Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in female patients with an atypical clinical presentation.

Abstract

BACKGROUND/AIMS:

Acute appendicitis is a clinically challenging surgical disease which is particularly difficult to diagnosis in women. An atypical presentation is a major obstacle to quickly diagnose acute appendicitis.

METHODOLOGY:

Fifty female patients with acute abdomen pain who were suspected of having appendicitis, but who had atypical findings were included in this study. After an intravenous injection of technetium-99m hexamethylpropyleneamineoxide (Tc-99m HMPAO) labeled white blood cells, serial anterior abdomen-pelvis images at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images.

RESULTS:

Thirty-two patients received a laparotomy for surgical and pathological diagnoses. The remaining 18 patients did not receive operations and showed no evidence of appendicitis after at least a one-month follow-up period. Two patients had false-positive white blood cell scan findings and 2 patients had false-negative white blood cell scan findings. The overall sensitivity, specificity, and accuracy for white blood cell scans in diagnosing appendicitis was 93.3%, 90.0%, 92.0%, respectively. One patient had false-positive abdominal sonographic finding and 5 patients had false-negative abdominal sonographic findings. The overall sensitivity, specificity, and accuracy for abdominal sonography scans in diagnosing appendicitis were 83.3%, 95.0%, and 88.0%, respectively.

CONCLUSIONS:

The Tc-99m HMPAO white blood cell scan provides a more sensitive and accurate method for the diagnosis of appendicitis in female patients with equivocal clinical presentation when compared with abdominal sonography.

• Authors: Ken-Sheng Cheng, Yu-Chien Shiau, Cheng-Cheih Lin, Cheng-Chun Lee, Albert Kao
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2003 Jan-Feb Vol. 50 Issue 49 Pg. 136-9 ISSN: 0172-6390 [Print] Greece
• PMID: 12630009 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Chemical References

• Oximes
• hexamethylpropyleneamine oxime

Topics

• Abdomen (diagnostic imaging)
• Acute Disease
• Adolescent
• Adult
• Aged
• Appendicitis (diagnostic imaging)
• Child
• Female
• Humans
• Leukocytes (diagnostic imaging)
• Middle Aged
• Oximes
• Radionuclide Imaging
• Reproducibility of Results
• Sex Factors
• Ultrasonography