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^99mTc-Human Serum Albumin Scans in Children with Protein-Losing Enteropathy

Departments of Pediatrics and Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Correspondence: For correspondence or reprints contact: Siema M. Bakheet, MD, King Faisal Specialist Hospital & Research Centre, Department of Radiology (MBC #28), P.O. Box 3354, Riyadh 11211, Saudi Arabia.

ABSTRACT

Protein-losing enteropathy (PLE) can be diagnosed scintigraphically using ^99mTc-human senjm albumin (HSA) scans. Methods: To evaluate the usefulness of this method in detecting enteric protein loss, we retrospectively reviewed the ^99mTc-HSA scans of 18 children presenting consecutively with PLE. Results: Enteric ^99mTc-HSA uptake was noted in 12 patients (8 boys, 4 girls) with a mean age of 7.4 y. Early dynamic images showed abdominal uptake that was most likely in the small bowel in 91% of the scans. Delayed images showed abnormal accumulation that was localized in the colon in 73% and in the small bowel in 27% of the scans. A 4-mo follow-up scan obtained in 3 patients showed reduced HSA uptake after a high-protein, low-fat, medium-chain triglyceride oil-based diet and fat-soluble vitamins. Mean serum albumin, total protein, gammaglobulin, and calcium levels were significantly decreased. Ten patients (from 4 families) were diagnosed to have primary intestinal lymphangectasia. One patient had active Salmonella enterocolitis, and 1 had giardiosis. ^99mTc-HSA was normal in the remaining 6 patients (3 boys, 3 girls) with a mean age of 3.5 y (range, 2–5 y). Mean serum albumin, total protein, gammaglobulin, and calcium levels were less decreased than those of the first group. Five of these patients had primary intestinal lymphangactesia (associated with infantile systemic hyalinesis in 1 patient). The remaining patient had normal duodenal biopsy, and the cause of protein loss remained unknown. Conclusion: The ^99mTc-HSA scan is useful in the evaluation of children with PLE, especially those with severe hypoproteinemia and hypoalbuminemia, presumably reflecting a high rate of protein loss.

Key Words: ^99mTc-human serum albumin • protein-losing enteropathy • primary intestinal lymphangectasia

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				N.-T. Chiu, B.-F. Lee, S.-J. Hwang, J.-M. Chang, G.-C. Liu, and H.-S. Yu Protein-losing Enteropathy: Diagnosis with 99mTc-labeled Human Serum Albumin Scintigraphy Radiology, April 1, 2001; 219(1): 86 - 90. [Abstract] [Full Text]