Gallium scintigraphy in patients with adult T-cell leukemia lymphoma

Gallium scintigraphy was evaluated in 25 patients with adult T-cell leukemia lymphoma (ATLL). Anterior and posterior images were obtained at 72 h after administration of 3 mCi 67Ga-citrate using a gamma camera (Maxi-Camera 400 T, General Electric Co.) with a medium energy standard parallel hole collimator. Abnormally high accumulations were observed in 17 out of 25 cases (superficial lymph node, 8; hilar and mediastinal lymph node, 7; paraaortic lymph node, 2; lung, 9; liver, 1; bone, 1). There were 10 malignant lesions detected by 67Ga scintigraphy in 9 out of 17 cases (superficial lymph node, 1; hilar and mediastinal lymph node, 6; paraaortic lymph node, 1; liver, 1; bone, 1). White blood cell count and serum LDH levels were raised in patients with abnormally high accumulations of 67Ga. In conclusion, 67Ga scintigraphy seemed to be a useful examination to detect malignant lesions in patients with ATLL.     

The role of gallium-67 tumour scintigraphy in patients with small,non-cleaved cell lymphoma

Two hundred and thirty-four scintigraphic studies were performed in 34 patients (27 men, 7 women, age 17.3±7.7 years) with small, non-cleaved cell lymphoma who had follow-up for 3–96 months (mean 21.6±21.7 months). Whole-body scintigraphy was performed 48–72 h following i.v. injection of 370 MBq gallium-67 citrate. Gold standards for truth determinations were surgery, autopsy, histology, axial x-ray computed tomography, magnetic resonance imaging, ultrasonography and clinical follow-up. Overall, 181 of 234 studies were true negative. Eighty proven sites of disease had true positive ⁶⁷Ga uptake (in 21 patients/37 studies). Nineteen sites (in 12 patients/15 studies) were false positive. In addition, 31 benign lesions were detected and interpreted correctly in terms of non-malignancy. Ten lymphoma sites (in 6 patients/10 studies) were missed by scintigraphy. Overall, sensitivity of gallium scintigraphy was 89% when calculated by sites and 79% when calculated by studies. Corresponding specificities were 91% and 92%, respectively. Positive predictive values were 81% (sites) and 71% (studies), and negative predictive values 95% (sites and studies). Thus, gallium scintigraphy proved to be a sensitive and specific method for staging and follow-up in patients with small, non-cleaved cell lymphoma.Recipients of Fogarty Fellowships Correspondence to: D. Sandrock     

False-positive granulocyte scintigraphy in a patient with acute leukemia

This study describes a 12-year-old patient who was hospitalized because of arthritislike symptoms. A scintigraphy performed with in vivo labelled granulocytes revealed, in addition to a few foci, an abnormal intravasal persistence of the labelled cells. An acute leukemia was found that was restricted to the bone marrow.     

Comparison of magnetic resonance imaging and (67)gallium scintigraphy in the evaluation of posttherapeutic residual mediastinal mass in the patients with Hodgkin's lymphoma

INTRODUCTION: Detection of residual disease following the completion of primary treatment in Hodgkin's lymphoma (HL) patients diagnosed with mediastinal tumor mass has an exceptional importance in the assessment of therapeutic response. Magnetic resonance imaging (MRI) and (67)gallium ((67)Ga) scintigraphy can be used to identify active tumor tissue in the mediastinal residuum. AIMS: To evaluate: the accuracy of MRI and (67)Ga scintigraphy in the prediction of clinical HL relapse/progression; congruence of findings and the probability of mediastinal disease relapse/progression regarding to the detection of active/inactive tissue by both imaging methods. MATERIALS AND METHODS: Thirty HL patients with abnormal mediastinal tissue following the completion of primary treatment were examined by MRI and (67)Ga scintigraphy. Positive findings were: high signal intensity on unenhanced T2-weighted images on MRI and the abnormal accumulation of gallium on scintigraphy or SPECT. These findings were compared with the clinical follow-up. RESULTS: Sensitivity, specificity, accuracy, positive and negative predictive values were: 75.0%, 96.2%, 93.3%, 75.0%, 96.2% in MRI and 50.0%, 88.5%, 83.3%, 40.0%, 92.0% in (67)Ga scintigraphy. Discrepant results concerning the mediastinal tissue activity were found in 3 of 30 patients (10%). No statistically significant differences were found between both imaging methods in sensitivity, specificity and accuracy. Estimated 2-years progression free survival (PFS) for patients without and with active residual mediastinal tissue by MRI was 96% and 25% (p=0.0001), respectively. The probability of 2-years PFS in the cases with negative and positive findings on (67)Ga scintigraphy was 92% and 60% (p=0.026), respectively. CONCLUSION: Although MRI showed better results than (67)Ga scintigraphy in the assessment of residual mediastinal tissue activity in HL patients after primary treatment, the difference between these methods was not statistically significant. Both methods could be included in the standard restaging protocol.     

