Gallium-67 Citrate Scanning Research Articles

Use of He-Ne Laser for Treatment of Soft Tissue Trauma: Evaluation by Gallium-67 Citrate Scanning

Sequential quantitative Gallium-67 Citrate (Ga-67) scanning was used to evaluate the resolution of inflammation in standardized bruises in rat thighs with and without Helium Neon (He-Ne) laser treatment. The severity of inflammation in the injured tissue was assessed as the ratio of Ga-67 localized in the bruise to the Ga-67 localized in the noninjured area of the same geometry. During the first 12 days after injury, both (He-Ne laser) treated and nontreated rats healed rapidly with no observable differences in Ga-67 localization. J Orthop Sports Phys Ther 1986;8(2):93-96.

Use of technetium-99m methylene diphosphonate and gallium-67 citrate scans after intraarticular injection of Staphylococcus aureus into knee joints of rabbits with chronic antigen-induced arthritis.

Numerous clinical studies have questioned the ability of radionuclide scans to differentiate septic from aseptic joint inflammation. A clinical study may not be able to document an underlying disease process or duration of infection and, thus, may make conclusions about the accuracy of scan interpretations open to debate. In this study, the Dumonde-Glynn model of antigen-induced arthritis in rabbits was used as the experimental model to study technetium and gallium scans in Staphylococcus aureus infection of arthritic and normal joints. Gallium scans were negative in normal rabbits, usually negative in antigen-induced arthritis, but positive in septic arthritis. The bone scan was usually negative in early infection but positive in late septic arthritis, a finding reflecting greater penetration of bacteria into subchondral bone because of the underlying inflammatory process.

Scintigraphic evaluation of giant cell tumor of bone.

Technetium-99m methylene diphosphonate bone scans were performed in 21 patients with giant cell tumors of bone. All tumors showed increased radiophosphate uptake, often more intense at the tumor periphery than in its center. However, radionuclide bone scanning often overestimated intraosseous tumor extent as a result of increased tracer uptake beyond true osseous tumor limits. In addition, it failed to detect soft-tissue tumor extension in nine patients. Therefore, scintigraphy is less useful than either computed or conventional tomography in planning surgical margins of giant cell tumors. Gallium-67 citrate scans obtained in seven patients showed slight uptake in four tumors and no uptake in three. Radiogallium imaging is thus of limited use in evaluation of suspected giant cell tumors of bone.

Radiation absorbed-dose estimates for the liver, spleen, and metaphyseal growth complexes in children undergoing gallium-67 citrate scanning.

Quantitative conjugate-view external counting techniques were applied to estimate the radiation dose to the liver, spleen, and metaphyseal growth complexes (distal femur and proximal tibia) for ten pediatric patients undergoing gallium-67 scanning procedures. The effective half-life of Ga 67 in these organs was approximately 78 hours. The dose per unit of administered activity for the liver and spleen was between 0.3 and 4.0 rad/mCi (0.08 to 1.08 Gy/GBq) and 0.5 and 7.0 rad/mCi (0.13 to 1.89 Gy/GBq), respectively. For the metaphyseal growth plates, the range was 2.3 to 14.3 rad/mCi (0.62 to 3.86 Gy/GBq).

The role of nuclear scanning in head and neck surgery

A number of procedures in nuclear medicine are available to assist the surgeon in evaluating pathologic conditions of the head and neck. Gallium-67 citrate scanning is occasionally useful in determining the extent of head and neck tumors but rarely can it detect an occult tumor and it cannot distinguish between an infection and a tumor. Technetium-99m pertechnetate can be used to evaluate diseases of the salivary glands including 123 and technetium-99m pertechnetate are commonly used to obtain images of the thyroid, but some malignant thyroid nodules will accumulate technetium-99m pertechnetate and the suspicious character of the nodule may be only appreciated by iodine scanning. The use of iodine 131 is generally limited to the detection of a substernal thyroid, therapeutic thyroid ablation, and the treatment of hyperthyroidism and thyroid cancer. Bone scanning has been used experimentally to evaluate the healing of mandibular bone grafts and to detect local extension of primary head and neck tumors to skull and facial bones.

Sensitivity of 67Ga-scanning in sarcoidosis: Detection of biopsy proven pulmonary lesions radiographically undetectable

Three cases are reported in which gallium-67 citrate scanning disclosed the presence of pulmonary sarcoid lesions, which were confirmed by open lung biopsy. In all three cases the chest radiography showed no evidence of pulmonary parenchymal leisons. The present report provides evidence that the gallium-67 scan is more sensitive than radiography in disclosing sarcoid lesions of the lung parenchyma. The scan is useful in the management of sarcoidosis, as it shows progressions or remissions of disease more reliably than chest radiographs.

