67Ga Uptake Research Articles

Early inflammatory response during the development of right ventricular heart failure in a rat model

Inflammatory activation plays an important role in the pathogenesis and progression of left ventricular (LV) heart failure. In right ventricular (RV) heart failure, little is known about the role of inflammatory activation. We aimed to study the role of inflammatory activation in RV heart failure by serial monitoring during disease progression. Right ventricular heart failure was induced in male Wistar rats by intraperitoneal injection of monocrotaline (MCT). Two groups were studied: MCT-treated rats (MCT-rats), and age-matched controls (CON-rats). Serial echocardiography and in vivo 67-Gallium ((67)Ga) scintigraphy were performed. Local inflammation in the RV was assessed by (i) ex vivo semi-quantitative (67)Ga autoradiography, (ii) immunohistochemistry of myeloperoxidase (MPO), a marker of neutrophil activity, and (iii) mRNA assays of tumour necrosis factor-alpha (TNF-alpha). In MCT-rats, (67)Ga scintigraphy showed increased myocardial uptake which started during the early stages of RV disease. (67)Ga autoradiography revealed that this increased (67)Ga uptake occurred in the RV and inter-ventricular septum, but not in the LV. The stage-dependent increases of in vivo (67)Ga RV myocardial uptake were paralleled by increases in mRNA gene expression for TNF-alpha in RV, and increased MPO staining in RV. Development and progression of RV heart failure is associated with an early increase in RV inflammation. (67)Ga scintigraphy may be used for the serial assessment of inflammation and monitoring of disease progression in RV heart failure.

Ga-67 scintigraphy in the differential diagnosis between acute interstitial nephritis and acute tubular necrosis: an experimental study

The differentiation between acute interstitial nephritis (AIN) and acute tubular necrosis (ATN) is crucial in patients with acute kidney injury. Gallium-67 citrate (Ga-67) has been used clinically in the differential diagnosis between these entities, but its efficacy is disputed. The aim of this study was to evaluate Ga-67 scintigraphy efficacy in the differentiation between experimental models of drug-induced AIN and ATN. Animals were divided into three groups: AIN (n = 8), ATN (n = 8) and control (NL, n = 10). The AIN group received intraperitoneal puromycin aminonucleoside (single dose, 150 mg/kg). The ATN group received a single intraperitoneal injection of cisplatin (6 mg/kg). The NL group did not receive active drugs. All of the animals were submitted to Ga-67 scintigraphy, serum creatinine (Cr) and urinary osmolality assessment, and blinded renal histology evaluation. Renal Ga-67 uptake was strikingly more intense in the AIN group when compared to the ATN (P < 0.0001) and NL (P < 0.001) groups. The ATN group had increased Cr when compared to the NL group (P < 0.001) and lower urinary osmolality vs the NL (P < 0.001) and AIN (P < 0.01) groups. Renal histology showed severe acute tubular injury in the ATN group and intense interstitial inflammation in the AIN group, and was normal in control animals. Ga-67 scintigraphy was extremely effective in the differentiation between experimental drug-induced ATN and AIN.

Identifying Ga-67 Uptake in Brown Adipose Tissue WithSPECT/CT

Identifying Ga-67 Uptake in Brown Adipose Tissue WithSPECT/CT

Rapid deterioration of renal function in a patient with multiple myeloma associated with amyloid and light chain depositions

Here we report a 75-year-old man with multiple myeloma who developed acute deterioration of renal function. Systemic AL amyloid deposition was found in the stomach, duodenum and brachial artery. A small amount of proteinuria without significant abnormal urinary sediments, increased excretion of urinary low-molecular-weight proteins and Bence Jones protein were observed. Significant renal Ga-67 uptake suggested acute tubulointerstitial lesions. Renal necropsy after sudden death 40 days after introduction of hemodialysis revealed mesangial expansion with glomerular basement membrane thickening, tubular basement membrane thickening with or without tubular atrophy and massive tubulointerstitial fibrosis. Slight amyloid depositions in the mesangium and vessels, and massive granular electron-dense deposits and deposition of monoclonal light chain lambda in renal basement membranes and vessels were found, indicating the rare condition of coexistence of amyloidosis and light chain deposition disease(LCDD). The rapid progression of renal failure may have been caused by massive deposition of monoclonal light chains in our patient.

