The potential role of radiolabeled red blood cell scintigraphy in diagnosis of endometriosis

Document Type : Original Article

Authors

1 Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: Endometriosis is a gynecological disease and disorder that occurs when endometrial cells are shed through the fallopian tubes and are implanted on the surfaces of pelvis and abdomen. They form lesions that respond to hormones of the menstural cycle and will stimulate inflammation. It is controversial whether [99mTc]Tc-RBC scan would be sufficient for localizing bleeding sites. This study evaluated the value of [99mTc]Tc-RBC in diagnosing endometriosis.
Methods: Twenty patients were included in the study for endometriosis localization. Between the 2nd and the 5th days of menstruation, when the lesions were highly activated, [99mTc]Tc-RBC scan was performed and compared with TVUS, pelvic MRI and laparoscopic surgery findings. Scans of the patients were reported by two nuclear medicine specialists who were blind to patients’ history.
Results: The patients’ age range was 21-48 years (mean age: 35±8.79). The sensitivity, specificity, positive predictive value and negative predictive value for the right pelvic bleeding sites were 73.3%, 80.0%, 91.7% and 50%, respectively while the corresponding indices on the opposite pelvic site were find to be 87.5%, 75.0%, 93.0% and 60%, respectively.
Conclusion: Radiolabeled red blood cell scintigraphy has the potential to be used as an alternative procedure for diagnosing endometriosis.

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  1. Batt R. A history of endometriosis: Springer Science & Business Media; 2011.
  2. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006 Aug 15;74(4):594-600.
  3. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB. The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma.  Fertil Steril. 1993 Nov;60(5):776-80.
  4. Fedele L, Bianchi S, Raffaelli R, Portuese A. Pre-operative assessment of bladder endometriosis. Hum Reprod. 1997 Nov;12(11):2519-22.
  5. Kinkel K, Chapron C, Balleyguier C, Fritel X, Dubuisson J-B, Moreau J-F. Magnetic resonance imaging characteristics of deep endometriosis. Hum Reprod. 1999 Apr;14(4):1080-6.
  6. Dumontier I, Roseau G, Vincent B, Chapron C, Dousset B, Chaussade S, Moreau JF, Dubuisson JB, Couturier D. Comparison of endoscopic ultrasound and magnetic resonance imaging in severe pelvic endometriosis. Gastroenterol Clin Biol. 2000 Dec;24(12):1197-204.
  7. Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2004 Aug;24(2):180-5.
  8. Siegelman E, Outwater E, Wang T, Mitchell D. Solid pelvic masses caused by endometriosis: MR imaging features. AJR Am J Roentgenol. 1994 Aug;163(2):357-61..
  9. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004 Aug;232(2):379-89.
  10. Kataoka ML, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H, Rahman M, Higuchi T, Fujii S. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005 Mar;234(3):815-23.
  11. Abrao MS, Gonçalves MOdC, Dias Jr JA, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 2007;22(12):3092-7.
  12. Farkas Z, Török P. Role of CA 125 level in management of endometriosis. Eur J Obstet Gynecol Reprod Biol. 2019;234:e109-e10.
  13. Demirel F, Koca G, Demirel K, Aydogmus H, Akbulut A, Sadic M. Can Tc-99m labeled erythrocyte scintigraphy be an alternative non-invasive method to endometriosis diagnosis? Int J Res Med Sci 2017;5(2):588.
  14. Singh SS, Suen MW. Surgery for endometriosis: beyond medical therapies. Fertil Steril. 2017;107(3):549-54.
  15. Hascalik S, Celik O, Kekilli E, Elter K, Karakas HM, Aydin NE. Novel noninvasive detection method for endometriosis: research and development of scintigraphic survey on endometrial implants in rats. Fertil Steril. 2008;90(1):209-13.
  16. Cerçi SS, Cerçi C, Balcı T, Komek H, Kılınç N. Abdominal wall endometriosis imaged with scintigraphy: report of a case. SDÜ Tıp Fak Derg. 2005;12:57-60.
  17. Winzelberg GG, McKusick KA, Froelich JW, Callahan RJ, Strauss HW. Detection of gastrointestinal bleeding with 99mTc-labeled red blood cells. Sem Nucl Med. 1982 Apr;12(2):139-46.
  18. Bearn P, Persad R, Wilson N, Flanagan J, Williams T. 99mTechnetium-labelled red blood cell scintigraphy as an alternative to angiography in the investigation of gastrointestinal bleeding: clinical experience in a district general hospital. Ann R Coll Surg Engl. 1992 May;74(3):192-9.
  19. Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Obstet Gynecol. 1999 Jan;93(1):51-8.
  20. Patel MD, Feldstein VA, Chen DC, Lipson SD, Filly RA. Endometriomas: diagnostic performance of US. Radiology. 1999;210(3):739-45.
  21. Front D, Israel O, Groshar D, Weininger J, editors. Technetium-99m-labeled red blood cell imaging. Semin Nucl Med. 1984 Jul;14(3):226-50.
  22. Dunselman GAJ, Beets-Tan RGH. Diagnosis of Endometriosis: Imaging. In: Giudice LC, Evers JLH, Healy DL. Endometriosis: Science and practice. United Kingdom: Wiley Blackwell publication; 2012. p. 299-308.
  23. Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol. 2004 Aug;16(4):299-303.
  24. Howarth DM. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med.2006 Apr;36(2):133-46.
  25. Sinzinger H, Rodrigues M. Cellular Labeling with 99m Tc Chelates: Relevance of in vitro and in vivo viability testing.  In: Zolle I. Technetium-99m Pharmaceuticals: Springer; 2007. p. 103-22.
  26. Cerçi SS, Cerçi C, Balci Ta, Komek H, Kilinç N. Abdominal wall endometriosis imaged with scintigraphy: report of a case. SDU Tıp Fak Derg. 2005;12(1):57-60.
  27. Takahashi N, Yang DJ, Kurihara H, Borne A, Kohanim S, Oh CS, Mawlawi O, Kim EE. Functional imaging of estrogen receptors with radiolabeled-GAP-EDL in rabbit endometriosis model. Acad Radiol. 2007 Sep;14(9):1050-7.