To present the current state-of-the art of molecular imaging in the management of patients affected by inflammatory bowel disease (IBD).

A systematic review of the literature was performed in order to find important original articles on the role of molecular imaging in the management of patients affected by IBD. The search was updated until February 2016 and limited to articles in English.

Fifty-five original articles were included in this review, highlighting the role of single photon emission tomography and positron emission tomography.

To date, molecular imaging represents a useful tool to detect active disease in IBD. However, the available data need to be validated in prospective multicenter studies on larger patient samples.

• White blood cell scintigraphy
• Inflammatory bowel disease
• Inflammation
• ¹⁸F-Fluorodehoxiglucose positron emission tomography/computed tomography
• Molecular imaging

INTRODUCTION

Due to limitation of colonoscopy in assessing the entire bowel and patients’ intolerance in inflammatory bowel disease (IBD), in the current study, we aimed to prospectively compare the accuracy of ^99mTc(V)-dimercaptosuccinic acid (DMSA) and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations.

METHODS

Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent ^99mTc (V)-DMSA scintigraphy and colonoscopy. The accuracy of ^99mTc (V)-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated.

RESULTS

A total of 22 patients with ulcerative colitis (UC) and 8 patients with Crohn’s disease (CD) were evaluated in our study. Sensitivity, positive likelihood ratio (PLR), and positive predictive value (PPV) of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio (NLR)=0.41, PPV=84.21%, and negative predictive value (NPV)= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively.

CONCLUSION

The ^99mTc (V)-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC.

• Adult
• Aged
• Aged, 80 and over
• Biological Transport
• Cell Count
• Cell Movement
• Female
• Humans
• Indium Radioisotopes/metabolism
• Lung/diagnostic imaging
• Lung/immunology
• Lung/metabolism
• Male
• Middle Aged
• Neutrophil Infiltration
• Neutrophils/cytology
• Neutrophils/diagnostic imaging
• Neutrophils/immunology
• Organotechnetium Compounds/metabolism
• Pulmonary Disease, Chronic Obstructive/diagnostic imaging
• Pulmonary Disease, Chronic Obstructive/immunology
• Pulmonary Disease, Chronic Obstructive/metabolism
• Sputum/immunology
• Tomography, Emission-Computed, Single-Photon

• 077940 Wellcome Trust

The diagnosis of inflammatory bowel disease (IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained samples. Radiological and scintigraphic methods are mainly used as an adjunct to endoscopy. In this review, we focus on the diagnostic potential of nuclear medicine procedures. The value of all radiotracers is described with special reference to those with greater experience and more satisfactory results. Tc-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD, as well as for the evaluation of disease extension and severity. Recently, pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease activity. Positron emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.

• Crohn’s disease
• Technetium-99m pentavalent dimercaptosuccinic acid
• Intestinal inflammation
• Scintigraphy
• Ulcerative colitis