The role of gallium 67 imaging in non-Hodgkin's lymphoma of the gastrointestinal tract

To evaluate the clinical usefulness of gallium 67 imaging in the detection of gastrointestinal (GI) non-Hodgkin's lymphoma (NHL) and in the assessment of the therapeutic effects, images were reviewed in 24 cases (25 lesions: stomach, 20; ileum, 2; and terminal ileum and or cecum, 3) and were compared using barium studies and, in 16 cases, computerized tomography (CT). In all, 23 (92.0%) of the 25 lesions were detected by 67Ga citrate imaging, the barium studies detected all 25, and CT detected 15 of 16 lesions (93.8%). The two lesions not identified by imaging and the one not found by CT were the smallest of all. In 2 (8.7%) of the 23 lesions positively identified by 67Ga-citrate imaging, both CT and imaging revealed the extent of the tumor more accurately than did the barium studies. In all but one of the patients, a close correlation existed between the imaging results and the therapeutic effects. These data suggest that 67Ga imaging is useful in conjunction with CT and barium studies for the detection of GI NHL and for the assessment of both the spatial extent of disease and the therapeutic effects, although a lack of 67Ga uptake after therapy does not always indicate a good therapeutic effect.     

原发性胃肠道恶性淋巴瘤的外科处理

目的：总结原发性胃肠道恶性淋巴瘤的有效诊治方法。方法：对66例原发性胃肠道恶性淋巴瘤的临床诊断做回顾性分析。结果：66例患者均行手术探查,其中胃恶性淋巴瘤23例,术前确诊14例,均为胃镜下活检确诊,小肠淋巴瘤19例,术前确诊4例,为CT或B超引导下穿刺活检确诊;结肠淋巴瘤24例,术前确诊10例,均为肠镜下活检确诊。共52例获得随访,其中胃恶性淋巴瘤术后5年生存率为47％;小肠为57．9％,结肠为45．8％。病理类型均为非何杰金氏淋巴瘤,其中B细胞型40例,T细胞型14例,52例行辅助COAP化疗,总有效率92．6％。结论：（1）内窥镜下活检和CT或B超引导下活检最具确诊价值,X线检查有辅助诊断价值。（2）手术治疗和化疗同等重要,免疫组化分型可作为判断预后的指标。     

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.     

~(99)Tc~m-MIBI显像在非霍奇金淋巴瘤化疗疗效评价中的价值

目的探讨99Tcm-MIBI显像在非霍奇金淋巴瘤疗效评价及提示预后方面的临床价值。方法对20例非霍奇金淋巴瘤病人于化疗前后分别行99Tcm-MIBI早期(10 min)与延迟(120 min)双时相显像,计算每例病人早期摄取率(EUR)、延迟期摄取率(DUR)及洗脱率(WR%)并进行比较。对99Tcm-MIBI显像结果进行疗效评价。平均随访时间34个月。结果 8例病人化疗后99Tcm-MIBI显像阴性,达完全缓解(CR)。12例病人化疗后99Tcm-MIBI显像阳性,其中4例达部分缓解(PR),2例处于稳定(SD)状态,6例进展(PD)。将病人分为化疗有效组(CR+PR)12例,疗效不佳组(SD+PD)8例。20例病人化疗后DUR明显低于化疗前(1.2±0.7∶2.9±1.2,P0.05)。化疗有效组与疗效不佳组相比,前者化疗前的DUR值高于后者(2.9±1.2∶1.5±0.9,P0.05),WR%低于后者(21.9±2.4∶42.7±5.6,P0.05),而前者化疗后的DUR值低于后者(1.0±0.2∶2.0±0.3,P0.05)。结论 99Tcm-MIBI作为一种功能性显像,有助于预测、评价非霍奇金淋巴瘤病人的疗效及预后。     

胃肠道淋巴瘤的影像诊断新进展

胃肠道淋巴瘤是最常见的结外淋巴瘤之一,大多为非霍奇金淋巴瘤.其影像学及临床表现均与胃肠道癌类似,易造成误诊.随着影像新技术、新设备的不断发展,如宝石能谱成像、CT灌注成像、MR扩散成像、MR灌注成像、PET/CT等在胃肠道淋巴瘤的诊断、鉴别诊断中的广泛应用,给该病的治疗及预后带来显著影响.就胃肠道淋巴瘤的影像诊断进展予以综述,以期提高对胃肠道淋巴瘤的认识,为胃肠道淋巴瘤的诊断提供新思路.     