SPECT-TAC de baja dosis con 67Ga en un caso de espondilodiscitis y hernia de Schmorl

A 61-year-old male patient with microbiological diagnosis of L3-L4 spondylodiscitis and persist pain underwent a 67Ga scintigraphic study to assess the antibiotic treatment response. Pathological uptake foci in vertebral bodies of L2 and L4 were observed in the 67Ga planar scintigraphy. A SPECT low-dose CT of the lumbar spine was performed as part of anatomical correlated protocol, detecting an active spondylodiscitis in L3-L4 and a second uptake foci in L2 that was identify as a Schmorl's node. In this case the SPECT-CT hybrid image allowed us to avoid a false positive diagnosis to by locate and characterize an image with abnormal uptake of 67Ga, improving the test specificity and avoiding a wrong diagnosis.

Résultats atypiques et faux-négatifs de la scintigraphie au 67Ga et de la TEP-TDM au 18F-FDG chez une patiente avec sarcoïdose et cancer du sein bilateral

We describe the case of a patient with biopsy proven sinonasal sarcoidosis and a bilateral breast cancer that was unknown at the time of 67Ga scintigraphy and 18F-FDG PET-CT. 67Ga scintigraphy showed low sensibility in the assessement of sarcoidosis localizations. Conversely, multiple foci of intense 18F-FDG uptake were assessed suggesting the presence of active granulomatous disease in sinonasal region, rhinopharynx, skin and several peripheral lymphadenopathy, which were not previously detected by conventional evaluation. On the other hand, an atypical focal accumulation of 67Ga uptake was showed in right breast parenchyma, proving to be a grade III infiltrating canalar carcinoma coexistent with pleomorphic type, without axillary metastastic lymphadenopathy. Surprisingly, no 18F-FDG uptake abnormalities were detected in the right breast in correspondence of 67Ga pathological uptake. The whole of these results is discussed according to histological nature of the lesions and the data of the literature.

“Tight-Fitting Cloth”-Like Uptake of Ga-67 in a Patient With Psoriasis

A 52-year-old man had a history of psoriasis vulgaris with regular follow-ups and medical treatment for more than 10 years. Because of his intermittent chills without fever, we performed a Ga-67 scan to evaluate the possibility of occult infection. The images showed evenly increased uptake, like a tight-fitting cloth, and delineated the outline of his body.

Lacrimal Gland Uptake of Gallium (67Ga) Citrate in Patients without Ocular Pathology

Purpose: To report a series of patients with bilateral lacrimal gland uptake of Gallium (67Ga) Citrate in patients without ocular pathology and to assess the degree to which this can be a normal phenomenon. Methods: We present an index case of lacrimal gland uptake of Gallium (67Ga) Citrate in a patient without lacrimal pathology and a subsequent retrospective review of all Gallium scans performed at the Bristol Royal Infirmary, UK from 2002 to 2008. Patients who demonstrated Ga67 uptake within the lacrimal glands were identified and case notes from all scans were retrieved and reviewed. The notes were analysed to determine the rationale for the gallium investigation as well as whether there was any preexisting ocular pathology. Results: Retrospective review demonstrated that 21 gallium scans were performed from 2002 to 2008, from which 4 patients demonstrated bilateral lacrimal gland Ga67 uptake with no evidence of past or current lacrimal/ocular pathology. On the basis of our review, we report that bilateral gallium uptake is not a specific finding, occurring in normal individuals with no history or symptoms of ocular or orbital pathology.

