Ga-67 Citrate Research Articles

PS-R05-5: A CASE OF SEPTIC PULMONARY EMBOLISM DUE TO MITRAL VALVE ENDOCARDITIS OCCURRING EARLY IN THE INDUCTION PHASE OF HEMODIALYSIS

A 66-year-old man with end-stage kidney disease (ESKD) due to chronic glomerulonephritis who was scheduled to start hemodialysis after surgery for radiocephalic arteriovenous fistula (AVF) was admitted to our hospital because of volume overload. He developed fever and cough after an upper endoscopy was performed on the 20th hospital day. Chest CT revealed an infiltrative shadow in the right lower lung and he was diagnosed with bacterial pneumonia and treated with sulbactam/ampicillin and azithromycin. Two sets of blood cultures were negative. There were no findings suggesting infection of the AVF. His fever persisted and repeated CT on day 37 showed multiple nodule shadows along the blood vessels in the left lower lobe. We suspected septic pulmonary embolism (SPE) and transthoracic/esophageal echocardiography showed a newly developed MV regurgitation (MVR (II/IV), with a 17 mm vegetation and partial perforation. Repeat physical examination revealed nontender, small erythematous (Janeway) lesions on the toes and a new holosystolic murmur at the apex (II/VI). (The patient said he had similar lesions on his hands but they had disappeared.) Due to the accumulation of Ga-67 citrate in the peri-oral area and the MV, caries and periodontal disease were thought to be the source of infection. Infectious endocarditis (IE) was diagnosed based on modified Duke criteria. Ceftriaxone was added to cover gram-negative bacilli in the oral cavity, including HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella). Antibacterial treatment reduced the size of the vegetation and the MVR improved. Pulmonary nodules also disappeared. Dental treatment was performed after the vegetation had almost disappeared. Three additional sets of blood cultures were also negative. There have been few reports of SPE due to left sided IE. The onset of SPE in this case may have been caused by an embolus that formed in the MV and flowed into the right sided heart via an AVF, as emboli were also found in the peripheral extremities.

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99mTc sestamibi (MIBI) SPECT, 99mTc tetrofosmin SPECT, 201Tl SPECT, 82Rb PET, 201Tl SPECT, and 13N ammonia PET. Additional studies used were 123I MIBG SPECT, 123I BMIPP SPECT, 18F FDG PET, 67Ga citrate, and 11C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion–metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.

ОФЭКТ С 67Ga-ЦИТРАТОМ В ДИАГНОСТИКЕ СИСТЕМНОГО САРКОИДОЗА

Purpose: To study the possibilities of using 67Ga-citrate in patients with systemic manifestations of sarcoidosis to identify foci of pathological accumulation of the drug and assess the degree of process activity. Material and methods: Radionulide study with 67Ga-citrate was performed in 140 patients with respiratory sarcoidosis and suspected extrapulmonary localization. In addition, all patients underwent X-ray examination of the lungs, MSCT of the organs of the chest and abdominal cavity, SPECT of the lungs with radiopharmaceutical macroaggregates of albumin, ultrasound of the abdomen, pelvis, MRI of the head was performed in 16 patients with suspected neurosarcoidosis. Results: Most patients (n = 125) showed changes in the lungs, manifested by a bright glow (yellow or purple) on the computer screen, which indicated a pronounced impaired function of lymphoid tissue. In 22 patients, the changes were recurrent. The results correlated with published data on damage to the nervous system (r = 0.96), musculoskeletal system (r = 0.97), parotid glands (r = 0.91), liver, spleen (r = 0.83) . At the same time, the results for eye damage (r = 0.23), ENT organs (r = 0.15), intestines (r = 0.48) were significantly different. In our study, no heart lesions were detected in any case. Conclusions: The use of positive scintigraphy with Ga-67 citrate, taking into account the whole body scan and SPECT of areas of interest of interest (chest cavity, abdominal cavity, head, pelvis) is effective for the diagnosis of systemic sarcoidosis and in determining the activity of the process. The study is recommended to be performed 72 hours after intravenous administration of the drug. The combination of CT, MRI and radionuclide studies allows you to obtain reliable information about the activity of the process, to identify the localization of increased metabolic activity, that is, the topography of active sarcoidosis.