Elastography and strain rate imaging of the gastrointestinal tract

Ultrasound based elastography of the gastrointestinal tract may be a useful approach to improved tissue characterisation. Distinguishing malignant lesions from benign may be one useful application. Monitoring of inflammatory bowel lesions for degree of inflammation or fibrosis would be another clinically useful tool. The anatomy of the bowel, however, raises many challenges for strain or shear wave imaging due to thin structures, non-constant boundary conditions and intrinsic contractility. Pathological lesions tend to increase bowel wall thickness and may ease elastography imaging. Very few studies have addressed issues of bowel wall elastography so far, and both inflammatory and neoplastic lesions seem to increase tissue hardness in the bowel wall.     

A case of non-Hodgkin's lymphoma infiltrating the brachial plexus detected by Ga-67 scintigraphy

The author reports a rare case of brachial plexus infiltration by non-Hodgkin's lymphoma. T2-weighted MRI showed high signal intensity along the right brachial plexus and soft tissue masses. Ga-67 scintigraphy showed abnormal tracer uptake along the course of the right brachial plexus, and was superior to MRI in detecting the abnormality.     

Metastasis of the gastrointestinal tract: FDG-PET imaging

We assess the usefulness of F-18-fluoro-deoxyglucose (FDG) positron emission tomography (PET) in the evaluation of gastrointestinal metastases. Four cases (five lesions) in which metastases from three lung cancers and one malignant fibrous histiocytoma (MFH) of the femur were found in the gastrointestinal tract were reviewed (men/women 3 : 1, age 63–78 years, mean 72 years). The five lesions were duodenal, jejunal metastasis, and two stomach metastases from lung carcinoma, and rectal metastasis from MFH of the femur. FDG-PET was unable to detect small masses, but it was able to detect unforeseen lesions such as gastrointestinal metastases because FDG-PET is a whole-body scan in a single-operation examination. FDG-PET imaging provided valuable information for the diagnosis of gastrointestinal metastasis.     

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     

Mechanism of gallium 67 accumulation in inflammatory tissue

The present study was undertaken to elucidate the accumulation mechanism of gallium 67 in inflammatory tissue.⁶⁷Ga accumulation in inflammatory tissue was observed by macro- and microautoradiogram. Permeability indices were calculated for serum albumin from blood vessels into inflammatory and normal tissue. Neutrophils and macrophages did not play a major role in⁶⁷Ga accumulation in the inflammatory tissue because⁶⁷Ga could hardly be detected in the sites in which neutrophils were crowded; the accumulation was concentrated in the intercellular space around these cells in the tissue. Permeability indices for inflammatory tissue were much greater than those for normal tissues. It is thought from the present study and previously reported results that⁶⁷Ga, together with plasma from permeable blood vessels, readily penetrates the inflammatory tissue and stays there by binding to the acid mucopolysaccharide present in the tissue.     

原发性胃肠道淋巴瘤MR扩散加权成像的应用研究

目的:探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)MR扩散加权成像的诊断价值。方法:分析34例PGIL(46个病灶),33例结肠癌(33个病灶),以及40例正常腰大肌的DWI信号以及ADC值,PGIL和结肠癌病例均经手术或活检病理证实。结果:本组34例PGIL病灶DWI均呈高信号,平均ADC值约(0.896±0.044)×10-3mm2/s,33例结肠癌病灶平均ADC值为(1.229±0.312)×10-3mm2/s,正常腰大肌平均ADC值为(1.739±0.318)×10-3mm2/s,前两者进行t检验,P值为0.021(0.05)。结论:原发性胃肠道淋巴瘤(PGIL)的DWI信号以及ADC值具有一定的特征性,有较高的临床应用价值。     

Excretion of gallium 67 in human breast milk and its inadvertent ingestion by a 9-month-old child

The concentration of radioactivity excreted in breast milk following the administration of gallium 67 to 3 patients was measured in milk samples obtained for several days after injection. Similar values were obtained from all 3 patients, with milk samples obtained approximately 120 h after administration containing 4.3–5.7 Bq/ml per MBq of ⁶⁷Ga administered. These values are lower than those previously reported. The image of a child who had inadvertently been breast-fed for 48 h after administration of ⁶⁷Ga to the mother showed activity in the intestines only. Our results seem to confirm recommendations by other authors that gallium scintigraphy should be avoided in nursing mothers. Should the administration of ⁶⁷Ga be inevitable, breastfeeding should be discontinued, since interruption periods of approximately 2 weeks may be required to reduce the effective dose equivalent to the infant below 1 mSv. However, close contact between mother and child need not be avoided.Offprint requests to: S.M. Rubow     

Conventional radiological strategy of common gastrointestinal neoplasms

This article summarizes the clinical characteristics and imaging features of common gastrointestinal(GI) neoplasms in terms of conventional radiological imaging methods. Barium studies are readily available for displaying primary malignancies and are minimallyor not at all invasive. A neoplasm may be manifested as various imaging findings, including mucosal disruption, soft mass, ulcer, submucosal invasion and lumen stenosis on barium studies. Benign tumors typically appear as smoothly marginated intramural masses. Malignant neoplasms most often appear as irregular infiltrative lesions on barium examination. Tumor extension to adjacent GI segments may be indistinct on barium images. Cross-sectional images such as computed tomography and magnetic resonance imaging may provide more accurate details of the adjacent organ invasion, omental or peritoneal spread.     

