Gallium-67 Citrate Research Articles

Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate

Previous studies have demonstrated the feasibility of targeting lymphoma lesions with somatostatin receptor binding agents, mainly with In-111-pentetreotide. In the present work another somatostatin analog, Tc-99m depreotide, is investigated. One-hundred and six patients, 47 with Hodgkin's (HL) and 59 with various types of non-Hodgkin's lymphoma (NHL), were imaged with both Tc-99m depreotide and Ga-67 citrate. Planar whole-body and single photon emission tomography/low resolution computerized tomography (SPECT/CT) images were obtained. A total of 142 examinations were undertaken at different phases of the disease. Depreotide and gallium findings were compared visually and semi-quantitatively, with reference to the results of conventional work-up and the patients' follow-up data. In most HL, intermediate- and low-grade B-cell, as well as in T-cell NHL, depreotide depicted more lesions than Ga-67 and/or exhibited higher tumor uptake. The opposite was true in aggressive B-cell NHL. However, there were notable exceptions in all lymphoma subtypes. During initial staging, 93.3% of affected lymph nodes above the diaphragm, 100% of inguinal nodes and all cases with splenic infiltration were detected by depreotide. On the basis of depreotide findings, 32% of patients with early-stage HL were upstaged. However, advanced HL and NHL cases were frequently downstaged, due to low sensitivity for abdominal lymph node (22.7%), liver (45.5%) and bone marrow involvement (36.4%). Post-therapy, depreotide detected 94.7% of cases with refractory disease or recurrence. Its overall specificity was moderate (57.1%). Rebound thymic hyperplasia, various inflammatory processes and sites of unspecific uptake were the commonest causes of false positive findings. The combination of depreotide and gallium enhanced sensitivity (100%), while various false positive results of either agent could be avoided. Except perhaps for early-stage HL, Tc-99m depreotide as a stand-alone imaging modality has limited value for the initial staging of lymphomas. Post-therapy, however, depreotide scintigraphy seems useful in the evaluation of certain anatomic areas, particularly in non-aggressive lymphoma types. The combination with Ga-67 potentially enhances sensitivity and specificity. If fluorodeoxyglucose positron emission tomography is not available or in case of certain indolent lymphoma types, Tc-99m depreotide may have a role as an adjunct to conventional imaging procedures.

Thyroiditis mimicking relapse of acute lymphoblastic leukemia: Gallium-67 scan suggested the diagnosis

Acute lymphoblastic leukemia (ALL) is the most common form of leukemia in childhood and accounts for 85% of cases. ALL frequently presents as an infectious process with an abrupt onset of high fever. Thyroid disease has been reported to have a strong association with acute leukemia. Gallium (Ga-67) citrate has been used in the investigation of patients labeled as having pyrexia of unknown origin. We report a case of a 13-year-old female patient who presented with fever and suspected disease relapse after a period of disease remission; however, gallium-67 citrate whole body scan suggested the diagnosis of thyroiditis.

ACR Appropriateness Criteria® on Metastatic Bone Disease

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

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.

Ga-67 citrate SPECT-CT of a giant renal cyst

0212-6982/$ see front matter © 2010 Elsevier Espana, S.L. and SEMNIM. All rights reserved. We present a 67-year-old patient with a history of hepatic hydatidosis and toxic syndrome, anemia and fever who underwent gallium-67 citrate study. Planar imaging 48 h after the administration of 185 MBq of galium-67 citrate only showed linear uptake of the radiotracer in the lower left hemiabdomen interpreted as physiological intestinal uptake (fig. 1). Single photon emission computerized tomography and abdominal axial computerized tomography (SPECT-CT) demonstrated a giant cyst with lobes in the left kidney with an hydroaerial level presenting uptake of the radiotracer in the inferior wall (fig. 2). Histologic analysis of Interesting images

