A method of quantitative 67Ga scintigraphy in the evaluation of pulmonary sarcoidosis

⁶⁷Ga scintigraphy was performed in 42 patients with pulmonary sarcoidosis and in 30 control subjects. Accumulation of the radionuclide in hili and lungs was quantified by a computer method. The values in control subjects were found to be within a relatively narrow range. The pattern of ⁶⁷Ga accumulation clearly differed in patients who were radiographically defined as having only lymphadenopathy and in patients also having parenchymal involvement. Corticosteroid therapy resulted in a sharp decline of values of isotope uptake, although hilar activity remained slightly elevated. The quantitative uptake measurement proved to be superior to a subjective scoring method.     

67Ga scintigraphy as an aid in the differentiation of fibrosis and granulomatosis in pulmonary sarcoidosis (author's transl)

Gallium scintigraphy enables the following statements: 1. It is possible to establish the existence of an active granulomatosis both in the acute and in the chronic stage I, as well as the granulomatous pulmonary infiltration of stage II. 2. A therapy-induced or spontaneous regression of granulomatosis is associated with a reduced and later on absent deposition of 67Ga. 3. Signs of fibrosis visible on x-ray film do not exclude the continued presence of granulomatous pulmonary infiltrations. Such a granulomatosis can progress and thus produce further fibrosing and hence functional disorders up to the development of pulmonary heart disease (cor pulmonale.) It follows from this that in such cases corticoid treatment must be continued or resumed. 4. Reduced or no longer apparent storage of 67Ga under therapy does not represent a safeguard against relapse. X-ray controls chould be performed after discontinuation of corticoid therapy in order to discover, if any, discrete signs of recurring granulomatosis. In such cases, gallium scintigraphy can clearly show the revival of granulomatosis. 5. In our opinion, gallium scintigraphy is mandatory in all pulmonary affections.     

86例肺结节病67Ga显像分析

目的探67Ga显像非典型或典型“熊猫脸”征象对肺结节病的诊断价值。方法回顾性分析86例经病理检查证实为肺结节病患者的67Ga全身显像资料，与185例非结节病患者67Ga显像结果对照。结果86例肺结节病患者中表现为泪腺和腮腺摄取放射性，呈典型“熊猫脸”征象并伴有纵隔和(或)肺门淋巴结肿大者39例，占45．3％；表现为泪腺或腮腺摄取放射性，呈非典型“熊猫脸”征象并伴有纵隔和(或)肺门淋巴结肿大者18例，占20．9％。所有表现为泪腺和(或)腮腺有放射性摄取、伴有纵隔和(或)肺门淋巴结肿大者均经病理检查确诊为结节病。在非结节病患者中未出现该征象。结论67Ga显像非典型与典型“熊猫脸”征象有同样的诊断价值，在伴有纵隔和(或)肺门淋巴结肿大时是诊断结节病的可靠征象。     

^67Ga显像对结节病的临床研究

对２４例结节病（４例活动期，２０例非活动期）患者进行了＾６７Ｇａ显像，并测定了血清血管紧张素转化酶（ＳＡＣＥ），进行了肺功能及ＣＴ或Ｘ线检查。４例活动期结节病患者中有３例表现为双侧肺门对称性放射性浓聚，似“八”字状；其中２例患者因双侧泪腺和腮腺＾６７Ｇａ摄取增高，呈特殊的“熊猫”面容。４例活动期结节病患者其病灶对＾６７Ｇａ摄取明显增多，相当于３＋；２０例非活动期患者中８例（４０％）＾６７Ｇａ显像异     

Comparative evaluation of 18F-FDG PET and 67Ga scintigraphy in patients with sarcoidosis.