Intermittent irritability in a toddler

A comparative study of the parts played by technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis is presented. Nineteen patients were included in the...

Radionuclide Imaging of Cardiac Amyloidosis and Sarcoidosis: Roles and Characteristics of Various Tracers

Amyloidosis and sarcoidosis are systemic diseases that affect multiple organ systems. Accurate diagnosis of cardiac amyloidosis and sarcoidosis is particularly important because cardiac involvement can be fatal. Amyloidosis is characterized by the deposition of amyloid fibrils, and cardiac amyloidosis is classified into amyloid immunoglobulin light chain (AL) and amyloid transthyretin (ATTR) types. Radionuclide tracers for amyloidosis include (a) bone tracers, (b) amyloid-directed molecules, and (c) PET amyloid agents. Bone tracers are particularly sensitive in detection of ATTR type amyloidosis, whereas PET amyloid agents show a higher affinity for the AL type. In sarcoidosis, gallium 67 (67Ga) citrate scintigraphy and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET are pivotal to diagnosis of cardiac sarcoidosis, and 18F-FDG PET/CT has particularly high efficacy in detection of sarcoidosis and monitoring of response to therapy. A major limitation of 18F-FDG is physiologic uptake in the myocardium, which can remain in approximately 20% of patients even after elaborate preparation (eg, prolonged fasting >12-18 hours, modification to a high-fat and low-carbohydrate diet, and injection of unfractionated heparin). This limitation has led to a search for potential new tracers. Recently introduced tracers that show promise include those used in somatostatin receptor imaging and cellular proliferation imaging, which provide detectability as high as that for 18F-FDG without requiring dietary restrictions and have potential for monitoring disease activity. ©RSNA, 2020.

Molecular Imaging of Pulmonary Inflammation and Infection.

Infectious and inflammatory pulmonary diseases are a leading cause of morbidity and mortality worldwide. Although infrequently used in this setting, molecular imaging may significantly contribute to their diagnosis using techniques like single photon emission tomography (SPET), positron emission tomography (PET) with computed tomography (CT) or magnetic resonance imaging (MRI) with the support of specific or unspecific radiopharmaceutical agents. 18F-Fluorodeoxyglucose (18F-FDG), mostly applied in oncological imaging, can also detect cells actively involved in infectious and inflammatory conditions, even if with a low specificity. SPET with nonspecific (e.g., 67Gallium-citrate (67Ga citrate)) and specific tracers (e.g., white blood cells radiolabeled with 111Indium-oxine (111In) or 99mTechnetium (99mTc)) showed interesting results for many inflammatory lung diseases. However, 67Ga citrate is unfavorable by a radioprotection point of view while radiolabeled white blood cells scan implies complex laboratory settings and labeling procedures. Radiolabeled antibiotics (e.g., ciprofloxacin) have been recently tested, although they seem to be quite unspecific and cause antibiotic resistance. New radiolabeled agents like antimicrobic peptides, binding to bacterial cell membranes, seem very promising. Thus, the aim of this narrative review is to provide a comprehensive overview about techniques, including PET/MRI, and tracers that can guide the clinicians in the appropriate diagnostic pathway of infectious and inflammatory pulmonary diseases.

Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of Sauropus androgynus

Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus purée daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.

Effectiveness of use of CT and SPECT with 99mTc-MAA and Ga-67 citrate in assessing the expansion of lung cancer in the determination of surgical intervention tactics