Positive gallium-67 citrate scintigraphy in Wiskott-Aldrich syndrome with malignant lymphoma

This case describes the first detection of solid lymphoma lesions by gallium-67 scintigraphy in a 12-year-old patient with Wiskott-Aldrich syndrome. Gallium 67 uptake was found in multiple sites in the patient who had developed an undifferentiated small, noncleaved cell lymphoma. Response to chemotherapeutic treatment is correlated with findings on the gallium scintigraphy follow-up.     

Gallium scintigraphy in Hansen's disease

Gallium 67 imaging was used in 12 patients with documented Hansen's disease undergoing treatment or not, in an attempt to determine the pattern of the disease. Diagnosis was confirmed by histopathology in all patients. The Mitsuda reaction was seen in all patients. Specific nuclear studies were performed when needed to evaluate particular organs better. Gallium 67 images show homogeneous, diffuse and moderate accumulation over the entire skin surface (except for the face) of untreated patients with multibacillary disease. The facial skin in these cases presented homogeneous, diffuse but very marked uptake of gallium. Internal organ involvement was variable. There was a very good correlation among clinical, scintigraphic, immunological and histopathological data. The pattern of the body skin (skin outlining) and facial skin (beard distribution) may be distinct for untreated patients with multibacillary leprosy.     

Positron emission tomography changes management,improves prognostic stratification and is superior to gallium scintigraphy in patients with low-grade lymphoma: results of a multicentre prospective study

Purpose  Positron emission tomography (PET) was evaluated in low-grade non-Hodgkin lymphoma (NHL) to determine its impact on staging and management and to compare PET and gallium scans. Methods  PET resulted in management plan changes in 74 patients with untreated low-grade NHL stages I to III. Patient outcomes to 12 months were documented. Results  PET identified additional lesions in 50% of patients, led to a change in stage in 32%, and had a significant impact on management in 34%. Inferior progression-free survival was noted in patients with additional lesions detected by PET (p=0.001) and in the 28% of patients upstaged by PET to stage III or IV (p=0.024). In a subset of 16 patients undergoing both PET and gallium scans, PET was found to be superior. Conclusion  PET has a major role in the management of low-grade NHL in addition to its proven role in aggressive lymphoma.     

Gallium uptake in cerebrotendinous xanthomatosis

In a patient with cerebrotendinous xanthomatosis, a rare familial sterol storage disease, increased uptake of gallium-67 was observed in the tendon xanthomas. This is considered to have resulted from the tumour-like proliferation of histiocytic cells in the xanthomas. Abnormalities in the white matter of the cerebellum and the brain stem observed by X-ray computed tomography and magnetic resonance imaging were not detected by⁶⁷Ga scintigraphy, possibly due to the small size of the CNS lesions.     

Gallium scintigraphy in small cell lung cancer

We have undertaken gallium imaging studies in 49 patients with histologically proven small cell lung cancer. Tracer uptake in the primary tumour was seen in 98% of cases. Twenty five patients underwent repeat scanning after induction chemotherapy and a correlation was demonstrated between conventional parameters of response and gallium scan changes (P<0.01). There was no correlation between initial gallium activity and subsequent chemoresponse (which was evaluated in 32 patients) or survival (measured in 42 patients). Ten patients who had shown a complete response to induction treatment were followed up with gallium scans repeated at three monthly intervals. Such longitudinal studies were particularly helpful in excluding tumour activity when the appearance of the chest radiographs were difficult to interpret.     

Massive acroosteolysis in adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma is a relatively uncommon disease, most often found in Japan, the Caribbean, the southeastern United States, and South America. To date there have been few reports of its skeletal manifestations. A case is reported in a 44-year-old man in which a short history of swelling of the hands and feet and painful motion in the fingers was followed by the rapid development of severe acroosteolysis.     

