I enjoyed the article by Albert et al (Gut 2005;52:1721–7) comparing newly emerging imaging modalities for the assessment and detection of small bowel Crohn’s disease, an area of the gastrointestinal tract that is often difficult to adequately image, assess, and biopsy.

However, their article failed to mention 99mTc HMPAO labelled white cell scanning 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.¹ 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.² 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 white cell scanning has been shown to correlate very well with histology (r = 0.8, p<0.0001) in subjects with active inflammatory bowel disease.³

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.^4,5

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