Seltene und spezielle Indikationen für eine nuklearmedizinische Entzündungsdiagnostik

S. Tesche; B. Meller; U. Siefker; A. Hamann; C. O. Sahlmann; J. Meller

doi:10.1055/s-2007-960530

Der Nuklearmediziner 2007; 30(2): 154-167
DOI: 10.1055/s-2007-960530

Seltene und spezielle Indikationen für eine nuklearmedizinische Entzündungsdiagnostik

Rare and Special Indications for Nuclear Medicine Evaluation of Infective DiseaseS. Tesche¹ , B. Meller² , U. Siefker¹ , A. Hamann¹ , C. O. Sahlmann¹ , J. Meller¹

¹Abteilung Nuklearmedizin, Georg August Universität Göttingen
²Abteilung Nuklearmedizin, Universität zu Lübeck

Abstract

Zusammenfassung

Dieser Artikel gibt einen evidenzgeleiteten Überblick über entzündungsszintigrafische Verfahren bei einigen seltenen Indikationen. Bei der Diagnostik und bei der Beurteilung der Aktivität einer chronisch-entzündlichen Darmerkrankung bleibt die Szintigrafie mit ^99mTc-HMPAO-markierten autologen Leukozyten die nuklearmedizinische Standarduntersuchung. Eine Appendizitis kann sowohl mittels in vitro markierter Leukozyten als auch immunentzündungs-szintigrafisch mit hoher Sicherheit nachgewiesen und ausgeschlossen werden. Die späte SPECT (20-24 h p. i.) mit ^99mTc-markierten monoklonalen Anti-CD-66-Antikörpern ist eine sinnvolle Zusatzuntersuchung zur transösophagealen Echokardiografie bei der Endokarditisdiagnostik. Infizierte Gefäßprothesen sollten mittels ^99mTc-HMPAO-markierter autologer Leukozyten untersucht werden. Es muss diskutiert werden, ob die [¹⁸F]FDG-PET oder [¹⁸F]FDG-PET / CT bei dieser Fragestellung eine höhere diagnostische Genauigkeit aufweist.

Abstract

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.

Schlüsselwörter

entzündliche Darmerkrankungen - Appendizitis - infizierte Gefäßprothese - Endokarditis - Szintigrafie - radioaktiv markierte Leukozyten - [¹⁸F]FDG

Key words

inflammatory bowel disease - appendicitis - infection of vascular prostheses - endocarditis - scintigraphy - labelled white blood cells - [¹⁸F]FDG

Full Text

References

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PD Dr. J. Meller

Abteilung Nuklearmedizin

Robert-Koch-Str. 130

37075 Göttingen

Phone: +49 / 5 51 / 39 85 12

Fax: +49 / 5 51 / 39 85 26

Email: jmeller@med.uni-goettingen.de