Usefulness of<Superscript>67</Superscript>Ga scintigraphy in extranodal malignant lymphoma patients

OBJECTIVE: 67Ga scintigraphy has a well-documented role in nodal lymphoma for both disease staging and assessment of treatment response. The objective of the present study was to examine the role of 67Ga scintigraphy in diagnosis and assessment of treatment response, in patients with extranodal malignant lymphoma. METHODS: Seventy-one patients with extranodal malignant lymphoma were studied. Whole body scans in all and SPECT scans in some selected patients were performed 72 hours after injection of 67Ga-citrate. The influence of tumor site, histological classification and tumor size on 67Ga scintigraphy sensitivity was analyzed. Twenty-one of the seventy-one patients also had a second 67Ga scintigraphy to assess response to treatment. RESULTS: The overall 67Ga scintigraphy sensitivity was 83.1% (59/71). The sensitivity was low in patients whose extranodal lymphoma occurred in skin (0/3) and urinary bladder (0/1), as compared to other tumor sites. According to the histological classification of the lesion, the sensitivity was lower in low-grade than in intermediate and high-grade lymphoma. According to the tumor size, the sensitivity was low in lesions less than 2 cm in diameter than those more than 2 cm in diameter. The results changed from positive to negative accumulation in 20 (95.2%) of the 21 patients who had 67Ga scintigraphy to assess the response to treatment. These 20 patients showed a good clinical course. CONCLUSIONS: Although 67Ga scintigraphy did not show positive accumulation in patients with skin and urinary bladder lymphoma, it was helpful to confirm the diagnosis and to evaluate the therapeutic effect in most patients with extranodal malignant lymphoma.     

Determinants of diagnostic accuracy in pulmonary scintigraphy for pulmonary capillary protein leak associated with adult respiratory distress syndrome (ARDS): A technical note

Radionuclide assessment of pulmonary capillary protein leak using [^99mTc] human serum albumin (^99mTc-HSA) was first reported from our laboratory. In this study we investigated the impact of 1) sampling time post tracer injection, and 2) lung region assignment, on diagnostic accuracy between 2 groups (controln=20 and ARDSn=20). Each patient received 370 MBq^99mTc-HSA i.v. and was imaged for 45 min. The slope index (SI) [change in lung: heart activity ratio/min] was calculated from 11 computer assigned lung regions for intervals of 5–15 (early [E]) and 15–45 (late [L]) min. The diagnostic accuracy of E vs L SI calculations for the 11 regions was evaluated by stepwise logistic regression. E SI data and L SI data from the lower 1/3 of the lung did not achieve significance for inclusion in the discriminant model (P<0.05). In the nine remaining regions L SI was significant. Optimal discrimination was achieved from L SI data obtained from a region confined to the lateral half of the mid 3rd of the lung field (sensitivity 81%, specificity 85%, accuracy 83%). The results confirm that: 1) a late (15–45 min) sampling period and 2) proper region assignment are necessary to maximize accuracy of this technique.Supported by NIH Grant # 1R23GM27245-01     

Bone and gallium scintigraphy of an oleothorax

Olcothorax was largely used for the treatment of pulmonary tuberculosis, before the advent of specific chemotherapy. Although the method was dis-continued more than 30 years ago, late complications do occur. We report here a case of a painful oleothorax that took up ^99mTc-MDP and ⁶⁷Ga-citrate.     

Lung hilar Ga-67 uptake in patients with lymphoma following chemotherapy

Scintigraphic characteristics of lung hilar Ga-67 uptake (HU) and their relationship with the etiology (benign vs. malignant) of the hilar lesions in lymphoma patients following chemotherapy were retrospectively investigated. A total of 161 lymphoma patients were included in the study. The presence/absence of HU and if present, symmetry/asymmetry and intensity of HU (on the basis of a 3 scale grading system) were visually and semiquantitatively assessed on transaxial sections of thorax Ga-67 SPECT. By drawing ROIs over right and left hilum, asymmetry index (AI%) was also calculated. HU was categorized as benign or malignant depending on the radiological correlation and clinical follow-up. In the malignant group, the majority of patients (85.7%) had grade 2 or grade 3 uptake and all had asymmetric pattern. However, in the benign group, grade 1 uptake was more common (66%) and was mainly symmetric (94.6%) in appearance. AI% in the malignant group (73.7 +/- 36.6) was significantly higher than in the benign group (5.7 +/- 4.9) confirming the marked asymmetry in malignant patients.     

