Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy: an EANM procedural guideline

Abstract

IntroductionRadiolabelled autologous white blood cells (WBC) scintigraphy is being standardized all over the world to ensure high quality, specificity and reproducibility. Similarly, in many European countries radiolabelled anti-granulocyte antibodies (anti-G-mAb) are used instead of WBC with high diagnostic accuracy. The EANM Inflammation & Infection Committee is deeply involved in this process of standardization as a primary goal of the group.AimThe main aim of this guideline is to support and promote good clinical practice despite the complex environment of a national health care system with its ethical, economic and legal aspects that must also be taken into consideration.MethodAfter the standardization of the WBC labelling procedure (already published), a group of experts from the EANM Infection & Inflammation Committee developed and validated these guidelines based on published evidences.ResultsHere we describe image acquisition protocols, image display procedures and image analyses as well as image interpretation criteria for the use of radiolabelled WBC and monoclonal antigranulocyte antibodies. Clinical application for WBC and anti-G-mAb scintigraphy is also described.ConclusionsThese guidelines should be applied by all nuclear medicine centers in favor of a highly reproducible standardized practice.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…Recently, procedural guidelines for the labelling of the white clood cells, and for the correct acquisition and interpretation criteria for WBCS were published. 40 The diagnosis of VGEI infection is based on the presence of pathological accumulation of labelled white blood cells at the site of infection. At least two sets of images are required (2 e 4 and 20 e 24 hours after injection) and an increase in intensity or size with time is considered positive for an infection.…”

“…When positive, SPECT/CT images are mandatory for exact localisation of the infection (soft tissue only, graft, or extension). 40 WBCS is a very specific method, but it has some limitations. The procedure is time consuming and labour intensive, as the imaging needs to be performed at least at two different time points (preferably 2 e 4 and 20 e 24 hours after injection) and in a laboratory specifically equipped to perform leukocyte labelling.…”

“…Using antigranulocyte antibody scintigraphy as an alternative does not demand laboratory labelling, but does require dual time point imaging and is hampered by physiological uptake in bone marrow and excretion in the intestinal tract. 40 Moreover, the diagnostic accuracy of antigranulocyte antibody scintigraphy is, in general, somewhat lower than WBCS. 40 The estimated sensitivity of WBCS (without SPECT/CT) in diagnosing VGEI in the most recent meta-analysis was 0.90 (95% CI 0.85 e 0.94) with a specificity of 0.88 (95% CI 0.81 e 0.94).…”

“…40 Moreover, the diagnostic accuracy of antigranulocyte antibody scintigraphy is, in general, somewhat lower than WBCS. 40 The estimated sensitivity of WBCS (without SPECT/CT) in diagnosing VGEI in the most recent meta-analysis was 0.90 (95% CI 0.85 e 0.94) with a specificity of 0.88 (95% CI 0.81 e 0.94). 37 When WBCS was combined with SPECT/CT, the sensitivity increased to 0.99 (95% CI 0.92 e 1.00), with a specificity of 0.82 (95% CI 0.57 e 0.96) ( Fig.…”

18F-FDG PET for Diagnosing Infections in Prosthetic Joints

“…In PJI, further accumulation of labeled leukocytes is seen in the late images due to increased uptake in infected areas and reduction in background activity. 24 Labeled leukocyte scintigraphy has other important drawbacks, including its complexity, high costs, potential hazards due to the direct handling of blood products, and considerable radiation burden. 25 Fludeoxyglucose F 18 ( 18 F-FDG) PET is practically superior, because it is routinely available, provides a completed examination within 1 hour after 18 F-FDG administration (rather than 24 hours for labeled leukocyte imaging), and has a favorable safety profile (lack of pathogens in the final product).…”