顎下リンパ節腫脹が診断の契機となったサルコイドーシスの1例

Sarcoidosis is a systemic disease of unknown etiology characterized pathologically by noncaseatingepithelioid cell granulomas affecting any organ. It is often associated with bilateral hilar lymphadenopathy, pulmonaryinfiltration, and skin or eye lesions. We report a case of sarcoidosis with submandibular lymphadenopathy.The patient was a 28-year-old woman who presented with a left submandibular painless nodule. Magnetic resonanceimaging（MRI）revealed a submandibular mass with low intensity on T-1 weighted images and high intensityon T-2 weighted images. Under general anesthesia, resection of the lesion was performed. Histologically thespecimen consisted of numerous noncaseating epithelioid cell granulomas. The histological diagnosis was sarcoidosis,and additional examinations were conducted. Ga-67 scintigraphy bilaterally showed increased uptake inthe lacrimal glands, parotid glands, and hilar lymp nodes. Bilateral hilar lymphadenopathy was confirmed on thoracicCT scanning, and bilateral swelling of the parotid gland was confirmed on MRI. The results of the tuberculinskin test were negative, and the serum levels of angiotensin-converting enzymes and γ-globulin were increased.These findings supported the histological diagnosis. Because the patient was asymptomatic, only careful follow-upwas continued, without treatment. During 24 months of follow-up, bilateral swelling of the parotid gland graduallydecreased, and abnormal uptake of Ga-67 disappeared in all lesions.

Diagnosis of Acute Bacterial Prostatitis by Ga-67 Scintigraphy and SPECT-CT

Gallium-67 (Ga-67) is effective in imaging neoplasms and infection; however, its potential role in diagnosis of acute prostatitis is not well reported. We report a 66-year-old male patient who presented with back pain, fever, chills, and elevated white blood count. Plain x-ray of the lumbosacral spine showed degenerative changes in the L4 to L5 intervertebral disc space. The patient subsequently underwent Ga-67 scintigraphy and SPECT-CT for evaluation of diskitis, which showed diffuse intense uptake of Ga-67 within the prostate, suggesting acute prostatitis. There was complete resolution of symptoms after a course of antibiotics.

Late computed tomography scan response improvement and gallium scintigraphy evaluation as on-treatment prognostic parameters to tailor treatment intensity in patients with Hodgkin's lymphoma. A prospective phase II study

BackgroundTailoring treatment intensity is critical in Hodgkin's lymphoma (HL). Ongoing prognostic parameters may be an useful adjunct to pretreatment stratification. We used the kinetics of computed tomography (CT) scan response and residual gallium (Ga)-67 uptake to better stratify risk. Materials and methodsPatients received 4–8 adriamycin, bleomycin, vinblastine and dacarbazine courses according to stage. Disease was reassessed evaluating late computed tomography scan response improvement (CTRI) and Ga-67 uptake. Patients received no further treatment, radiotherapy (RT) or additional chemotherapy + RT according to the presence of none (low risk), one (intermediate risk) and both parameters (high risk). Patients with bulky mediastinum received RT anyhow. ResultsAmong 102 assessable patients, 35 showed late CTRI and 9 residual Ga-67 uptake. In 30 patients with bulky mediastinum, the 3-year progression-free survival (PFS) was significantly better when neither parameter was present (100% versus 69%; P=0.02). In 72 patients without bulky mediastinum, treatment was tailored according to risk assignment. Relapses occurred in 5 of 47 low-risk and 3 of 21 intermediate-risk patients, with no differences between the two groups, and in 3 of 4 high-risk patients. ConclusionThis study shows that two on-treatment parameters, late CTRI and residual Ga-67 uptake, can predict PFS in HL and identify patients in which RT can be spared without apparently affecting the outcome.

