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P207 67-Gallium citrate oral Scintigraphy evaluation in inflammatory activity in Crohn′s disease: a new highlighter?

J. B. Tajra*1, J. U. Calegaro2, A. P. De Paula3, D. Bachour4, D. Silveira1

1Instituto Hospital de Base, Coloproctology, Brasilia, Brazil, 2Instituto Hospital de Base, Nuclear Medicine, Brasília, Brazil, 3Hospital Regional da Asa Norte, Rheumatology, Brasilia, Brazil, 4Instituto Hospital de Base, Pathology, Brasilia, Brazil

Background

There is not gold-standard diagnostic form to identify inflammatory activity in Crohn’s disease (CD). The aim was to analyse the accuracy of oral 67-gallium scintigraphy to measure inflammatory activity in CD under treatment.

Methods

The study population was derived from eligible subjects who were known to have CD. Eligible patients were at least 18 years of age were known to have CD or were suspected of having CD. Exclusion criteria included pregnancy, intestinal surgery, and corticosteroid user. Twenty-four patients were enrolled in a prospective consecutive cross-sectional study from January 2018 to June 2018. The gold-standard test was the histopathological analyses. The patients were underwent a digestive transit studies with 67-gallium citrate (300 μCi) after oral ingestion with 10 ml of water. The radionuclide protocols were performed in 3, 6, 12, 24, 48, and 72 h after oral ingestion of radiotracer. We used statics pictures with 300000 count each in anterior abdomen projection using a γ camera with large field of vision, medium-energy collimator, and 20% window centred in 92–300 keV photopeaks. Then, patients underwent a colonoscopy, until terminal ileum. Simple endoscopic score for CD (SES-CD) classified patients under suspect or proven for CD. In this case, each segment was subjected to two biopsies. Mucosal biopsies were taken from terminal ileum to rectum, targeting the interest area with haematoxylin–eosin. A single specialised gastrointestinal histopathologist scored affected areas using the Global Histological Activity Score (GHAS). Pairwise comparisons of areas under the ROC curves were subsequently performed.

Results

The clinical characteristics of 24 patients with CD undergoing assessment have been revealed in Table 1.

Clinical characteristics of patients with CD.

Endoscopic activity disease was present in 52% and histological activity in 77% of the sample. There is not difference between endoscopic (p = 0.88) and histology (p = 0.43) results in groups with or without clinical activity disease. The Spearman correlation between histological activity and 67-gallium scintigraphy was 0.69 with p = 0.004. When was used correlation with colonoscopy, the Spearman was 0.81 with p = 0.0001. The ROC curve showed in the Scintigraphy 0.96 area under curve with confidence interval (0.8–1) and standard error 0.05. The specificity of scintigraphy was estimated in 75%.

Conclusion

The identification of inflammatory activity in CD through 67-gallium scintigraphy have good accuracy, superior to clinical activity index and similar to colonoscopy.

References

1. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet 2012;380:1590–605.

2. Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: Diagnosis and medical management. J Crohns Colitis 2017;11:3–25.

3. Pai RK, Geboes K. Disease activity and mucosal healing in inflammatory bowel disease: a new role for histopathology? Virchows Arch 2018;472:99–110.

4. Hoffer P. Role of gallium-67 in inflammatory disease. J Nuclear Med 1980;21:282–5.

5. Becker W, Meller J. The role of nuclear medicine in infection and inflammation. Lancet Infect Dis 2001;1:326–33.