Vermeulen, L.E.M. (2013) De protocollen bij uitvoering en beoordeling van leukocytenscintigrafie: een adequate benadering? thesis, Medicine.
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Abstract
Introduction: For decades the white blood cell scintigraphy is being used as the golden standard for different infective and septic inflammation indications. This diagnostic imaging technique makes use of radioactive labelled white blood cells. These cells mainly accumulate at sites with acute septic inflammation. In 2010 new guidelines for the execution and the assessment of the white blood cell scintigraphy were published. Until now, no specific scientific research has been performed about the reliability of the white blood cell scintigraphy. In this study different assessment methods were examined. Besides the assessment methods, the diagnostic reliability at different indication groups. Last the effect of the correction factor for nuclear decline was analysed. Material and methods: This study reanalysed 315 white blood cell images of patients with inflammatory symptoms. Retrospectively these images were visually and by means of semi quantitative measurements analysed. The assessments were compared with the final diagnosis. After the assessment of the images and the evaluation of the patient data 297 patients were included in the study. In 63 cases (21,2%) an inflammatory diagnosis was present. The final diagnosis was reached by follow-up data, pathological and/or microbiological results. The analysis was oriented towards at the reliability values: sensitivity, specificity, accuracy and the predictive values. These values could be calculated from true positive and negative results and the false positive and negative results. Results: The analysis of the visual assessments from the grand total gives a sensitivity of 82,0% and a specificity of 94,9%. The reliability values of the osteomyelitis and osteosynthesis material indication groups were significantly higher. Whereas the prosthesis, soft tissue infection and head-neck region had significant lower reliability values. The analysis of the semi quantitative measurements generated the highest values with the contralateral position as the reference point. The addition of the semi quantitative measurements after a doubtful visual assessment, gave even higher reliability values than the measurement analysis in total. The calculation of an average of all semi quantitative measurements gave no improvement of the diagnostic sensitivity. The adjustment of de images by using a correction factor for nuclear decline rises the reliability values of the white blood cell scintigraphy. When the white blood cell images are investigated with the aid of the recommendations from this study, high reliability values are obtained: sensitivity 97,9%, specificity 91,8% and accuracy 93,1%. Recommendations: A correction factor for the nuclear decline has to be added to the late image. Start with the visual assessment and add a semi quantitative measurement when there is an equivocal visual assessment. Conclusion: This study demonstrates that the protocols from the IAEA for white blood cell scintigraphy give a good guideline for the generation of adequate diagnostic results.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Glaudemans, E.F.J. and Vries, de A.W.J.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1350 |
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