Poor accumulation of technetium-99m glucoheptonate in sarcoidosis and other diffuse infiltrative lung diseases as compared with gallium-67 citrate

Forty-two patients with diffuse infiltrative lung diseases were imaged with Ga-67 citrate and Tc-99m glucoheptonate (GH). Twenty patients had sarcoidosis, six had fibrosis, six had tuberculosis, nine had lung infiltration, and one had pleural empyema. The main difference between Ga-67 and Tc-99m GH was the much greater uptake of Ga-67 in sarcoidosis than that of Tc-99m GH. Fifteen patients with sarcoidosis had positive Ga-67 scans but only six had positive Tc-99m GH scans. The results in other diffuse infiltrative lung diseases were almost equal with Ga-67 and Tc-99m GH. Although Tc-99m GH is less expensive and simpler to use, it is not an adequate substitute for Ga-67 in diffuse infiltrative lung diseases.     

Comparison of 99Tcm-HMPAO-labelled white blood cells and 67Ga citrate scans to detect myocarditis in the acute phase of Kawasaki disease.

Myocardial imaging with 99Tcm-HMPAO-labelled white blood cells (WBC) and 67Ga citrate was used to detect myocarditis in the acute phase of Kawasaki disease among 22 infants and children; 18 cases of myocarditis were detected by 99Tcm-HMPAO-labelled WBC heart scans, but only one case was detected by 67Ga citrate heart scans. In conclusion, 99Tcm-HMPAO-labelled WBC scanning provides a more sensitive method than 67Ga citrate scanning in the detection of myocarditis in Kawasaki disease.     

Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin-section CT scans

Thin-section computed tomography (CT) was performed in 244 patients with infiltrative lung diseases and 29 healthy control subjects to evaluate the frequency, profusion, and diagnostic value of subpleural parenchymal micronodules. These areas of increased attenuation (less than 7 mm in diameter) were analyzed in four groups: coal miners with chest radiographic findings of coal worker's pneumoconiosis (n = 61), coal miners with no radiographic evidence of pneumoconiosis (n = 73), patients with nonoccupational chronic infiltrative lung disease (n = 110), and healthy adults (n = 29). Subpleural parenchymal micronodules were observed with high frequency in pulmonary lymphangitic carcinomatosis, coal worker's pneumoconiosis, and sarcoidosis but were also seen in 14% of control subjects. Predominant sites of lesions were the posterior subpleural areas in the upper lobes. Subpleural parenchymal micronodules have no diagnostic value when observed as an isolated CT finding but may suggest that diagnosis of pneumoconiosis, sarcoidosis, or pulmonary lymphangitic carcinomatosis when observed in association with mild parenchymal lesions.     

Combined 67Ga citrate and 99Tcm-human immunoglobulin imaging in human immunodeficiency virus-positive patients with fever of undetermined origin

Patients infected with the human immunodeficiency virus (HIV) suffer from serious and life-threatening infections. These patients often present with pyrexia but without localizing signs. Despite its high sensitivity in identifying focal infection 67Ga citrate scintigraphy lacks specificity; lymphoma and solid tumours may also be imaged. This presents particular problems in HIV-positive patients with pyrexia where the differential diagnosis is often between infection and lymphoma. In an attempt to improve the specificity of radionuclide imaging in these patients a combination of 67Ga citrate and the new agent 99Tcm-labelled human immunoglobulin (99Tcm-HIG) was used in 25 patients who were sequentially imaged with the two agents. Fourteen patients had 29 sites of microbiologically confirmed infection; 67Ga citrate identified 27 sites and 99Tcm-HIG identified 16 sites. Seven of the nine sites visualized with 99Tcm-HIG, but positive with 67Ga citrate, were intrathoracic. Abnormal concentration of 67Ga citrate, not due to infection, occurred at eight sites; five lymphoma, one gout, one recent fracture and one patient with prominent bone marrow islands. 99Tcm-HIG showed increased concentration of tracer in only one of the patients with lymphoma. A combination of 67Ga citrate and 99Tcm-HIG imaging in HIV-positive patients with pyrexia of unknown origin enables a differentiation between infection and lymphoma to be made more readily. The poor sensitivity of 99Tcm-HIG in the chest will limit its sole use in this patient group.     

