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Re: White cell scanning has a role in imaging small and large bowel

Dear Editor,

I enjoyed the article by Albert et al. comparing newly emerging imaging modalities for the assessment and detection of small bowel Crohn’s disease, an area of the gastro-intestinal tract that is often difficult to adequately image, assess and biopsy.[1]

However, their article failed to mention 99mTc HMPAO labelled white cell scanning at all as a method of imaging the small (and large) bowel. Planar white-cell scintigraphy is a well-established, non-invasive method of assessing intestinal inflammation.[2] While histological assessment is considered to be the gold standard method of detecting intestinal inflammation planar white-cell scintigraphy accurately reflects disease extent and histological activity.[3] The new imaging methods discussed by Albert et al. also suffer from this disadvantage of not allowing histological assessment.

In addition to planar white cell scanning single photon emission computerised tomography (SPECT) white cell scanning has been shown to correlate very well with histology (r=0.8 p<0.0001) in subjects with active IBD.[4]

We have previously shown that both white cell scanning techniques are valuable not only in assessing extent and severity of inflammation but in following up response to treatment in subjects with ulcerative colitis and Crohn’s disease.[5,6]

When evaluating newly emerging imaging techniques it is vital not to forget previously established techniques.

References

1. Albert JG, Martiny F, Krummenerl A et al.Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 2005;52(12):1721-1727.

2. Danpure HJ. Osman S. Carroll MJ. The development of a clinical protocol for the radiolabelling of mixed leucocytes with 99Tcm- hexamethylpropyleneamine oxime. Nuclear Medicine Communications 1988;9(6):465-75.

3. Lantto E, Jarvi K, Krekla I, et al. Technetium-99m hexamethyl propylene anime oxine leucocytes in the assessment of disease activity in inflammatory bowel disease. Eur J Nucl Med 1992;19(1):14-18.

4. Weldon MJ, Masoomi AM, Britten AJ et al. Quantification of inflammatory bowel disease activity using technetium-99m HMPAO labelled leucocyte single photon emission computerised tomography (SPECT). Gut 1995; 36(2)243-50.

5. Poullis A, Irwin AG, Dearing M, et al. Methodological study to assess repeat planar white cell scanning in monitoring the efficacy of treatment in inflammatory bowel disease. Gut 2003;52 (Suppl I):A87.