Introduction. Algorithms of the early detection of lung cancer remain a topic of discussion and the problem of timely assessment of the expansion of lung cancer remains unresolved.Objective – to determine if the combined use of contrast­enhanced MDCT and 99mTc­MAA SPECT and Gallium‐67 citrate SPECT is effective in assessing the expansion of lung cancer in the determination in the intervention tactics.Material and methods. In the study, radiologic examination was performed to 81 patients with lung cancer. Combined examinations included bolus contrast­enhanced computed tomography (n = 81 patients), 99mTc­MAA SPECT (n = 62 patients) and Gallium‐67 citrate SPECT (n = 9 patients).Results.According to MDCT data in most cases (n = 65 patients; 80 %) this method was able to diagnose the T­stage of the tumor; in some cases, the stage of malignancy was overestimated (n = 8 patients, 10 %), or underestimated (n = 8 patients, 10 %). According to the results of 99mТc­МАА SPECT, it was possible to reliably determine the microcirculation disorders that were observed in the whole group of patients, while in 12 cases the impaired blood flow was recorded only according to the results of 99mTc­MAA SPECT and in 50 cases the severity of changes in blood flow was more signifcant than according to MDCT. When analyzing Ga­67 citrate SPECT data, in all 9 cases whole­body Ga­67 citrate SPECT showed intense hot areas at the tumor region. It was also possible to show several mildly increased foci in the hilar lymph nodes in 6 cases, but in 3 cases the result was false positive.Conclusions. Bolus contrast­enhanced computed tomography in most cases allows to correctly determine the T­stage of lung cancer and show tumor invasion into the surrounding tissues and vessels. At the same time, an additional 99mTc­MAA SPECT study allows to clarify the degree of disturbance of the microvasculature in more detail. It is possible to supplement the assessment of regional metastasis by Gallium‐67 citrate SPECT, however, it is necessary to take into account the inflammatory nature of lymph node changes as a cause of false­positive data.

A new bis-(3-hydroxy-4-pyridinone)-DTPA-derivative: Synthesis, complexation of di-/tri-valent metal cations and in vivo M3+ sequestering ability

A new polyaminocarboxylic bis-(3-hydroxy-4-pyridinone), derivative of DTPA, DTPA(PrHP)2, was synthesized starting from maltol by means of a coupling reaction of a protected 3-hydroxy-4-pyridinone and DTPA bis-anhydride. The DTPA(PrHP)2 acid-base behavior was investigated by UV–Vis spectrophotometry and spectrofluorimetry at I = 0.15 mol L−1 in NaCl(aq) at T = 298.15 K and T = 310.15 K. To confirm the speciation scheme, also 1H NMR measurements were performed at T = 298.15 K. The protonation constants obtained from the cited different analytical techniques showed good accordance and were also in agreement with data reported in the literature. The complexing ability of DTPA(PrHP)2 towards divalent (Ca2+, Cu2+, Zn2+) and trivalent (Al3+, Fe3+) cations was studied by potentiometric, UV–Vis spectrophotometric and 1H NMR titrations at T = 298.15 K and I = 0.15 mol L−1 in NaCl(aq). The fitting analysis of experimental data led to the determination of different speciation models consisting of MpLqHr(pn+r-5q) species with different stoichiometry and protonation stages, hydrolytic mixed and polynuclear complexes. The equilibrium model and complex formation constants, obtained from various analytical techniques, are in good agreement. The sequestering ability of the ligand towards the metal cations was assessed through the determination of the pL0.5 and pM parameters at different pH values and pH = 7.4, respectively, which showed to follow the trend Fe3+ > Al3+ > Cu2+ > Ca2+ > Zn2+. Finally, biodistribution studies were carried out in mice previously injected with the radiotracer 67Ga–citrate to evaluate the in vivo ability of DTPA(PrHP)2 as chelating agent towards trivalent metal cations.

GALLIUM-67 CITRATE USED AS A TRACER OF ACETONE PRODUCTION ROUTE

In this work the pathway of the chemical product and the kinetics parameters were evaluated in a laboratory plant settled, using 0.4 GBq (10 mL) of 67Ga citrate as radiotracer and 18 NaI(Tl) radiation detectors. The AnaComp program was used to estimate the kinetic para ameters of the acetone production. The yield of the acetone production was estimated by the percentage ratio between the areas under the curve (AUC) of the curve profiles of the final product compartment divided by the concentration found inside the chemical reactor whose result was 87% yield during the first 30 minutes of reaction.