67Ga scintigraphy has been used for years in sarcoidosis for diagnosis and the extent of the disease. However, little information is available on the comparison of 18F-FDG PET and 67Ga scintigraphy in the assessment of sarcoidosis. The purpose of this study was to compare the uptake of 18F-FDG and 67Ga in the evaluation of pulmonary and extrapulmonary involvement in patients with sarcoidosis. METHODS: Eighteen patients with sarcoidosis were examined. 18F-FDG PET was performed at 1 h after injection of 185-200 MBq 18F-FDG. 67Ga whole-body planar and thoracic SPECT images were acquired 72 h after injection of 111 MBq 67Ga. We evaluated 18F-FDG and 67Ga uptake visually and semiquantitatively using standardized uptake values (SUVs) and the ratio of lesion to normal lumbar spine (L/N ratio), respectively. The presence of pulmonary and extrapulmonary lesions was evaluated histopathologically or by the radiologic findings. RESULTS: Five patients had only pulmonary lesions, 12 patients had both pulmonary and extrapulmonary lesions, and 1 patient had only an extrapulmonary lesion. Both 67Ga planar and SPECT images detected 17 of 21 (81%) clinically observed pulmonary sites. The mean +/- SD of the L/N ratio was 1.97 +/- 1.09. 67Ga planar images detected 15 of 31 (48%) clinically observed extrapulmonary sites. The mean +/- SD of the L/N ratio was 1.17 +/- 0.33. 18F-FDG PET detected all 21 (100%) clinically observed pulmonary sites. The mean +/- SD of the SUV was 7.40 +/- 2.48. 18F-FDG PET detected 28 of 31 (90%) clinically observed extrapulmonary sites. The mean +/- SD of the SUV was 5.90 +/- 2.75. CONCLUSION: The results of this clinical study suggest that 18F-FDG PET can detect pulmonary lesions to a similar degree as 67Ga scintigraphy. However, 18F-FDG PET appears to be more accurate and contributes to a better evaluation of extrapulmonary involvement in sarcoidosis patients.     

67Ga scanning for assessment of disease activity and therapy decisions in pulmonary sarcoidosis in comparison to chest radiography, serum ACE and blood T-lymphocytes

In 60 patients with histologically proven sarcoidosis, 67Ga scanning was evaluated in terms of sensitivity and specificity for assessing disease activity and compared with chest radiography, serum ACE and blood T-lymphocytes. While 67Ga scans had the highest sensitivity (94%), the specificity was only 68%. The sensitivity of chest radiography was 80%, of serum ACE and blood T-lymphocytes 77% and 48%, respectively. While in patients with radiographical type I, 67Ga scanning, chest radiography and serum ACE had a sensitivity of 92%-100%, in patients with radiographical type II-III, only 67Ga scans had a sensitivity exceeding 90%. A 67Ga score correlated significantly with serum ACE levels (r = 0.59, P less than 0.001). After effective steroid treatment, 67Ga uptake and serum ACE activities decreased markedly. While in 25% of cases, chest radiography failed to provide reliable information, 67Ga scanning and serum ACE activities always proved useful in evaluating the course of the disease and the patient's response to steroid therapy. A negative 67Ga scan together with normal serum ACE levels seem to have a high predictive value for excluding active sarcoidosis.     

67Ga scanning for assessment of disease activity and therapy decisions in pulmonary sarcoidosis in comparison to chest radiography,serum ACE and blood T-lymphocytes

In 60 patients with histologically proven sarcoidosis, ⁶⁷Ga scanning was evaluated in terms of sensitivity and specificity for assessing disease activity and compared with chest radiography, serum ACE and blood T-lymphocytes. While ⁶⁷Ga scans had the highest sensitivity (94%), the specificity was only 68%. The sensitivity of chest radiography was 80%, of serum ACE and blood T-lymphocytes 77% and 48%, respectively. While in patients with radiographical type I, ⁶⁷Ga scanning, chest radiography and serum ACE had a sensitivity of 92%–100%, in patients with radiographical type II–III, only ⁶⁷Ga scans had a sensitivity exceeding 90%. A ⁶⁷Ga score correlated significantly with serum ACE levels (r=0.59, P<0.001).After effective steroid treatment, ⁶⁷Ga uptake and serum ACE activities decreased markedly. While in 25% of cases, chest radiography failed to provide reliable information, ⁶⁷Ga scanning and serum ACE activities always proved useful in evaluating the course of the disease and the patient's response to steroid therapy. A negative ⁶⁷Ga scan together with normal serum ACE levels seen to have a high predictive value for excluding active sarcoidosis.     

Testicular involvement of sarcoidosis diagnosed by gallium-67 scintigraphy

Gallium-67 scintigraphy helped to determine the extent of systemic sarcoidosis and demonstrated testicular involvement in a 32-year-old black man who presented with ataxia, weight loss, and a left testicular mass. To our knowledge, this is the first case of testicular sarcoidosis demonstrated by gallium-67 scintigraphy in a patient with systemic sarcoidosis. Offprint requests to: A. Cahid Civelek     

Testicular involvement of sarcoidosis diagnosed by gallium-67 scintigraphy

Gallium-67 scintigraphy helped to determine the extent of systemic sarcoidosis and demonstrated testicular involvement in a 32-year-old black man who presented with ataxia, weight loss, and a left testicular mass. To our knowledge, this is the first case of testicular sarcoidosis demonstrated by gallium-67 scintigraphy in a patient with systemic sarcoidosis.     