99mTc-interleukin-2 and 99mTc-HMPAO granulocyte scintigraphy in patients with inactive Crohn's disease

Crohn's disease (CD) is a chronic inflammatory bowel disease that may involve the whole gut. Marked intestinal T cell and macrophage activation is a key feature of the disease. Polymorphonuclear cell infiltration is also observed in the diseased gut, mainly during active inflammation. Scintigraphic detection of granulocytes and activated lymphocytes infiltrating the gut wall may be useful in identifying a subgroup of patients with clinically inactive CD who are undergoing early clinical relapse. The aims of the present study were (a) to compare the effectiveness of scintigraphy with (99m)Tc-labelled interleukin-2 ((99m)Tc-IL2) and with (99m)Tc-HMPAO labelled granulocytes ((99m)Tc-WBC) in detecting the presence and extent of bowel inflammation in patients with long-term inactive CD (>12 months) and (b) to assess the accuracy of these techniques in predicting future disease relapse. We studied 29 patients with ileal and/or colonic CD in stable clinical remission (Crohn's Disease Activity Index <150 for at least 12 months) using both (99m)Tc-IL2 and (99m)Tc-WBC scintigraphy in order to evaluate the extent of acute and chronic inflammation in the bowel. Planar and single-photon emission tomography images were acquired in each patient at 1 h p.i. For quantitative analysis of (99m)Tc-IL2 uptake, the abdomen was divided into 32 regions of interest. Despite the absence of symptoms, 18 patients (62%) showed a positive (99m)Tc-IL2 and 18 (62%) a positive (99m)Tc-WBC scan. Only 12 patients (41.4% of the total group) were positive on both scans, and the sites of IL2 and granulocyte bowel uptake were usually located in different segments, indicating that in CD, acute and chronic inflammation can be present in different sites. As far as the prognostic role of the two scans in predicting future disease relapse is concerned, both (99m)Tc-IL2 and (99m)Tc-WBC scintigraphy showed a high negative predictive value (1.00 and 0.91, respectively) but a weak positive predictive value (0.44 and 0.39, respectively). Nevertheless, Kaplan-Meier curves generated between scintigraphic findings and time free from disease relapse were statistically different only for (99m)Tc-IL2 scintigraphy (log-rank test, P=0.013). These results indicate that (99m)Tc-IL2 scintigraphy can be useful in selecting CD patients in clinical remission who could benefit from preventive therapy to avoid disease relapse.     

Chronic osteomyelitis: monitoring by 99mTc phosphate and 67Ga citrate imaging

Thirteen patients with chronic osteomyelitis, treated for 6 months with rifampin, had serial 99mTc phosphate and 67Ga scans to determine their value in assessing response to treatment. In patients who responded to treatment, gallium scans were deemed more accurate than 99mTc phosphate bone scans. The gallium scans, although still abnormal at the end of 6 months of antibiotic therapy, showed an improvement trend in all the responders except one in whom fracture recurred. Worsening or lack of improvement on gallium scans predicted active bone infection in five of six "clinical-failure" patients who had documented active bone infection. 67Ga scans eventually became normal in all patients who remained asymptomatic (excluding one with recurrent fracture). 99mTc phosphate scans became normal in only one of five clinical responders. All nonresponders had persistently abnormal scans, although after 6 months of therapy only four of seven showed worsening or no improvement on the scan. Therefore, 67Ga is preferred over 99mTc phosphate bone scans in the assessment of response to therapy in chronic bone infection. Clinical utility of the gallium scan is most significant in patients whose clinical assessment is uncertain, but routine use of this technique does not appear to be warranted. Gallium images are most valuable when obtained over a period of time, so that the trend of improvement versus nonimprovement is evident.     