New bis-(3-hydroxy-4-pyridinone)-NTA-derivative: Synthesis, binding ability towards Ca2+, Cu2+, Zn2+, Al3+, Fe3+ and biological assays

A new bis-(3-hydroxy-4-pyridinone) ligand (NTA(PrHP)2), derived from nitrilotriacetic acid (NTA), was synthesized and evaluated for its selective solution metal complexation capacity as well as its in vivo sequestering power for hard metal cations. After the study of its acid-base properties and determination of the protonation constants, the binding ability of NTA(PrHP)2 towards divalent (Ca2+, Cu2+, Zn2+) and trivalent (Al3+, Fe3+) metal cations was investigated by means of UV–Vis spectrophotometric, potentiometric and 1H NMR measurements. The determined speciation models consist of MpLqHr species with different stoichiometry. The obtained stability constants for the ML species follow the trend: Fe3+ > Al3+ > Cu2+ > Zn2+ > Ca2+. Furthermore, the sequestering ability of the ligand towards these metal cations was investigated by the determination of the pL0.5 and pM parameters calculated at different pHs and pH = 7.4, respectively. High pL0.5 values were obtained with significant variation of the sequestering ability with the investigated pH range. Analysis of the pM values at pH = 7.4 showed that the metal-ligand affinity follows the trend: Fe3+ > Al3+ > Cu2+ > Zn2+ > Ca2+. Finally, in vivo assays were performed to verify the efficacy of NTA(PrHP)2 as sequestering agent towards trivalent metal cations, when administered to mice preloaded with the radiotracer 67Ga–citrate.

Gallium Complexes as Anticancer Drugs.

Clinical trials have shown gallium nitrate, a group 13 (formerly IIIa) metal salt, to have antineoplastic activity against non-Hodgkin's lymphoma and urothelial cancers. Interest in gallium as a metal with anticancer properties emerged when it was discovered that 67Ga(III) citrate injected in tumor-bearing animals localized to sites of tumor. Animal studies showed non-radioactive gallium nitrate to inhibit the growth of implanted solid tumors. Following further evaluation of its efficacy and toxicity in animals, gallium nitrate, Ga(NO3)3, was designated an investigational drug by the National Cancer Institute (USA) and advanced to Phase 1 and 2 clinical trials. Gallium(III) shares certain chemical characteristics with iron(III) which enable it to interact with iron-binding proteins and disrupt iron-dependent tumor cell growth. Gallium's mechanisms of action include the inhibition of cellular iron uptake and disruption of intracellular iron homeostasis, these effects result in inhibition of ribonucleotide reductase and mitochondrial function, and changes in the expression in proteins of iron transport and storage. Whereas the growth-inhibitory effects of gallium become apparent after 24 to 48 hours of incubation of cells, an increase in intracellular reactive oxygen species (ROS) is seen with 1 to 4 hours of incubation. Gallium-induced ROS consequently triggers the upregulation of metallothionein and hemoxygenase-1 genes. Beyond the first generation of gallium salts such as gallium nitrate and gallium chloride, a new generation of gallium-ligand complexes such as tris(8-quinolinolato)gallium(III) (KP46) and gallium maltolate has emerged. These agents are being evaluated in the clinic while other ligands for gallium are in preclinical development. These newer agents appear to possess greater antitumor efficacy and a broader spectrum of antineoplastic activity than the earlier generation of gallium compounds.

The use of 67Ga scintigraphy in patients with sarcoidosis.

Sarcoidosis is a systemic disease of unknown aetiology characterised by the formation of noncaseating granulomas in various organs and tissues. The various imaging modalities that are useful in the investigation of lesions, staging and establishing indications for treatment include: conventional radiography, CT, MRI, and scintigraphy with ⁶⁷Ga, ²⁰¹Tl, 99mTc sestamibi, and somatostatin receptor scintigraphy (SRS) as well as ¹⁸F-FDG-PET/CT. This paper discusses the most commonly used technique of the scintigraphic, gallium (⁶⁷Ga) citrate) and its role in the evaluation and monitoring of patients with sarcoidosis.