Noninvasive methods for detection of valve vegetations in infective endocarditis

To determine the optimal noninvasive method for the demonstration of endocarditic vegetations, 35 consecutive episodes of clinically diagnosed endocarditis in 33 patients were studied with M mode and two dimensional echocardiography, and with gallium-67 citrate and technetium-99m stannous pyrophosphate cardiac scanning. Clinical criteria for the diagnosis of endocarditis were: temperature higher than 38 ° C; sustained bacteremia with at least three positive blood cultures; no extracardiac focus of bacteremia; and known underlying heart disease, a new or changing murmur or a history of intravenous drug abuse with radiologic evidence of septic pulmonary emboli. M mode echocardiography detected 18 vegetations in 17 of the 35 episodes of endocarditis studied (49 percent positive); two dimensional echocardiography detected 30 vegetations in 28 of the 35 episodes studied (80 percent positive). In contrast, no vegetations were detected with technetium-99m stannous pyrophosphate scanning, and only two gallium-67 citrate scans were positive. The advantage of the two dimensional echocardiographic technique over all others tested was particularly notable for the identification of aortic and tricuspid valve vegetations.

Gallium-67 citrate scanning for noninvasive detection of inflammation in pericardial diseases

The treatment of acute nonspecific pericarditis is controversial. No study is available that confirms the efficacy of the administration of corticosteroids or nonsteroid anti-inflammatory agents in this condition. There is no reliable invasive marker for pericardial inflammation, because echocardigraphy demonstrates only the presence of fluid. In four patients with pericarditis, gallium-67 citrate scanning was performed, and the isotope was localized to the cardiac silhouette in all. In one patient with effusion the gallium scan was positive and then reverted to negative with corticosteroid therapy. In another, the gallium scan remained positive despite resolution of the pericardial effusion with corticosteroid therapy. This patient eventually required pericardial stripping. Pericardial localization of gallium was useful in detecting the cause of fever in a patient after aortocoronary bypass grafting and in detecting pericardial involvement in a patient with multisystem viral disease. Pericardial localization of gallium-67 may be diagnostically useful and may provide a proper control for the study of the efficacy of corticosteroids versus nonsteroid anti-inflammatory agents in pericarditis.

Differential bone-scanning in the evaluation of a painful total joint replacement.

In an attempt to differentiate between loose and infected total joint replacements, seventy-nine patients were studied with both technetium-99 pyrophosphate and gallium-67 citrate bone scans. Seventy of these patients had positive technetium scans. Nineteen had positive gallium scans and all nineteen had positive cultures at the time of operation, while one patient had a false-negative gallium scan. Ten other patients who had negative technetium-99 scans and a painful total joint were followed without operative intervention. Of these, only two required operation after their technetium-99 scans became positive. Based on these studies, gallium-67 citrate scans combined with technetium-99 pyrophosphate scans are believed to be useful in differentiating between loose and infected prostheses. A negative technetium scan should weigh heavily against surgical exploration in an attempt to find the source of pain.

Gallium-67 citrate scanning in the staging of idiopathic pulmonary fibrosis: Correlation and physiologic and morphologic features and bronchoalveolar lavage.

Idiopathic pulmonary fibrosis is a fatal disorder characterized by interstitial fibrosis and parenchymal inflammation. Current concepts of this disease suggest that the inflammation precedes and probably induces the fibrotic state. To evaluate the extent and relative activity of the inflammatory process, we scanned patients with idiopathic pulmonary fibrosis using gallium-67, a radionuclide known to concentrate in regions of inflammation. To quantify the amount of isotope in the lung parenchyma, the 67Ga-index was developed, a parameter derived from estimates of the size of regional pulmonary uptake, the uptake intensity, and its texture. Evaluation of 67Ga scans in 30 patients with idiopathic pulmonary fibrosis and 19 control subjects demonstrated that the 67Ga-index in the group with idiopathic pulmonary fibrosis was significantly higher (P less than 0.001) than that in the control group. When compared with lung biopsy morphologic studies in 22 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the degree of interstitial cellularity (P less than 0.05) and the degree of alveolar cellularity (P less than 0.005). When compared with cellular analysis of bronchoalveolar lavage fluid in 17 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the differential percentage of neutrophils (P less than 0.05), but not lymphocytes, eosinophils, or macrophages. These studies indicate that 67Ga accumulates in the lungs of patients with idiopathic pulmonary fibrosis and is probably associated with the active inflammatory state. The associations of the 67Ga-index with morphologic features and bronchoalveolar lavage analysis suggest that quantitative evaluation of these scans may be useful in staging the activity of idiopathic pulmonary fibrosis and following responses to therapy.

