Radiobelled white blood cells or FDG for imaging on inflammation and infection?

N medicine plays an important role in the management of patients with inflammatory and infectious diseases, especially when anatomical changes in inflammatory foci are absent or obscured. Several radiopharmaceuticals methods have been used for scintigraphic imaging of infectious and sterile inflammatory foci, including 67Ga-citrate, labelled white blood cells, antibodies, human immunoglobulin and antibiotics. Since the 1970s, scintigraphic imaging with labelled white blood cells has been the most frequently used nuclear imaging method for clinical diagnosis of infection and inflammation worldwide. The success of white blood cell scintigraphy is primarily due to its superb diagnostic accuracy. White blood cell scintigraphy comprises the isolation of autologous leukocytes, the ex vivo labelling of these cells with either 99mTc-HPMAO or 111In-oxine and reinjection of the labelled cells into the patient. The preparation of the radiopharmaceutical is the Achilles’s heel of white blood cell imaging, because it requires a trained technician and special facilities. The procedure is laborious and time-consuming and requires the handling of the patient’s blood, which could potentially be contaminated with pathogens. During the preparation of the radiopharmaceutical care should be taken that the leukocytes are not damaged, as this would result in leakage of the radioactivity from the cells, sticking of the labelled leukocytes to the vascular endothelium (especially in the microvasculature of the lungs) and 1Department of Nuclear Medicine and Molecular Imaging University Medical Center Groningen University of Groningen, Groningen, the Netherlands 2Department of Nuclear Medicine, "La Sapienza"University, S. Andrea Hospital, Rome, Italy 2Center of Nuclear Medicine National Commission of Argentine Atomic Energy Buenos Aires, Argentina