Accumulation of gallium-67 within mature and immature teratoma in pediatric patients: investigation for the uptake mechanism

We encountered cases of mature and immature teratoma with positive uptake of (67)Ga. The objective of this study is to investigate the mechanism of (67)Ga accumulation within mature and immature teratomas by comparing the findings of gallium scan, computed tomography (CT), and autoradiography of surgical specimens with the pathological findings. The subjects comprised 14 children who underwent surgical resection for intra-abdominal mature and immature teratomas, which were histologically proved to be of the mature and immature subtype. Their age ranged from 24 days to 14 years. The origins of the mature teratomas consisted of seven ovaries including one bilateral case, two retroperitoneal, and two sacrococcygeal regions. The origins of the immature teratomas were retroperitoneum in two cases, an ovary and a sacrococcygeal region. Complete surgical excision was feasible in all children. They underwent both gallium scan and CT prior to surgery. Single-photon emission computed tomography was added in some cases. For two gallium-positive cases, radiography and scintigraphy (autoradiography) of the resected specimen were performed. Of the 14 children, 5 (one with immature and four with mature subtype) showed positive (67)Ga uptake within tumors, which originated from the retroperitoneum in the 3 boys, and from the ovary in the 2 girls. All had typical CT findings of teratoma, including calcifications, fat components, cystic areas, and solid parts. (67)Ga accumulation in the four mature teratomas appeared discretely strong, and was considered to correspond with intralesional calcifications. However, in the remaining one immature teratoma, the gallium distribution was diffuse within the tumor. The comparison between radiography and autoradiography of the resected mature teratomas confirmed the correlation between the intralesional calcifications and areas of (67)Ga accumulation. A high-uptake ratio of (67)Ga in benign teratoma was indicated. A close correlation between gallium scan and CT helps to ascertain whether (67)Ga uptake results from malignant and/or immature elements, or mature tissue components.

Occult cholecystitis presenting as PUO demonstrated on Gallium

Gallium-67 scintigraphy is commonly performed to investigate Pyrexia of Unknown Origin (PUO) due to its affinity for infection or inflammation. The dissemination of hybrid SPECT CT imaging allows improved identification and localisation of causes of PUO. A 74 year old male was referred for investigation of pyrexia of unknown origin. Gallium SPECT CT was performed and demonstrated increased Gallium uptake in the gallbladder wall with features of cholelithiasis and collection on the corresponding CT images. At operation the gallbladder revealed areas of chronic cholecystitis and xanthogranulomatous inflammation. Figure 1 Figure 1: A 74 year old male was referred for investigation of pyrexia of unknown origin. A Gallium scan was performed and a whole body planar and SPECT/CT were acquired up to 48 hours following the administration of 300 MBq of Ga-citrate. Gallium SPECT (Top Row) and SPECT/CT fused (Middle Row) images demonstrated increased Gallium uptake in the gallbladder wall (solid arrow). CT (Bottom Row)) images also revealed pericholecystic fat stranding (arrowhead) and a small collection at the interface between the gallbladder and the liver (solid arrow). Occult cholecystitis presenting as PUO demonstrated on Gallium 2 of 3 Figure 2 Figure 2: An ultrasound was performed for further evaluation. The US demonstrated a non-mobile calculus (solid arrow) in the gallbladder neck (Top image) and confirmed cholecystitis (Lower image) with a pericholecystic collection (solid arrow). The patient subsequently underwent laparotomy and cholecystectomy. A 39mm diameter gallstone and a haemorrhagic inflamed gallbladder were removed. Histologic examination revealed organising chronic cholecystitis and areas of xanthogranulomatous inflammation. There are number of causes of PUO including pyogenic infection (soft tissue abscess, pneumonitis, musculoskeletal), non-pyogenic infection (mycobacterial, viral, chronic bacterial, fungal/rickettsial), non-infective inflammation (sarcoidosis, inflammatory bowel disease, vasculitis, “collagen” disease, organ rejection), and neoplasia (haemoproliferative, renal cell carcinoma, melanoma). 1,2 There are a number of proposed mechanisms of 67 Ga uptake into pathologic sites including increased vascular permeability to 67 Ga-transferrin complex, radiotracer accumulation in expanded regional vascular and interstitial fluid spaces, and binding of the metal-protein complex to extravascular transferrin receptors. 3,4,5 Cholecystitis is a relatively common condition usually diagnosed clinically and confirmed by ancillary laboratory investigations and imaging with ultrasound and hepatobiliary scintigraphy. 6,7,8 The addition of Hybrid SPECT CT to 67 Ga scintigraphy improves the sensitivity and specificity of the modality in investigating PUO.