耳下腺内嚢胞性疾患の検討

We evaluated differential diagnoses of cystic parotid gland lesions and the efficacy of preoperative diagnosis. Of 191 parotid gland nodules resected between January 2003 and October 2008, 167 (87%) were benign and 24 (13%) malignant. Thirty-five parotid gland nodules whose components were almost cystic were enrolled in this study. All cystic lesions were retrospectively evaluated with respect to preoperative diagnostic examinations and histopathological confirmed diagnosis. Cystic components in surgical specimens were also evaluated histopathologically. The relationships with magnetic resonance imaging (MRI) findings and histopathological confirmed diagnosis were studied. Of 35 cystic lesions, 11 were complete cystic masses and had no mural nodules, while remaining 24 were incomplete and had mural nodules. Histopathological examinations showed that 5 were nonneoplastic, 27 were cystic degenerations of benign tumors, and 3 were cystic degenerations of malignant tumors. In the 11 complete cysts, preoperative diagnosis could not be made using any modality, whether with FNAC, salivary scintigraphy, or 67-gallium citrate scintigraphy. Of 24 incomplete cysts, only 9 cystic Warthin tumors were diagnosed correctly before surgery. Studies of cystic components in MRI and histopathology suggested that hemorrhagic degeneration of malignant tumors should be kept in mind for cystic lesions showing hemorrhagic portions. Cystic parotid gland lesions are difficult to diagnose correctly before surgery, but the evaluation of cystic components by MRI and FNAC is helpful in differentiating between benign and malignant tumors.

Chilaiditi's syndrome demonstrated by SPECT/CT

Purpose: Chilaiditi’s syndrome is a rare condition commonly diagnosed as an incidental radiological finding. The aim of this report is to show the role of SPECT-CT in this syndrome and state the functional and anatomical role of this hybrid imaging modality. &#x0D; Materials and Methods: A case report.&#x0D; Results: A 49-year-old female patient was referred for gallium-67 citrate for a possible&#x0D; granulomatous myositis and underwent SPECT-CT of the abdomen to assess the area of decreased gallium uptake on planar images of the liver. The combined SPECT and CT modality demonstrated findings consistent with the clinical evidence of Chilaiditi’s syndrome. The anatomical part of this hybrid modality made it easier to evaluate the area of gallium lack of uptake which was due to air in the colon.&#x0D; Conclusion: This case does not only show the role of SPECT-CT in this syndrome but also suggest that the use of such modality should be considered whenever available in the evaluation of patients in whom the localization of active disease becomes imperative.

Diagnosis of Prosthetic Aortic Valve Endocarditis With Gallium-67 Citrate Single-Photon Emission Computed Tomography/Computed Tomography Hybrid Imaging Using Software Registration

Prosthetic valve endocarditis can be challenging to diagnose and is associated with high mortality rates even if recognized and managed early. We present a case of staphylococcal sepsis soon after aortic valve surgery and permanent pacemaker implantation for which conventional investigation with echocardiography and computed tomography (CT) failed to identify an infective focus. Subsequent gallium–single-photon emission CT (67Ga-SPECT) imaging with software registration of the SPECT data helped to correctly identify the prosthetic aortic value as the source of sepsis, with resolution of changes on subsequent imaging. A 70-year-old woman underwent bioprosthetic aortic valve replacement and coronary artery bypass grafting for symptomatic severe aortic stenosis and significant 2-vessel coronary disease. Her postoperative course was complicated by significant bradycardia necessitating dual-chamber permanent pacemaker implantation. She presented 3 months after surgery in a confused state, with low-grade pyrexia. The examination identified a soft systolic aortic murmur but no diastolic component, normal breath sounds, absence of cutaneous markers of endocarditis, and no evidence of …

Late Stent Thrombosis After Drug-Eluting Stent

Following the inspiration of Dr S. Windecker, the team from Bern, Switzerland, has contributed >30 studies on drug-eluting stent efficacy and safety, several of which represent essential pieces in the puzzle. The article in this issue of Circulation by Cook et al1 belongs to that select group of key references. The series of robust and detailed reports on the Bern-Rotterdam cohort studies have coined the 0.6% yearly linear rate of definite late stent thrombosis associated with the permanent coronary implantation of first-generation drug-eluting stents.2 Intravascular ultrasound imaging of the thrombosed stents has revealed the strong association of incomplete strut apposition with the event.3 At the same time, collective analysis of all the available evidence4 demonstrated that a reduction in restenosis with drug-eluting stents prevented adverse events caused by the treatment of the more frequent recurrences with bare metal stents. With the former compensating for the latter, the net result of this balancing act between safety and efficacy resulted in no difference in death and myocardial infarction rates up to 4 years after the initial procedure. Article see p 391 In the present study, late hypersensitivity reaction was identified as a cause for late stent thrombosis, in association with stent malapposition caused by necrotizing vasculitis around the stent struts. Histopathological analysis of aspirated thrombus showed eosinophilic infiltration typical for type IVb hypersensitivity reaction following implantation of sirolimus-eluting stents. Macrophage infiltration typical for type IVc hypersensitivity was seen with paclitaxel-eluting stents. The biomarker gradient between coronary and peripheral blood was significant for high-sensitivity C-reactive protein and myeloid-related protein 8/14, both markers of local inflammatory reaction. These patterns were not observed with early drug-eluting stent thrombosis, early …

