis. Confirmation can be obtained only after percutaneous computed tomography (CT)-guided aspiration of the necrotic tissues or fluid collection; although the important role of 99Tc(m)-HMPAO-labeled granulocyte scintigraphy has been recently emphasized. The aim of this study was to determine the sensitivity and specificity of 99m-technetium-hexamethylpropyleneamine oxime (99Tc(m)-HMPAO)- or 111In-oxine-labeled granulocyte scintigraphy for the diagnosis of infection in pancreatic or peripancreatic necrosis to define the ideal label for diagnosis. Thirty-six scintigraphic examinations were performed in 34 consecutive patients (mean age, 58 +/- 2 years) 20 +/- 2 days after the onset of acute pancreatitis (Balthazar classes A-C, n = 7; classes D and E, n = 29). The scintigraphic study included scintigraphic tomography and static acquisition 1 and 3 h, respectively, after reinjection of the autologous 99Tc(m)-labeled granulocytes and static images 3-4 and 24 h after the simultaneous reinjection of 111In-oxine-labeled autologous granulocytes. The diagnosis of infected pancreatic or peripancreatic necrosis was confirmed with percutaneous CT-guided aspiration (14 positive aspirates among 20 performed) and sterile necrosis after negative aspiration (6 negative aspirates) or after a 6 +/- 1-month follow-up free of clinical or biological signs of ongoing sepsis. The sensitivity and specificity were 86 and 73%, respectively, for scintigraphic tomography, 100 and 55% for 3-h 111In images, 93 and 68% for 3-4-h 111In images, and 100 and 64% for 24-h 111In images. The fall in splenic activity between the 3-4 and the 24-h 111In images was 26 +/- 3% in patients with septic pancreatic and peripancreatic necrosis (n = 14) and 16 +/- 3% in those with sterile necrosis (n = 22) (p < 0.01). Labeled granulocyte scintigraphy was thus shown to be an effective tool for the diagnosis of infection in pancreatic and/or peripancreatic necrosis due to acute pancreatitis, especially when the scintiscans are performed early after injection of 99Tc(m) or when the fall in splenic activity over the 24 h following reinjection of 111In is measured in particularly difficult cases. These promising preliminary results should be confirmed by a prospective study.