Al-toxicity studies in yeast using gallium as an aluminum analogue

Aluminum (Al) is normally present in soils as the insoluble, harmless Al2O3. The highly toxic Al3+ and AlOH2+ monomeric cations are formed in acid soils but there is little consensus on the physiological basis of Al toxicity in plants. A major factor that has retarded progress in understanding aluminum toxicity in vascular plants is the lack of a convenient radioisotope for Al. Yeast and vascular plants share similar membrane transport mechanisms and so yeast (Saccharomyces cerevisiae) provides a convenient model system for studies of Al-toxicity. Al and gallium (Ga) have closely similar toxic effects on the yeast cells (Ki approximately 100 mmol m-3) and Ga3+ and Al3+, respond similarly to pH and are both reversible by a chelation agent (citric acid). We tested the feasibility of using 67Ga radioisotope as a tracer for Al transport with the view of using it to investigate the mechanism of Al uptake and toxicity in plants. The clinically available 67Ga citrate is unsuitable to use as an aluminum analogue because the chelated form is not toxic. Arrangements need to be made for it to be supplied as 67GaCl3. Large amounts of 67Ga rapidly bind to the cell wall of yeasts with a t 1/2 of approximately 1 s. There is a very slow net uptake of 67Ga into a second phase, presumably the cytoplasm. Uptake into the slow phase has a Vmax of only approximately 16 +/- 4 pmol m(-2) s(-1) (n = 16). The Km of 67Ga uptake could not be precisely determined but is below 100 mmol m(-3) (45 +/- 42 mmol m(-3), n = 16).

Usefulness of 67Ga SPECT and integrated low-dose CT scanning (SPECT/CT) in the diagnosis of cardiac sarcoidosis

We performed 67Gallium (Ga) single-photon emission computed tomography (SPECT) with integrated low-dose computed tomography (CT) for the interpretation of myocardial outline to investigate the value of co-registered fusion imaging using a hybrid system (SPECT/CT) in patients with cardiac sarcoidosis. SPECT/CT of the region in question was performed with VG Hawkeye. The subjects in this study were 37 patients [mean (+/-SD) age 61.0+/-13.0 years; 12 men and 25 women], 13 of whom had a clinical diagnosis of cardiac sarcoidosis and 24 a negative diagnosis. An intravenous injection of Ga (dosage 111 MBq) was performed on patients 48 h or 72 h before obtaining static planar images of the whole-body and the SPECT/CT scan. Abnormal Ga uptake in the myocardium was observed in 10 of the 13 subjects with true sarcoidosis, and in 11 of 24 with negative sarcoidosis without CT fusion. The sensitivity without CT fusion was 77%, the specificity 54%, and the accuracy 62%. Use of SPECT/CT changed the diagnosis only in a patient with true sarcoidosis, and changed the diagnosis in eight patients with negative sarcoidosis. The sensitivity with CT fusion was 69%, the specificity 79%, and the accuracy 76%. The difference in diagnostic accuracy was statistically significant (McNemar's test, P=0.039). SPECT scanning using Ga and integrated low-dose CT is a very useful diagnostic imaging technique because it improves the diagnostic specificity of Ga SPECT to allow the highly specific diagnosis of cardiac sarcoidosis.