Femoropopliteal prosthetic bypass graft infection due to Mycobacterium abscessus localized by FDG-PET/CT scan

A patient with postvascular graft placement presented with bacteremia but no localizing symptoms. Our standard infected graft workup of computed tomography (CT) scan, ultrasound scan, magnetic resonance imaging (MRI) scan, and additional laboratory tests did not localize the infection source. Nuclear medicine had three options including white blood cell (WBC) scan, gallium scan, and the fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan. FDG-PET/CT imaging alone demonstrated the location. We present an unusual case of Mycobacterium abscessus in a vascular graft not localized with CT scan, ultrasound scan, or MRI scan and could only be localized with FDG-PET/CT scan.

Hepatorenal Polycystic Disease and Fever: Diagnostic Contribution of Gallium Citrate Ga 67 Scan and Fluorine F 18 FDG-PET/CT

A cyst infection was suspected in a patient who was on haemodialysis for renal failure secondary to hepatorenal polycystic disease with persistent fever and pain in right hypochondrium despite antibiotherapy. Radiologic exams (ultrasonography, computed tomography [CT]), however, did not show signs of infection. For surgical removal of the infected cyst, a precise location was required.This report shows how functional imaging, gallium citrate Ga 67 scan, and fluorine F 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed which cyst was infected; however, the fused image provided by PET/CT showed the precise, required location.The infected cyst was located on the right kidney. A week later, after nephrectomy, all symptoms disappeared.

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.

67Gallium citrate scintigraphy to assess metastatic spread in a dog with an oral melanoma

Gallium scintigraphy was used to evaluate therapeutic response in a 10-year-old, male, Dutch sheepdog, suffering from an oral melanoma. Treatment was performed with a combination of carboplatin and hypofractionated radiation. Nineteen weeks after radiation therapy, the left submandibular lymph node was surgically removed because of metastatic disease. Thirty weeks after radiation therapy, 67Gallium scintigraphy was performed to assess for residual disease and metastasis. Increased uptake in the right submandibular lymph node area was noted and identified as a melanoma metastasis on cytology. Surgical excision was performed. Twenty-one weeks later, the dog was euthanased because of advanced pulmonary metastases. This report of a case of oral melanoma illustrates the advantages of 67Gallium scintigraphy in monitoring for the presence of metastatic disease and effectiveness of therapy.

Value of Gallium-67 Scanning in Monitoring Therapeutic Effectiveness in a Patient with Relapsing Polychondritis

We present a 57-year-old man who had low-grade fever and painful, swollen and erythematous ears. Gallium-67 citrate scintigraphy (gallium scan) performed prior to the commencement of treatment showed increased gallium uptake in bilateral external ears, neck, mediastinum and bilateral pulmonary hili. The results of ultrasonography of both ears were compatible with the diagnosis of chondritis. The patient's clinical condition and laboratory data improved after a course of nonsteroidal anti-inflammatory drugs and steroids. Gallium scan performed after treatment showed a diminished uptake in the external ears, neck, and mediastinum. Gallium scintigraphy is a valuable tool for evaluating inflammatory activity and monitoring therapeutic response in patients with relapsing polychondritis.

Non-Invasive Imaging of Complicated Osteomyelitis: The Added Value of Scintigraphic Techniques

Diagnosing osteomyelitis is clinically challenging. Laboratory tests are of limited utility, and other than isolation of the offending organism, diagnostic imaging tests are of paramount importance. There are a myriad of scintigraphic tests from which to choose, and no single test is optimal for all indications. With an accuracy of more than 90%, bone scintigraphy is the radionuclide test of choice for diagnosing osteomyelitis in unviolated bone. The test is less useful in violated bone conditions. Gallium-67 citrate imaging has been used in conjunction with the bone scan to improve test specificity. The overall accuracy of bone/gallium imaging, which is usually reserved for spinal osteomyelitis, is about 65%-80%. Except in the spine, combined radiolabeled leukocyte-marrow imaging is the radionuclide procedure of choice for diagnosing complicated osteomyelitis. The accuracy of the test is about 80%-90%. The in-vitro labeling procedure is a significant drawback to the test, and despite numerous attempts, no satisfactory in vivo labeling method is available. Recent work indicates that FDG PET is useful in the diagnosis of osteomyelitis. This tracer has shown promise for detecting acute and chronic infection in the axial and peripheral skeleton and has been reported to be highly accurate in suspected implant- (except prosthetic joint) associated infections. Increased FDG uptake, however, also is associated with inflammatory arthritis, acute fractures, normally healing bone and degenerative changes. Much investigation is still needed to determine the precise role of this procedure in musculoskeletal infection. Radiolabeled antibiotics and antimicrobials, which should in theory be highly specific for infection, have been investigated but are not in routine clinical use. It is important to recognize that no single tracer is equally efficacious in all regions of the skeleton and the selection of the appropriate study should be governed by the clinical question posed. Keywords: Complicated osteomyelitis, bone scan, gallium scan, leukocyte scan, marrow scan, FDG-PET