Molecular Imaging for the diagnosis of infective endocarditis: A systematic literature review and meta-analysis

BackgroundInfective endocarditis (IE) is a serious, potentially life-threatening condition. Currently, the modified Duke criteria is used to assist with the diagnosis of IE, but it can still remain difficult. Growing data supports the potential use of molecular imaging to assist in the diagnosis of IE. Our objective was to understand the potential utility of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT), 67Ga citrate and radiolabeled white blood cell (WBC) scintigraphy in the diagnosis of IE. Methods and resultsA systematic review of the literature and meta-analysis on the use of all 3 modalities in IE was conducted. The literature search identified 2753 articles. A total of 14 studies met the inclusion criteria (10 for 18F-FDG, 3 for WBC and 1 for both modalities). No 67Ga citrate study met the inclusion criteria. Pooled sensitivity of 18F-FDG studies with adequate cardiac preparation for the diagnosis of IE was 81% (95% CI, 73%–86%) and pooled specificity was 85% (95% CI, 78%–91%). There was good overall accuracy with an area under the curve (AUC) of 0.897. Pooled sensitivity of WBC for the diagnosis of IE was 86% (95% CI, 77%–92%) and pooled specificity was 97% (95% CI, 92%–99%). The overall accuracy of WBC was excellent with an AUC of 0.957. ConclusionsBoth 18F-FDG and WBC have good sensitivity, specificity and accuracy for the diagnosis of IE. Both modalities are useful in the investigation of IE, and should be considered in cases where the diagnosis is uncertain.

67Ga as a biosensor of iron needs in different organs: Study performed on male and female rats subjected to iron deficiency and exercise

The aim of the present study was to determine the iron needs in different organs and tissues using 67Ga as a biosensor in males and females rats subjected to iron deficiency (ID) and voluntary exercise (EX). 67Ga citrate was injected i.p. to female and male Wistar rats (n=5/sex/group). Groups: Control (sedentary conditions), Control+EX, ID and ID+EX. To determine the 67Ga uptake, samples from the following regions of interest (ROIs) were extracted 12h post-injection: blood, liver, gonads, bone marrow, heart, adrenal glands, skeletal muscle, stomach, kidney, eyeball, sciatic nerve, small intestine and peritoneum. The total 67Ga uptake was 412% higher in ID subjects than in control subjects, being 1011% higher in ID-males than ID-females. In ID-females, the ROIs with the greater 67Ga uptake were blood, kidney and bone marrow, while in ID-males they were sciatic nerve, eyeball and adrenals, which demonstrates that the biodistribution differed between sexes in sedentary conditions but when subjected to EX, the biodistribution was similar in each sex group although females had a greater 67Ga uptake. In ID+EX subjects, the ROIs that showed the highest uptake were sciatic nerve, eyeball and adrenal glands. Using 67Ga as a biosensor, it is possible to identify the needs of iron that each organ requires to perform their functions in normal physiological conditions. In addition, a higher or lower 67Ga uptake in a specific organ may indicate its malfunction or show damage.

Salivary Gland Scintigraphy in Patients with Sjogren's Syndrome: A local Experience with Dual-tracer.

Objective(s):To review the findings of the patients with Sjögren’s syndrome (SS) having technetium99-m-pertechnetate (99mTc-pertechnetate) and gallium67- citrate (Ga-67) salivary gland scintigraphy in the past eight years.Methods:The patients with SS, who were referred to our department for salivary gland scintigraphy during January -2008December 2015 were studied using both 99mTc-pertechnetate and Ga-67 citrate scintigraphy.Results:Eighteen patients were included in the study, 17 of whom had positive findings on 99mTc-pertechnetate salivary gland scintigraphy. One patient had negative parotid glands findings on 99mTc-pertechnetate, but positive findings in Ga-67 study. Four patients had asymmetric involvement of the parotid glands, and one patient had asymmetric involvement of the submandibular glands in 99mTc-pertechnetate salivary gland scintigraphy. On the other hand, one patient had only submandibular gland involvement in the 99mTc-pertechnetate scan. Nine patients (18/9) had positive parotid gland findings on Ga-67 study. The involvements of the parotid glands were all symmetrical, except for one patient. No abnormal gallium uptake in the submandibular glands in our patients was noted.Conclusion:99mTc-pertechnetate salivary gland scintigraphy is sufficient for the assessment in the majority of patients with SS. Ga-67 scintigraphy may be a useful supplementary test, especially if the result of 99mTc-pertechnetate scintigraphy is not conclusive.

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections.