Gallium-67 scanning for carcinoma of the lung

Gallium-67 citrate scanning was prospectively evaluated in 55 patients who had lung lesions suspected to be primary carcinoma on chest x-ray films and in whom subsequent histologic diagnosis was obtained. Of 47 patients with histologically proved carcinoma of the lung, 44 (94 per cent) had a positive 67Ga scan. No patient with a positive scan had a benign lesion, so that the positive scan accuracy rate was 100 per cent. All 8 patients with a benign lesion and 3 patients with a malignant lesion had negative scans, for a negative scan accurary rate of 72 per cent for benign lesions. These results give statistical validity for the usefulness of the 67Ga scan in diagnosing carcinoma of the lung (p less than 0.001). Tumor cell type had little effect on the sensitivity of 67Ga scan. The 67Ga scan was equally useful in the evaluation of peripheral and central lesions. There was little difference amount T1, T2, and T3 classified lesions in their ability to take up 67Ga. The 67Ga scan was competitive with mediastinoscopy in assessing mediastinal lymph node metastases and provides a noninvasive method of assessing hilar lymph node metastases. There was a good correlation between the clinical staging of patients with lung cancer based on a chest x-ray film and 67Ga scanning and the staging after surgical treatment based on the histology of the resected specimens.

Gallium-67 citrate scanning in Hodgkin's disease and non-Hodgkin's lymphoma.

Gallium-67 citrate scintigraphy was performed in 33 patients with Hodgkin's disease and 25 patients with non-Hodgkin's lymphoma. Three hundred twenty-eight sites of potential involvement were investigated. Confirmation of involvement was made by physical examination, roentgenographic evaluation and histopathologic examination of tissue obtained at diagnostic laparotomy. The results of scintigraphy correlated with all other clinicopathologic data in only 35% of patients, the true-positive rate being significantly higher above the diaphragm (61%) than below (40%). The overall true-positive and true-negative rates were 53 and 90%, respectively. A significant correlation existed between tumor histology and scanning accuracy; the true-positive rate in Hodgkin's disease was 74% compared to only 13% in patients with lymphocytic lymphoma. A similar variation of 67Ga concentration with tumor histology was also noted in 70 tissue specimens obtained from 28 patients at the time of diagnostic laparotomy or biopsy. The routine use of 67Ga-citrate to detect splenic involvement with tumor appeared to be precluded by the low true-positive and high false-negative rates of 57 and 27%, respectively. Gallium-67-citrate scintigraphy may be useful as an adjunct to established clinical staging procedures in untreated patients and in the detection of recurrent disease in treated patients. Our data indicate it is not sifficiently reliable to replace established methods presently used for clinical staging.

Scanning treated Hodgkin's disease with 67Ga citrate.

Eleven patients who had previous diagnoses and therapy for Hodgkin's disease are described. Gallium-67 citrate scanning was the first objective evidence of new growth or recurrence of disease in these patients, and in one patient, indicated the recurrence prior to onset of clinical symptoms. Gallium scanning is recommended as part of the routine follow-up in Hodgkin's disease patients or whenever there is a clinical suspicion of tumor growth.

Giant cell tumor of bone

I Department of Diagnostic Radiology, University of Kansas College of Health Sciences and Hospital, 39th and Rainbow Blvd., Kansas City, KS 66103. Address reprint requests to E. Levine. 2 Department of Surgery, Division of Orthopedic Surgery. University of Kansas College of Health Sciences and Hospital, Kansas City, KS 66103. AJR 143:343-348, August 1984 0361 -803x/84/1 432-0343 0 American Roentgen Ray Society Technetium-99m methylene diphosphonate bone scans were performed in 21 patients with giant cell tumors of bone. All tumors showed increased radiophosphate uptake, often more intense at the tumor periphery than in its center. However, radionuclide bone scanning often overestimated intraosseous tumor extent as a result of increased tracer uptake beyond true osseous tumor limits. In addition, it failed to detect soft-tissue tumor extension in nine patients. Therefore, scintigraphy is less useful than either computed or conventional tomography in planning surgical margins of giant cell tumors. Gallium67 citrate scans obtained in seven patients showed slight uptake in four tumors and no uptake in three. Radiogallium imaging is thus of limited use in evaluation of suspected giant cell tumors of bone.