QUANTIFICATION OF DISEASE-ACTIVITY IN CROHNS-DISEASE BY COMPUTER-ANALYSIS OF TC-99M HEXAMETHYL PROPYLENE AMINE OXIME (HMPAO) LABELED LEUKOCYTE IMAGES

The reliability and clinical applications of computerised image analysis measurement of bowel uptake of Tc-99m HMPAO labelled leucocytes has been examined as a measure of disease activity in Crohn's disease. In 54 studies carried out on 33 patients with established Crohn's disease, the mean 'scan score', a quantitative assessment of image intensity, was 82-1 SEM (13.6), in patients with clinically active disease compared to 24.7 (7.0) in those with quiescent disease, p less-than-or-equal-to 0.0005. A significant correlation was found between the scan score and Crohn's Disease Activity Index (rs=0.52, p<0.0001), and Harvey and Bradshaw Simple Index (rs=0.4, p<0.004). A low scan score correctly identified seven patients whose raised Crohn's Disease Activity Index incorrectly indicated active disease because symptoms used in calculation of the index were not caused by active inflammation. Of the laboratory measurements, the scan score correlated with the haemoglobin (rs=0.66, p<0-0001), albumin level (rs=0.6, p<0.0001), C-reactive protein (rs=0.7, p<0.0001), alpha-acid glycoprotein (rs=0.57, p<0.001), and platelet count (rs=0.47, p less-than-or-equal-to 0.006), but not with the erythrocyte sedimentation rate (rs=0.2, p less-than-or-equal-to 0.25). The scan score was raised in all patients who had clinically active disease but normal laboratory tests. The results of this study indicate that the scan score provides an objective indicator of disease activity in Crohn's disease which may be superior to clinical indices, and also to laboratory tests which although objective are often normal in the presence of active disease.