ObjectiveTo evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 (67Ga) citrate scintigraphy.Materials and MethodsWe studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of 99mTc-EDDA-HYNIC-TOC, and 21 after injection of 111In-DTPA-octreotide. All patients also underwent 67Ga citrate imaging, except for one patient who died before the 67Ga was available.ResultsIn 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by 67Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than 67Ga uptake in 11 of the 20 patients with positive images and similar to 67Ga uptake in the other 9 patients. The only patient who did not undergo 67Ga scintigraphy underwent 99mTc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis.ConclusionSPECT/CT with 99mTc-EDDA-HYNIC-TOC or 111In-DTPA-octreotide seems to be a good alternative to 67Ga citrate imaging for the evaluation of patients with systemic granulomatous disease.

Bronchiolitis Obliterans Organizing Pneumonia Following Consumption of <i>Sauropus androgynus</i>

Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disorder affecting the small airways, alveoli and the walls of small bronchi. This form of lung injury involves inflammation and stiffening of lung areas with organized tissue. There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. An outbreak of BOOP among young women has been publicly reported in Taiwan from late 1994 and onward. The source of the illness was traced to the consumption of Sauropus androgynus. Herein, we describe a case of a 28-year-old woman who developed a rapid pulmonary toxicity after drinking fresh S. androgynus puree daily for a period of two months, as an alleged regimen for weight reduction. Ga-67 citrate imaging portrayed the inflammatory status in her eyes, parotids and lungs. Pathological pattern of open-lung biopsy specimens was characteristic of BOOP. The toxicity is believed related to alkaloid papaverine contained in the plant. Bioactive principles of S. androgynus and pathogenetic mechanism underlying BOOP remain unidentified.

Is there a Role for Gallium-67 Citrate SPECT/CT, in Patients with Renal Impairment or Who are Renal Transplant Recipients, in Identifying and Localizing Suspected Infection?

To assess the added value of single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with end-stage renal failure (ESRF) or renal transplant recipients in whom focal infection was suspected. Gallium-67 (Ga-67) citrate scintigrams of 18 patients (10 in ESRF and eight with renal transplants) were reviewed. Sites of abnormal uptake seen on the whole body and SPECT were noted. A SPECT/CT was also reviewed to see if additional information could be obtained. Imaging results were compared with the final diagnosis. Overall, 14 out of 18 (78%) patients had a proven cause to explain symptoms while four patients did not have a final cause identified. Infection was proven in the final diagnosis in 12 out of 14 (86%) patients. Of the 10 patients with ESRF, six had confirmed infection with the Ga-67 citrate study correctly identifying five out of six (83%) patients, and SPECT/CT providing additional information in four out of five (80%) patients. In the eight renal transplant recipients, six had a confirmed source of infection (all identified by the Ga-67 citrate study). SPECT/CT provided additional information in two out of six (33%) patients. Ga-67 citrate imaging had an overall sensitivity of 13/14 (93%), with one false negative. SPECT/CT provided an additional contribution in eight out of 18 (44%) patients by better defining the location/extent of infection and differentiating the physiological from the pathological uptake.

Aortoenteric fistula as a complication of open reconstruction and endovascular repair of abdominal aorta.

The paper intends to present a review of imaging characteristics of secondary aortoenteric fistula (AEF). Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of AEF after open aortic repair. The pathogenesis of AEF formation after endovascular abdominal aortic repair is related to mechanical failure of the stent-graft, to stent graft infection, and to persistent pressurization of the aneurysmal sac. The major clinical manifestations of AEF comprise haematemesis, melaena, abdominal pain, sepsis, and fever. CT is the initial diagnostic modality of choice in a stable patient. However, the majority of reported CT appearances are not specific. In case of equivocal CT scans and clinical suspicion of AEF, scintigraphy, 67Ga citrate scans or 18F-FDG PET/CT is useful. Diagnostic accuracy of endoscopy in evaluation of AEF is low; nevertheless it allows to evaluate other than AEF etiologies of gastrointestinal bleeding. Without adequate therapy, AEF is lethal. Conventional surgical treatment is associated with high morbidity and mortality. The endovascular repair may be an option in hemodynamically unstable and high-risk surgical patients. We also illustrate an example of a secondary AEF with highly specific albeit rare radiologic picture from our institution.