Indium-111 leukocyte scintigraphy in suspected bowel ischemia

OBJECTIVE: The purpose of this study was to evaluate the utility of indium-111 leukocyte (In-111 WBC) scintigraphy in a large number of patients with suspected bowel ischemia. METHODS: All patients who underwent In-111 WBC scintigraphy for possible bowel ischemia over a 4-yr period and had subsequent endoscopic or surgical biopsy were retrospectively evaluated. Early (1-4 h postinjection) and late (18-24 h postinjection) images were obtained. Any study with tracer activity in the bowel on early or late images was considered positive for bowel ischemia. RESULTS: Fifty-nine patients were included in the analysis. In-111 WBC scintigraphy detected 23 of 24 cases of bowel ischemia (sensitivity = 96%). Of 35 cases without ischemia, 16 had a negative In-111 WBC scintiscan (specificity = 46%). Negative and positive predictive values for the diagnosis of bowel ischemia were 94% and 55%, respectively. Of the 19 cases without bowel ischemia and a positive scintiscan, 15 had another intraabdominal process responsible for the patients' symptomatology. CONCLUSIONS: In-111 WBC scintigraphy is a highly sensitive diagnostic tool for bowel ischemia. A normal In-111 WBC scintiscan strongly suggests that this disease is not present.