The evolutional stage changes in sarcoidosis on gallium-67 scintigraphy

Gallium-67 scintigraphy has been proven as the imaging modality of choice in monitoring the presence of active disease in sarcoidosis. The purpose of this study is to analyze the patterns of evolutional stage changes of sarcoidosis while on steroid therapy by Ga-67 scintigraphy.Methods: Eighty-six consecutive patients with biopsy-proved sarcoidosis are evaluated by Ga-67 scintigraphy. Thirty-six of 86 patients have had a baseline and one to eight follow-up Ga-67 scintigraphs (total 136 studies). The initial follow-up scintigraphs are obtained on average about 4–12 months after the baseline study.Results: Seventeen of 36 patients (47.2%) are in stage IV at the time of the baseline study. Following their first course of corticosteroid therapy, 13 patients remained in the same stage and activity distribution pattern while 13 patients have shown reversion to other stages, eight patients showed complete remission while two patients became active from inactive stage.Conclusion: Evolutional stage changes are seen in 23 patients (63.9%), including eight patients (22.2%) who showed complete scintigraphic remission. The evolutionary stage changes remain quite variable and unpredictable. This, however, should not detract from the usefulness of Ga-67 scintigraphy in the diagnosis and prognostic evaluation of sarcoidosis, particularly when extrapulmonary involvement (Stage IV disease) is present.     

Gallium-67 citrate scintigraphy in pulmonary embolism

Eight cases of pulmonary embolism were evaluated with Ga-67 citrate scintigraphy. Of the eight patients, all but one showed evidence of abnormal Ga-67 citrate localization within involved regions of the lung as demonstrated by ventilation-perfusion lung scintigraphy. The sole patient who did not demonstrate Ga-67 localization within the lung had marked breast accumulation of the radiotracer which may have obscured lung parenchymal uptake. Since Ga-67 citrate is known to accumulate within inflammatory lung processes, this radiotracer would not have a specific role in differentiating pulmonary embolism from these conditions. This study disagrees with the results of other studies in the medical literature that describe such a role.     

Study on liver uptake changes in serial 67Ga scintigraphy

During the past 3 years and 6 months, serial 67Ga-citrate scintigraphy have studied in 113 patients. 22 patients of these showed absent liver uptake. All cases had malignant tumors. 41% in malignant lymphoma and 20% in lung cancer showed absent liver uptake scintigraphy in their progress. This ratio is more frequent than reported ratio. There was significant relationship between therapy with antineoplastic agents and absent or increased liver uptake scintigraphy. 4 cases, treated by irradiation, showed absent liver uptake scintigraphy. In 3 cases, elevated liver uptake, one was administered renal toxic agent and all were given 5-FU. Mild change of accumulation in liver may be beyond reported ratio. 67Ga-citrate scintigraphy is repeatedly used in course of malignant patients. We must know given agents and past history of treatment when 67Ga scintigraphy is evaluated.     

Hodgkin disease: prediction of outcome with 67Ga scintigraphy after one cycle of chemotherapy

PURPOSE: To investigate gallium 67 scintigraphy performed early during treatment as a means to predict outcome and thus to optimize treatment of Hodgkin disease (HD) in the future. MATERIALS AND METHODS: Ninety-eight patients with HD were examined. Thirty-one patients underwent 67Ga scintigraphy after one chemotherapy cycle and 83 patients after a mean 3.5 cycles (range, 2-5 cycles). Sixteen patients underwent 67Ga scintigraphy both after one cycle and at midtreatment. Patients underwent whole-body scintigraphy and single photon emission computed tomography of the torso. Torso computed tomography (CT) was performed after a mean 3.5 cycles (range, 2-6 cycles). Failure-free survival was compared between patients with positive and patients with negative test findings (Kaplan-Meier method), and the significance of the difference was calculated. The association of failure-free survival with various prognostic clinical factors before treatment was compared (log-rank test univariate analysis). RESULTS: Failure-free survival differed significantly (P < .002) between patients with positive and patients with negative 67Ga scintigrams after one chemotherapy cycle but not at midtreatment. Failure-free survival was not significantly different between patients with positive and patients with negative CT scans at midtreatment. Twenty-two (92%) of 24 patients with negative 67Ga scintigrams after one cycle and 64 (82%) of 78 patients with negative scintigrams at midtreatment remained in complete response. In four (57%) of seven patients with positive 67Ga scintigrams after one cycle, treatment failed. CONCLUSION: 67Ga scintigraphy after one cycle of chemotherapy is a good early predictor of outcome of HD.