Increased Gallium Uptake Research Articles

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

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.

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.

False positivity of FDG‐PET/CT in a child with Hodgkin disease

Role of Positron Emission Tomography (PET) with F-18-2-fluoro-2-deoxy-D-glucose (FDG) in staging of Hodgkin disease is well established despite several controversies. We report a Stage III Hodgkin lymphoma patient with false positive FDG-PET/CT results. Seven-year-old male with Hodgkin lymphoma was in remission at end of chemotherapy. At third and fourth month of postchemotherapy follow-up, increased Gallium uptake and positive FDG-PET/CT in right lower quadrant of abdomen was observed. Open biopsy revealed lymphoid hyperplasia. He has been followed for 21 months without any evidence of disease. Despite its documented benefit, we believe that results of FDG-PET/CT should be interpreted with great caution in order to avoid unnecessary interventions.

Port-A Catheter-associated Nocardia bacteremia Detected by Gallium Inflammation Scan: A Case Report and Literature Review

Central venous catheter-associated Nocardia bacteremia is rarely reported. We present the case of a 48-y-old male with a history of advanced T-cell lymphoma who suffered from recurrent fever and persistent Gram-positive bacillus bacteremia. Port-A catheter-associated Nocardia bacteremia was diagnosed on the basis of the clinical response to removal of the catheter and the finding of increased gallium uptake, along with the Port-A catheter presented in the gallium inflammation scan.

Cold vertebrae on Ga-67 scintigraphy

40-YEAR-OLD woman with stage Ilia nodular sclerosis Hodgkin's disease was referred for a baseline Ga-67 scintigraphy study before therapy. The gallium scan showed a cold (ie, photon-deficient) area surrounded by a rim of increased activity in the region of the 10th thoracic vertebra and increased uptake in the superior mediastinum (Fig 1). The patient was treated with chemotherapy. After treatment, a follow-up gallium scan was performed and showed disappearance of both paravertebral and mediastinal increased gallium uptake; however, the photondeficient area in the lower thoracic region still remained (Fig 2). The computed tomography scan showed marked sclerotic changes in the 10th thoracic vertebra. Currently (2 years later), the patient remains in complete remission. Fig 1. Planar scintigraphy (upper panel) and SPECT (lower panel) of thoracic region show a photopenic defect within the area of increased tracer accumulation in the lOth thoracic vertebra and increased uptake in the superior medlastlnum before treatment. DISCUSSION

Cryptogenic fibrosing alveolitis: pattern of disease in the lung.

The distribution of disease has been studied in 10 patients with histologically confirmed cryptogenic fibrosing alveolitis by means of computed tomography of the lungs, gallium 67 uptake scintigraphy, and ventilation and perfusion scintigraphy. The findings of computed tomography and scintigraphy showed no correlation with the UICC/Cincinnati grades of the plain chest radiographs, even when these were supplemented with information from lateral and oblique chest films. Computed tomography showed subpleural shadowing in every patient except one who had responded well to corticosteroid treatment. Subpleural shadowing was commoner in the inferior and posterior parts of the lung lobes and was commonest in the posterior lower subpleural areas. The central lung showed three types of change--firstly, a dense shadowing, which was sometimes associated with much increased gallium uptake; secondly, dilated smaller airways with small bullae, suggesting airway disease; and, thirdly, gross bullous change.

Tumor cell toxicity of stable gallium nitrate: Enhancement by transferrin and protection by iron

The cytotoxicity of citrated gallium nitrate (NSC 15200) to EMT- 6/UW mouse sarcoma cells growing in vitro was assayed as growth inhibition in treated cultures as well as cell survival (colony-forming ability) after acute or chronic exposure to graded doses. Gallium nitrate is both cytostatic and lethal to cells, with some growth inhibition occurring after chronic exposure to low doses ( 10 μ g/ml) which kill essentially no cells. Cell kill and growth inhibition were both observed if cells were exposed for 24 hr or more to doses greater than 50 μ g/ml. The growth inhibitory and lethal effects of gallium nitrate were enhanced by the addition of human transferrin to the medium. This enhanced toxicity was consistent with, and proportional to, the increased gallium uptake in the presence of transferrin rather than a direct effect of this iron transport protein. The addition of ferric citrate greatly reduced the toxic effect of the gallium salt. Cells in stationary plateau phase cultures appear to be as sensitive to gallium nitrate as exponentially growing cells. Ga 3+ may mimic Fe 3+ in some aspects of cellular metabolism, and competition between the two metals occurs at the initial uptake step, binding to transferrin, and possibly at other points in cell metabolism.

Abnormalities of pulmonary vascular dynamics and inflammation in early progressive systemic sclerosis.

Abnormalities of pulmonary function were studied in 10 patients with progressive systemic sclerosis (PSS) and 3 control subjects. All underwent 81M krypton lung scanning and total body gallium scanning. Immune complexes were measured by Raji cell radioimmunoassay and polyethylene glycol (PEG) assay. Perfusion scans were abnormal in 7 of 9 patients, and 5 of 9 showed a decrease in pulmonary perfusion after cold challenge. Increased gallium uptake was noted in the lungs of 6 of 9 patients. Krypton scans were normal in the control group. Elevated immune complexes were noted in 8 of 10 patients by the Raji assay and in 5 of 10 with the PEG assay. Efforts to separate patients with PSS into subgroups may lead to a better understanding of and advances in therapy for PSS.

Relationship of iron metabolism to tumor cell toxicity of stable gallium salts.

The antitumor properties of citrated gallium nitrate (NSC 15200) have been tested using the EMT-6/UW mouse sarcoma growing in vitro or in vivo . This tumor system has been used in both growth forms in our studies which led to the transferrin receptor hypothesis of the mechanism of uptake of tracer levels of gallium-67 citrate. Gallium nitrate is both cytostatic and lethal in vitro with some growth inhibition occurring after chronic exposure to low doses (10 μg per ml) which kill essentially no cells. Cell kill and growth inhibition were both observed if cells were exposed for longer times at higher doses. The effects of gallium nitrate were enhanced by the addition of human transferrin to the culture medium. The enhanced toxicity was consistent with, and proportional to, increased gallium uptake in the presence of transferrin. The addition of ferric citrate greatly reduced the toxic effect of the gallium salt. The enhancing effect of transferrin and protective action of ferric citrate are consistent with our studies of the effect of these two agents on concentration of tracer levels of the tumor-imaging radiopharmaceutical, carrier-free gallium-67 citrate. Tumors in vivo were largely resistant to 10 daily doses of 90 mg kg −1 of gallium nitrate. Ga may mimic Fe in some aspects of cell metabolism. Competition between the two metals occurs at the initial uptake step (binding to transferrin) and possibly to a lesser extent at other points in cellular incorporation and deposition. Iron has been implicated as a regulatory factor in cell growth and may be essential for cell proliferation. The toxicity of stable gallium is interpreted in the context of similarities of metabolism of the two metals.