Comparison of simultaneous 99mTc-HMPAO and 111In oxine labelled white cell scans in the assessment of inflammatory bowel disease

Forty-seven patients, 29 with chronic inflammatory bowel disease (1131) and 18 with presumed irritable bowel syndrome, including one with uncomplicated diverticular disease, were studied with simultaneous technetium-99m hexamethylpropylene amine oxime and indium-111 oxine labelled leucocyte scans performed at 1, 3 and 24 h. Twenty-seven patients with IBD had active disease as judged by clinical and laboratory criteria and all of these had positive scans with both agents. No false positive studies were obtained. The 1-h ^99mTc-HMPAO WBC scans showed the same distribution to disease as the 3-h ¹¹¹-In WBC scans, with no difference in intensity (P < 0.92); they showed more extensive disease (P < 0.02) and more intense uptake (P < 0.001) than did the 1-h ¹¹¹-In scans. The 3-h ^99mTc-HMPAO WBC scans showed more extensive disease (P < 0.002), with greater intensity (P < 0.0005), than did the 3-h ¹¹¹In WBC scans. Physiological bowel activity on 3-h ^99mTc-HMPAO WBC scans was present in 12 patients but was faint and did not interfere with assessment of disease extent and activity. It is concluded that in terms of isotope availability, radiation dosimetry and image quality, ^99mTc-HMPAO is the agent of choice in detecting active IBD, with localization of disease possible at 1-h after re-injection and optimal resolution and definition of disease extent at 3 h. A negative scan reliably excludes active disease. Correspondence to: R.A. Allan     

Results of brain scanning with different radioisotopes (99mTc-PP, 99mTc-DTPA, 67Ga citrate)

Summary A comparison of the results obtained by ^99mTc-DTPA, ^99mTc-PP and ⁶⁷Ga-citrate scanning in ten meningioma patients is reported. The association of conventional brain scanning, bone scanning and tumor-positive scanning makes it possible to identify the primary tumor, its real extent, the perifocal damage and the contiguous bone damage.

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Ergebnisse der Hirn-Szintigraphie mit verschiedenen Substanzen

Zusammenfassung Die Verfasser vergleichen die abgegebenen Ergebnisse von ^99mTc-DTPA, ^99mTc-PP und ⁶⁷Ga-citrate bei 10 Patienten, von Meningiom befallen. Die Vereinigung der üblichen Hirn-Szintigraphie, der Knochen-Szintigraphie und der positiven Tumor-Szintigraphie erlauben die Identifizierung des ursprünglichen Tumors, seiner wirklichen Ausdehnung, des perifokalen Schadens und der angrenzenden Knochen-Veränderung.

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Etude comparative de la scintigraphie cérébrale avec differenis radio-elements (99^mTc-PP. 99^mTc-DTPA, 67 Ga citrate)Première partie: Etude des méningiomes

Résumé Les auteurs comparent les résultats de la scintigraphie cérébrale avec ^99mTc-DTPA, ^99mTc-PP et ⁶⁷Ga-citrate dans 10 cas de meningiome. L'association de la scintigraphie cérébrale conventionnelle, de la scintigraphie osseuse et de la scintigraphie néoplastique positive consent d'individualiser le foyer néoplastique, l'extension, le damage periphocale et l'altération osseuse concomitante.

     

Single photon emission computed tomography using201Tl chloride in pulmonary nodules: Comparison with67Ga citrate and99mTc-labeled hexamethyl-propyleneamine-oxime

