Imaging of infection in nuclear medicine

Knowledge of the pathophysiology of infection and inflammation has developed greatly since the introduction of infection imaging techniques in nuclear medicine in the second half of the 20th century. Radionuclide imaging of infection is no longer singularly the visualisation of a generalised process but the molecular depiction of different pathways in infectious and inflammatory processes. Nonetheless, infection and inflammation remain a major cause of patient morbidity and mortality, with its accurate and timely diagnosis being of the utmost importance. Infection can develop in previously healthy individuals but the most common group of patients affected with acute infections are individuals with underlying risk factors such as diabetes, compromised immunity or malignancy, as well as individuals who have had medical interventions for the insertion of orthopaedic hardware, intravenous lines and catheters. There are several approaches in nuclear medicine for imaging infection and inflammation, including the evaluation of regional blood flow and capillary permeability, the assessment of transferrin and lactoferrin receptor binding, the analysis of specific antibody distribution and uptake and the depiction of specific chemotactic activation and increased metabolic activity. This increase in complexity and specificity depicts the fact that, although nuclear medicine techniques are less commonly used than other diagnostic techniques for initial diagnosis and characterisation of infection, it is of unparalleled importance in secondary diagnosis as well as characterisation in specific clinical scenarios.

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