Rare and special indications for nuclear medicine evaluation of infective disease

This article gives an evidence-based overview about several special indications for scintigraphy in imaging infection and inflammation. In diagnosing and evaluating the extent of inflammatory bowel disease, the scintigraphy with 99mTc-HMPAO labelled leucocytes remains the standard evaluation in Nuclear Medicine. Appendicitis can be proven or excluded with a high grade of certainty both by 99mTc-labelled monoclonal antigranulocytic antibodies and FAb'-fragments and by in-vitro labelled leucocytes. In endocarditis a late SPECT (20-24 h p. i.) with a 99mTc-labeled anti-CD66 monoclonal antibody is a useful adjunct to echocardiographic techniques. In infected vascular prostheses, 99mTc-HMPAO-labelled autologous leucocytes remain the standard of Nuclear Medicine although [18F]FDG-PET or [18F]FDG-PET / CT may exhibit a higher diagnostic accuracy. (orig.)