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Indium-111-White Blood Cell Scintigraphy in Crohn's Patients with Fistulae and Sinus Tracts

Division of Nuclear Medicine, Division of Gastrointestinal Radiology, Department of Diagnostic Radiology, Victoria General Hospital, Halifax, Nova Scotia, Canada

Correspondence: For correspondence or reprints contact: E. Even-Sapir, MD, DSc, Div. of Nuclear Medicine, Dept. of Diagnostic Radiology, Victoria General Hospital, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9.

ABSTRACT

Method: Indium-111-white blood cell (¹¹¹In-WBC) images of 17 Crohn's patients with fistulae and sinus tracts were reviewed and correlated with radiographic results (n = 16 patients) and surgery (n= 16 patients), to characterize the scintigraphic appearance of fistulization and to determine the role of ¹¹¹In-WBC scintigraphy in this clinical setting. These were compared to 50 consecutive abnormal ¹¹¹In-WBC studies obtained in Crohn's patients with suspected active disease but no known fistulae or sinus tracts. Results: Scintigraphic findings which suggested the presence of fistulae were: (1) the presence of concomitant intestinal and extraintestinal lesions and (2) the absence of luminal activity on delayed images when early images detected bowel activity. The extraintestinal lesions were the drainage site of the fistula (n = 7) or an accompanying abscess (n = 6). Absence of luminal activity occurred in seven patients with fistulae and in two without fistulae; two patients had a proximal colostomy, two patients had bowel obstruction and five patients had fistulae to the skin (n = 3) or between the ileum and distal colon (n = 2). The distribution of active bowel disease as assessed scintigraphically was in complete agreement with surgery in 14 of 17 cases (82%) compared to 9 of 15 cases (60%) when correlating radiographic assessment with surgery. All surgically proven abscesses were detected on ¹¹¹In-WBC images. Conclusion: These results indicate that ¹¹¹In-WBC scintigraphy adds useful information to radiographic studies that is essential for appropriate management of Crohn's patients with fistulae and sinus tracts.

Key Words: intestines • disease fistula • radioactive radionuclide imaging • comparative studies • indium-111-leukocyte • Crohn's disease • gastrointestinal inflammation