Influence of the particle size of activated charcoal on labeling efficiency with 67Ga-citrate for colonic transit study

Indium-111 and 99mTc have been proposed for colonic transit study, but 111In is expensive and the half-life of 99mTc is too short for the study. Gallium-67 citrate is inexpensive and has a suitable half-life. In our previous study, we successfully labeled 67Ga-citrate activated charcoal, and the labeling efficiency exceeded 91% after a 96 hour incubation period. In this work, we evaluated the influence of the size of activated charcoal particles on the labeling efficiency with 67Ga-citrate. The data showed that the influence of particle size on the labeling efficiency of activated charcoal with 67Ga was insignificant. Both sizes of activated charcoal particles can be used for labeling with 67Ga in colonic transit study.

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.

The Imaging of Spinal Infections

Spinal infections can arise in a variety of anatomical locations and structures and encompass vertebral osteomyelitis, discitis, disc space infection, epidural abscesses, and infection of the adjacent soft tissue structures. Plain radiography, computed tomography, magnetic resonance imaging (MRI), and nuclear imaging all have a role in the diagnosis of spinal infection. MRI continues to be the gold standard for the imaging diagnosis of spinal infections. 67 Gallium citrate and Tc-99m-methylene diphosphonate scintigraphy have become the standard for nuclear imaging of the spine. Fluorine-18-fluorodeoxyglucose positron emission tomography, strepavidin/ 111 In-biotin, and 99m -ciprofloxacin have shown promise for aiding in the diagnosis and evaluation of spinal infection but warrant further study.

Infection Scintigraphy

Positron emission tomography (PET)/computed tomography (CT) imaging is a powerful dual-modality integrating physiology and anatomy. Analogously, fusing separate single-photon emission computed tomography (SPECT) and CT images can overcome interpretive challenges in characterizing and localizing abnormalities. This study explores the value of SPECT/CT image fusion compared with traditional "side-by-side" SPECT-CT image review for infectious /inflammatory processes. We identified 17 abnormal infection/inflammation SPECT scans in 16 patients (11 indium 111 WBC and 6 gallium citrate Ga 67) with a contemporary CT scan. The SPECT and CT images were uploaded onto "side-by-side" workstations, one with fusion software. Two nuclear radiologists reviewed "side-by-side" SPECT and CT images and fused SPECT/CT images. They scored 2 parameters (anatomical localization and diagnostic confidence) using a 4-point scale (1 "not helpful" to 4 "very helpful"). Score differences more than 1 indicated "added value" and less than 0, "no added value". Compared with "side-by-side" SPECT-CT, fused SPECT/CT images yielded "added value" for anatomical localization in 65%, diagnostic confidence in 71%, and altered interpretations in 47% of cases. Greater confidence was achieved in 75% of cases with altered interpretations and 55% of unaltered cases. The SPECT/CT image fusion outperformed "side-by-side" SPECT/CT review for anatomical localization and diagnostic confidence of infectious/inflammatory abnormalities. Therefore, SPECT/CT fusion potentially influences clinical decisions and treatment options.

Diffuse large B-cell lymphoma in the thyroid gland associated with primary hyperparathyroidism

We report a case of primary hyperparathyroidism associated with a malignant lymphoma in the thyroid gland. A 68-year-old woman was admitted to hospital with a cervical mass. Ultrasound and computed tomography (CT) revealed a hypoechoic, multinodular tumor in the left thyroid gland. A gallium-67 citrate scintigram revealed intense radioisotope uptake in the thyroid tumor. Histological examination of biopsy specimens indicated that this tumor was a large B-cell lymphoma. The coexistence of parathyroid adenoma in this patient was revealed by a sestamibi scintigram, performed prior to chemotherapy. Following the complete remission of the lymphoma by chemotherapy, we carried out an excision of the single parathyroid adenoma. To our knowledge, this is the first report to describe a malignant thyroid lymphoma associated with primary hyperparathyroidism.