A single photon emission computed tomography (SPECT) with 201Tl chloride (Tl-201) was carried out prospectively in 50 patients with pulmonary nodules and its diagnostic value was compared with those of 67Ga citrate (Ga-67) and 99mTc-labeled hexamethylpropyleneamine-oxime (Tc-99m-HMPAO). Tl-201 SPECT provided 88% (early)-91% (delayed) sensitivity, 85% (early and delayed) specificity and 87% (early)-89% (delayed) accuracy. The sensitivity of the Tl-201 planar image was 56 (early)-62% (delayed), which was significantly lower than that of SPECT. Delayed SPECT images at 2 hour postinjection were more preferable to disclose the malignant pulmonary nodule than early SPECT images at 15 minutes postinjection. The application of SPECT with Ga-67 failed to improve the sensitivity of planar imaging for malignant pulmonary nodules. Tc-99m-HMPAO was concentrated in 62% of 13 patients with malignant pulmonary nodules, which was slightly higher than Ga-67 in 54% of 28 patients. In an analysis of the histologic types of lung cancer, the sensitivity of Tl-201 was not significantly different in all types. On the other hand, Ga-67 was positive only in 25% of 12 patients with adenocarcinoma. A combination of SPECT and Tl-201 is the best choice among routine scintigraphic techniques for depicting malignant pulmonary nodules. The Tl-201 SPECT image may play a complementary role in the characterization of pulmonary nodules which are revealed on a plain radiograph and computed tomography.     

A preliminary investigation of 67Ga citrate distribution in hyperferraemic patients

Scanning for malignant or inflammatory lesions with ⁶⁷Ga citrate currently has a number of major limitations. In an effort to improve visualisation of the abdomen and pelvis, and to reduce the time between ⁶⁷Ga citrate injection and the scan (usually 72 h) a series of patients was given an intramuscular injection of 100 mg iron-sorbitol citric acid complex (jectofer) two hours prior to receiving an intravenous injection of ⁶⁷Ga citrate.Laboratory measurements on blood samples removed at different times showed that this pre-treatment altered radically both the amount of free transferrin and the level of ⁶⁷Ga activity in the blood pool for the majority of patients.Follow up of 30 patients entered in this preliminary trial showed that when 24 h and 48 h scans were analysed together, accuracy in the diagnosis and localisation of pathological lesions was at least as good as by the standard method. We believe that by saturating the free transferrin with iron, uptake into normal soft tissues may be modified sufficiently to enhance significantly the tumour to background ratio, thereby making earlier scanning possible. Investigations are continuing.     

Accumulation of67Ga citrate in early pregnancy

A 26-year-old pregnant woman complained of chest pain and dyspnea and was diagnosed with malignant lymphoma of the mediastinum. To determine the stage of malignant lymphoma, tumor scintigraphy with 67Ga citrate was performed. 67Ga scintigraphy revealed an abnormal accumulation in the center of the pelvic cavity. An artificial abortion was performed, and the early pregnancy obtained from the abortion showed a prominent uptake of 67Ga citrate ex vivo. 67Ga citrate re-examination, which was performed immediately after the abortion, showed no abnormal accumulation in the pelvic cavity. To our knowledge, this is the first medical report on an aborted tissue investigated ex vivo to determine whether it demonstrated increased uptake of 67Ga citrate.     

Accumulation of Tc-99m MIBI in breast lymphoma: Comparison with Ga-67 citrate

We report 2 cases of malignant lymphoma of the breast which were clearly shown on total body imaging as well as on SPECT with Ga-67 and Tc-99m MIBI. Tumor accumulation of Ga-67 was seen in all cases including a recurrent tumor. Ga-67 scintigraphy is useful for follow up in detecting relapse, as well as in predicting responses to therapy. Tc-99m MIBI was found to accumulate in the malignant lymphoma of the breast, and especially SPECT images of breast lesions provided better contrast than planar images, and Tc-99m MIBI SPECT could diagnose localization of the tumor because there was no uptake by the breast. But the Tc-99m MIBI accumulation of the tumor was lower than Ga-67.     

67Ga citrate and99mTc(v)-DMSA scintigraphy in a case of maxillary sinus liposarcoma

Scintigraphic images with⁶⁷Ga citrate and^99mTc(v)-dimercaptosuccinic acid and MR image of a 16-year-old male with maxillary sinus liposarcoma (predominantly myxoid type) are reported. The MR image clearly indicated the exact location, size and anatomical relationship of the tumor. Scintigraphic evaluation was useful in suggesting the malignant nature of the tumor and showed no distant metastasis. Both examinations were effective in treating this case.