The imaging features of gastrointestinal stromal tumours

Gastrointestinal stromal tumours (GISTs) are a rare group of mesenchymal neoplasms that occur predominantly in the gastrointestinal tract. Previously GISTs were classified as smooth muscle tumours referred to as leiomyomas, leiomyosacromas or leiomyoblastomas. However, with the advent of immunohistochemistry, GISTs are now defined by the identification of cKit positivity. This is now used to select patients with metastatic disease who may respond to chemotherapeutic agents such as the tyrosine kinase inhibitor, STI-571. In this pictorial essay we have attemped to describe the range of imaging findings of GISTs that can suggest a pre-biopsy diagnosis.     

MRI of the gastrointestinal tract

This article reviews the application of magnetic resonance imaging (MRI) to study the gastrointestinal (GI) tract. A summary of the current MRI techniques is included, emphasizing the choice of pulsing sequences, imaging plane, surface coils and intravenous and oral contrast agents for each of the different segments of the GI tract. The multiple available oral contrast agents are reviewed, including the role of both positive and negative. Finally, the major clinical applications of MRI in the GI tract are discussed by major disease categories (congenital abnormalities, inflammatory disease and benign and malignant neoplasms). The latter is further subdivided by GI tract segments such as esophagus, stomach, small bowel and colon. Received 22 January 1997; Revision received 26 March 1997; Accepted 28 March 1997     

Revisiting the prognostic role of gallium scintigraphy in low-grade Non-Hodgkin’s lymphoma

The purpose of this study was threefold: to evaluate the role of gallium-67 scintigraphy in the staging of low-grade non-Hodgkin’s lymphomas (LGNHL), to assess the relationship between the expression of CD71 on the surface of the neoplastic cells and the ⁶⁷Ga uptake by the tumour, and to establish the contribution of ⁶⁷Ga scan in defining the prognosis of LGNHL. Forty-eight patients with untreated LGNHL diagnosed in a single institution over a decade were reviewed. The end point of the study was survival of the patients according to the scintigraphic ⁶⁷Ga score at diagnosis. In addition to ⁶⁷Ga scan, other prognostic variables were studied, relating to the neoplastic burden, the biology of the tumour and the host. Univariate and multivariate analyses were used. ⁶⁷Ga scan identified only 116/286 (41%) nodes involved by lymphoma that were detected by clinical examination or computed tomography scan. A scintigraphic scoring system with an arbitrary cut-off value of 3 (high scan score) was able to predict patients with a dismal prognosis: with a mean follow-up of 47 months (range: 1–146 months) the median survival time was 28 months in patients with a high scan score and 74 months in patients with a low scan score (P=0.002). CD71 values were 27.4%±14.9% (mean ±SD) in the former and 8.9%±7.2% in the latter (P=0.0001). Only performance status and extranodal sites were significant variables for prognosis in multivariate analysis. It is concluded that ⁶⁷Ga scan is inaccurate in staging but might be very important in defining the prognosis in LGNHL, in association with other prognostic variables. Received 1 May and in revised form 6 August 1997     

Primary non-Hodgkin's lymphoma of the temporal bone. CT findings

We present a 15-year-old male with primary non-Hodgkin's lymphoma (NHL) of the temporal bone. Bone erosion and epidural mass seen on CT warranted biopsy. The response to therapy was evaluated with social CT scans.     

Computer quantitation of gallium 67 lung uptake in crocidolite (blue asbestos) workers of Western Australia

Pulmonary inflammation has been evaluated in 43 crocidolite-exposed asbestos (ASB) workers and 12 control subjects, using a quantitative index of gallium uptake (GI). The GI was compared with chest roentgenographs (CXRs) graded by the ILO classification. The ASB workers included 15 with asbestosis (CXR1/0), 19 with a normal CXR (CXR 0/0), and 9 with equivocal CXR changes (CXR 0/1). In individuals with asbestosis the GI was 3.6±0.3 (mean ± SEM),P < 0.01 compared with exposed patients without asbestosis. In exposed patients with equivocal CXR changes (0/1) the GI was 3.1±0.3, and in exposed patients with a normal CXR (0/0) the GI was 2.4±0.2 The GI for subjects without lung disease was 1.2±0.2,P<0.01 compared with exposed patients without asbestosis. The scans were scored independently by two observers, and the correlation coefficient of the two sets of GI was 0.95. These data demonstrate that subjects with crocidolite-induced asbestosis and exposed patients with equivocal CXR changes or a normal CXR have significantly increased GI.