Abstract 3302: Contribution of Cardiac F-18 FDG PET Imaging to the Management of Patients with Cardiac Sarcoidosis

Early detection and correct assessment of disease activity are critical for the optimal management of patients with cardiac sarcoidosis (CSRD). There are some recent reports showing F-18 FDG (FDG) uptake by sarcoid granulomas. In the present study, we estimated the significance of cardiac FDG PET imaging in 47 patients (57+/−11 years, 16 males and 31 females) with proven diagnosis of CSRD and receiving steroid therapy (30 – 60 mg prednisolone on alternate days) based on clinical signs of acute myocardial involvement. We interpreted regionally enhanced myocardial FDG uptake as positive in the 5-hr fasting FDG PET imaging. In addition, we determined standardized uptake value (SUV) of the FDG uptake. Before steroid therapy, positive myocardial finding was 89% (42/47) in FDG PET, 55% (21/38) in Tc-99m pyrophosphate tomographic imaging, 68% (30/44) in Ga-67 tomographic imaging, 49% (23/47) in echocardiographically estimated septal wall thinning and 35% (13/37) in biopsy. SUV was above 2.5 in all with positive FDG finding. In 3 patients with severe heart failure and with positive finding in biopsy, myocardial FDG uptake showed diffuse patterns and was hardly interpreted positive. The follow-up studies after steroid therapy revealed that the enhanced FDG uptake gradually reduced and disappeared in 6 months in most of the patients, while positive Ga-67 uptake disappeared soon after therapy. Afterwards, recurrence of active inflammation was symptomatically suspected in 4 patients. Performing FDG PET imaging, they all showed re-enhancement of myocardial FDG uptake, which contributed to decision-making of increasing steroid dose. These results suggest that the FDG PET imaging is a sensitive means in detecting disease activity of CSRD and contributes to the decision-making and evaluation of steroid therapy.

Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis

In patients with cardiac sarcoidosis, ventricular arrhythmias and/or conduction disturbances are frequently observed and sometimes fatal. However, few reports on disease activity and arrhythmic events in cardiac sarcoidosis are available. The purpose of this study was to investigate the relationship between disease activity and arrhythmic events in cardiac sarcoidosis and the effect of corticosteroid therapy. The study population consisted of 15 cardiac sarcoidosis patients with new-onset symptomatic arrhythmia, including eight patients admitted once for complete atrioventricular block (CAVB), five patients admitted once for sustained ventricular tachycardia (VT), and two patients admitted twice for two arrhythmic events (one for CAVB and the other for sustained VT). Disease activity was evaluated by gallium-67 citrate (Ga) scintigraphy. All patients with positive Ga uptake were treated with corticosteroids, and arrhythmic events were evaluated by repeat Holter recordings. Positive uptake of Ga was observed in 8 (80%) of the 10 CAVB events and in 1 (14%) of the 7 sustained VT events (80% vs 14%, P = .02). Corticosteroids abolished myocardial Ga uptake in all nine patients with positive Ga uptake. After corticosteroid therapy was started, AV conduction improved in 5 of 9 CAVB patients (including 8 patients with new-onset CAVB and one patient with history of CAVB). However, ventricular arrhythmias were not improved after corticosteroid therapy. In cardiac sarcoidosis patients, CAVB develops mainly during the active phase of the disease. Early treatment with corticosteroids might improve AV conduction disturbance. However, sustained VT is not closely linked with disease activity and frequently develops in the advanced stage of disease.

Monitoring Treatment Responses in Patients with Pulmonary TB Using Serial Lung Gallium-67 Scintigraphy

Gallium-67 scintigraphy is more sensitive than chest radiography in a single concurrent detection of pulmonary tuberculosis (TB). As for inflammation, the intensity of pulmonary uptake of 67Ga citrate theoretically is a function of the inflammation level in the lung. To maximize clinical applicability of 67Ga scintigraphy in the evaluation of pulmonary TB, we prospectively assessed serial qualitative associations between intensity of the uptake of 67Ga citrate and the severity of lung inflammation, reflected by the burden of Mycobacterium tuberculosis in the sputum of patients undergoing anti-TB chemotherapy. Each enrolled patient had chest radiographic, microbiologic, 67Ga imaging, and semiquantitation of sputum acid-fast bacillus (AFB) assessments before and at the third and sixth months after receiving anti-TB chemotherapy. The burden of pulmonary M. tuberculosis (presumably, in proportion to the semiquantitation of AFB in sputum) and the intensity of 67Ga citrate uptake in the lung at each synchronized assessment were regarded as a paired variable. Odds ratios were obtained from odds (derived using generalized estimating equations) in favor of higher pulmonary 67Ga uptake in differing scores of semiquantitation of sputum AFB. Linear trend for pulmonary 67Ga citrate uptake corresponding to varied pulmonary M. tuberculosis burdens was assessed using contrast analysis of their odds ratios. Thirty patients (24 men and six women) with pulmonary TB were enrolled. Eighty-six paired semiquantitations of sputum AFB-67Ga-scintigraphic studies were collected. Twenty-six patients were cured of their pulmonary TB. The pulmonary 67Ga uptake increased in proportion to the higher score of semiquantitation of sputum AFB (p = 0.009, for trend). In patients with pulmonary TB, the higher the burden of M. tuberculosis in the lung, the higher the intensity of pulmonary 67Ga citrate uptake. Serial 67Ga-scintigraphy examinations are helpful in evaluations of the effectiveness of anti-TB therapy when assessments based on chest radiography are difficult.

