An accurate test for acute appendicitis: In-111 WBC imaging
The decision to operate when acute appendicitis (APPY) is suspected is often difficult. Surgeons accept up to a 20% false positive rate to avoid any delay that may result in appendiceal rupture and peritonitis. The authors have successfully improved early diagnostic accuracy by using abdominal imaging beginning 2 hours after injecting In-111 labeled WBC. Patients with clear-cut (APPY) had laparotomy and were not studied. Those who were to be observed in the ER for possible (APPY) had their leukocytes harvested, labeled with In-111 oxine, and reinjected. Abnormal localized activity in the right lower quadrant (RLQ) imaged at 2 hours was graded relative to bone marrow activity (8M): 0, 1+BM. When available the surgical specimen was imaged for In-111 activity. Of 31 patients studied there were 13 with positive scans for (APPY) all surgically confirmed. There were 4 additional abnormal studies all demonstrating known diagnostic patterns, 2 of pertonitis and 2 of colitis. There were 14 negative studies in 8 of whom the clinical course was benign; the remaining 6 had laparotomy with 3 having (APPY) and 3 not. Thus there were no false positives and 3 false negatives. One case negative at 2 hours had appendiceal activity later. The 3 cases with 3+ activity all had apendiceal abscesses. This new application of In-111 oxine WBC imaging is safe, simple, sensitive and specific. It shortens the time to surgical intervention and should reduce the surgical false positive rate.
- Research Organization:
- Kaiser Permanente Medical Center, Oakland, CA
- OSTI ID:
- 6794736
- Report Number(s):
- CONF-850611-
- Journal Information:
- J. Nucl. Med.; (United States), Journal Name: J. Nucl. Med.; (United States) Vol. 26:5; ISSN JNMEA
- Country of Publication:
- United States
- Language:
- English
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62 RADIOLOGY AND NUCLEAR MEDICINE
ACCURACY
ANIMAL TISSUES
BETA DECAY RADIOISOTOPES
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
BONE MARROW
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DETECTION
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DIGESTIVE SYSTEM
DIGESTIVE SYSTEM DISEASES
DISEASES
DISTRIBUTION
DRUGS
ELECTRON CAPTURE RADIOISOTOPES
EVALUATION
GASTROINTESTINAL TRACT
HEMATOPOIETIC SYSTEM
INDIUM 111
INDIUM ISOTOPES
INTERMEDIATE MASS NUCLEI
INTESTINES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LABELLED COMPOUNDS
LARGE INTESTINE
LEUKOCYTES
LYMPHATIC SYSTEM
MATERIALS
MEDICINE
MEMBRANES
MINUTES LIVING RADIOISOTOPES
NUCLEI
ODD-EVEN NUCLEI
ORGANS
PERITONEUM
PERITONITIS
PHYSIOLOGY
RADIOISOTOPE SCANNING
RADIOISOTOPES
RADIOPHARMACEUTICALS
SAFETY
SCINTISCANNING
SEROUS MEMBRANES
SURGERY
TISSUE DISTRIBUTION
TISSUES