Gallium scintigraphy in a case of tuberculous trochanteric bursitis

We report a 67-year-old woman with systemic lupus erythematosus and systemic disseminated tuberculosis affecting the femoral trochanteric bursae, a site rarely affected by tuberculosis. For quantification of the inflammation with gallium-67 scintigraphy, we calculated the radioisotope count ratio in the most inflamed areas, the right lateral thorax and bursa of the right greater trochanter. Systemic scanning with this modality allowed evaluation of the extent of lesions and simple quantitative determination of the severity of inflammation, yielding information useful for the follow-up of the patient during the course of tuberculosis treatment.     

Thoracic CT findings of adult T-cell leukemia or lymphoma

OBJECTIVE: The aim of this study was to assess pulmonary CT findings in patients with adult T-cell leukemia or lymphoma. MATERIALS AND METHODS: We retrospectively reviewed CT scans of the lung in 87 patients with adult T-cell leukemia or lymphoma who had undergone chest CT between January 1996 and March 2002 at two institutions. The CT scans were interpreted by two chest radiologists working in consensus. Parenchymal abnormalities (ground-glass attenuation, consolidation, nodules, thickening of bronchovascular bundles, interlobular septal thickening, honeycombing, crazy-paving appearance, and bronchiectasis) were evaluated, as were enlarged lymph nodes, pleural effusion, and pleural thickening. In 46 patients who underwent surgical biopsy or autopsy, CT-pathologic correlation was performed with the actual specimens by a pathologist and two chest radiologists. RESULTS: On the CT scans, abnormal findings were seen in 60 patients (69.0%). CT findings consisted of ground-glass attenuation (n = 37), centrilobular nodules (n = 25), thickening of bronchovascular bundles (n = 22), and consolidation (n = 13). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 26). Pathologically, these findings corresponded with atypical lymphocyte infiltration along the interstitium and the alveolar spaces. Pleural effusion and enlarged lymph nodes were found in 22 and 27 patients, respectively. CONCLUSION: CT findings in patients with adult T-cell leukemia or lymphoma consisted mainly of ground-glass attenuation, centrilobular nodules, and thickening of the bronchovascular bundles in the peripheral lung. These findings, although nonspecific, are considered suggestive of thoracic involvement in patients with adult T-cell leukemia or lymphoma.     

Diagnosis of thyroid lymphoma and follow-up evaluation using Ga-67 scintigraphy

A strong association between malignant lymphoma and Hashimoto's thyroiditis has frequently been reported. However, it is difficult to detect the lymphomatous transformation of Hashimoto's thyroiditis in the early stage. The purpose of the present study was to examine the usefulness of 67Ga scintigraphy in the diagnosis and evaluation of the therapeutic effects during follow-up, in patients with a suspected diagnosis of primary thyroid lymphoma. Twenty-five patients who were suspected of having primary thyroid lymphoma and had undergone 67Ga scintigraphy were studied. 67Ga planar scintigraphy was performed 72 hours after injection of 67Ga-citrate. The degree and pattern of 67Ga accumulation were graded visually. Histopathology on biopsy examination revealed thyroid lymphoma in 17 and Hashimoto's thyroiditis in 8 patients. Abnormal accumulation of 67Ga in the thyroid was seen in all of the 17 thyroid lymphoma cases with additional mediastinal and abdominal involvement in one. Fifteen of 17 thyroid lymphoma patients also underwent 67Ga scintigraphy 2-4 weeks after chemotherapy and/or radiotherapy. All 15 patients showed diminishing 67Ga accumulation and a good clinical course. In one patient with local recurrence, abnormal accumulation could be depicted by follow-up scintigraphy. However, diffuse or enlarged accumulation in the thyroid was seen in all of the 8 Hashimoto's thyroiditis cases. The degree of abnormal accumulation in the thyroid in clinically active phase thyroiditis was more intense than that in the chronic phase thyroiditis. 67Ga scintigraphy was helpful to confirm the diagnosis of thyroid lymphoma and to evaluate the therapeutic effects during follow-up. However, 67Ga scintigraphy may not always distinguish thyroid lymphoma from Hashimoto's thyroiditis, especially the active phase of the disease.