Cryptococcal Lymphadenitis and Massive Splenomegaly in an Immunocompromised Patient

Abstract: We report an unusual case of lymphadenitis and splenitis in a hemophiliac with AIDS. Splenomegaly without focal lesions was shown by CT and MRI. A Ga-67 scan demonstrated markedly increased activity in the spleen and increased focal activity in the left supraclavicular region. Cryptococcus neoformans was cultured from blood. A fine needle aspirate of a supraclavicular lymph node revealed budding yeast. After therapy, a repeat gallium scan showed no supraclavicular activity and markedly reduced splenic uptake. Cryptococcal infection should be in the differential diagnosis of markedly increased Ga-67 uptake in splenomegaly and focal lymph node uptake in an immunocompromised patient.

Role of 99mTc MDP bone and 67Gallium imaging in evaluation of diabetic osteopathy

Background and objectives Osteomyelitis (OM), Foot Ulcers (FU) and neuropathic arthropathies, i.e. Charcot's Foot (CF) are complications of Diabetes Mellitus (DM) which can coexist. This retrospective study was undertaken to highlight the sensitivity of bone scan in diagnosing OM, to study patterns of 99mTc Methylene DiPhosphonate (MDP) bone and 67Gallium (Gallium citrate) uptake, their sensitivity in Charcot's detection and whether Gallium can be a useful cost effective adjunct imaging in evaluation of diabetic osteopathy. Methods 86 diabetic patients (M:F = 50:36) in age range 46–75 years (mean 52 ± 6 years) with clinical suspicion of OM/CF with normal X-rays were analyzed. All patients underwent 99mTc MDP three phase bone scan. A combined 67Ga scans were performed in 14 patients. OM positive patients further had bone curettage and bacteriological culture. Results Of 86 patients, bone scan wise, 34 had OM and 31 had positive bacteriological cultures. 15 patients showed no OM or CF. In remaining 37 patients, 16 (Group: A) had OM in metatarsal bones/phalanges apart from hot spots in other tarsal bones, with no clinical evidence of foot ulcers suggesting coexisting unsuspected CF. 21 patients (Group: B) showed tracer uptake only in tarsal bones with no coexisting foot ulcers (“CF Group”). 67Ga imaging was performed in 14 patients (6 from Group: A and 8 from Group: B) showing variable uptake patterns. In Group: A all six patients showed moderate congruent 67Ga and MDP uptake in sites of OM and three of them showed congruent but less 67Ga uptake in tarsals. In Group: B, three showed moderate 67Ga uptake congruent to MDP uptake in tarsals and five patients there is nil to mild uptake. Conclusion Our study shows three-phase bone scan has 100% sensitivity and 91.2% specificity for detecting diabetic Osteomyelitis in presence of normal X-rays. Bone scan is a simple and useful screening modality to detect OM and unsuspected cases of Charcot's foot in diabetics. Navicular and cuneiform bones are earliest to be involved in Charcot's foot. 67Gallium imaging has little incremental value in evaluation of diabetic osteopathy.