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Indium-111 Whole-Body Retention: A Method for Quantification of Disease Activity in Inflammatory Bowel Disease

Departments of Medicine, Diagnostic Radiology and Medical Physics, Hammersmith Hospital, London, England

Correspondence: For reprints contact: Marta Carpani de Kaski, MD, Department of Medicine, Hammersmith Hospital, Du cane Road, London W12 OHS, England.

ABSTRACT

Quantification of disease activity in inflammatory bowel disease (IBD) has been by measurement of fecal excretion of ¹¹¹In-granulocytes. The difficulties of this method prompted us to evaluate quantification of whole-body ¹¹¹In retention, expressed as a percentage of whole-body activity at 3 hr following injection, as an alternative method. The patient stood in front of the uncollimated gamma camera at a distance of 4 m and counts were collected over 2 min. The geometric mean was taken of posterior and anterior counts and compared with a ¹¹¹In standard. The lower limit of the 95% confidence interval for whole-body retention in normals was 90%. Forty-five studies were performed on 33 patients with IBD. They were assessed in two groups, one to whom routine instructions for the collection of feces were given (Group A) but who did not always comply. The other group received oral and written instructions and were also monitored during the collection period (Group B) and reported full fecal collection. Although in Group A the correlation between fecal excretion and whole-body retention was good (r = 0.7, n = 32; p < 0.001), in Group B the relationship between fecal excretion and whole-body retention was significantly better (r = 0.95, n = 18; p < 0.001). On average, ¹¹¹In whole-body retention was consistent with findings obtained during imaging: ¹¹¹In excretion (100-whole-body retention) was 7.8% ± 4.9% in 5 normal scans, 10% ± 5.9% in 17 (+) scans, 22.3% ± 8% in 20 (++) scans and 57% ± 16% in 8 (+++) scans. We conclude that imaging is more sensitive than whole-body retention and fecal excretion in the detection of disease, but for quantification, whole-body retention is an accurate reliable alternative to fecal excretion.