Review
The role of nuclear medicine in infection and inflammation

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Summary

Investigators have used various techniques and radionuclides such as51Cr and32P- diisofluorophosphate to label blood cells and to study cell survival. Early studies also used these radionuclides to label human leucocytes for cell survival by in-vitro counting. But external imaging could not be done with these agents. Starting with the use of the gammaemitting radionuclide 111In-oxine for in-vitro labelling of phagocytic leucocytes, external imaging became possible. This method was the basis of visualisation of cell distribution within the body. Because an abscess consists primarily of leucocytes, leucocytes labelled with 111In localise within the abscess and are detectable by imaging. Nowadays other radiopharmaceuticals with other underlying uptake mechanisms are also used to detect inflammatory or infectious foci in patients. Nuclear medicine can be most useful in patients with fever of unknown origin, where a focus has to be defined, or in patients where a lesion is known by clinical symptoms or by a radiological imaging and the differentiation between infection and other pathologies has to be made.

Section snippets

Biodistribution and uptake mechanism

Physiologically, 10–25% of67Ga citrate is excreted via the kidneys. The rest of the injected dose remains in the body and is equally distributed among the liver, bone and bone marrow, and soft tissues.6

Leucocytes at the site of inflammation or infection excrete some of their intracellular lactoferrin, which remains localised and bound to macrophages.67Ga citrate is transported either in ionic form or bound to transferrin, binds to the transferrin receptor (CD71), and may leak through the

Future prospects

The ideal new agent should provide high and early uptake in infectious foci and inflammatory tissue, show no accumulation in non-inflamed tissues, have low toxicity and display rapid background clearance. The current trend is towards smaller peptides, but it is possible that larger molecules will prove able to fulfil these criteria. It has been found that an IgM (925 kDa) antibody directed against the stage-specific embryonic antigen (SSEA-1, anti-CD15) has a sensitivity of 95% and a

Search strategy and selection criteria

Data for this review were identified by searches of Medline and references from relevant articles; numerous articles were identified through searches of the extensive files of the authors. Search terms were “nuclear medicine” and “infection imaging” and “inflammation imaging”, “Ga-67- citrate”, “In-111-oxin white blood cells”, “Tc-99m-labelled white blood cells”, “radiolabelled blood cells', “radiolabelled antigranulocyte antibodies”, “F-18-FDG and infection”, “F-18-FDG and inflammation”,

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