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PubMed1978

Mechanisms of localization of gallium-67 in tumors.

The mechanism of tumor localization of gallium-67 (67Ga) is not known with certainty, although much information has been derived regarding the biodistribution and subcellular fate of 67Ga in a variety of tumors and other tissues from experimental animals. After intravenous administration, 67Ga is bound to transferrin in the blood, and distributed to liver, lacrimal glands, salivary glands, and soft tissue tumors. Within the cells of the liver and tumors, gallium is found in lysosomes, and rough endoplasmic reticulum. Within these organelles, 67Ga is bound to a variety of macromolecules, including transferrin, ferritin, and a 45,000 molecular weight glycoprotein. Recent studies of tumor cells growing in tissue culture suggest an important role for transferrin in 67Ga tumor uptake. This uptake is mediated by a transferrin specific cellular receptor.

Animals↗

PubMed1976

Evaluation of gallium-67 in the diagnosis of bronchial carcinoma.

Twenty-four patients with carcinoma of the bronchus had lung scans performed with gallium-67. The results were compared with corresponding chest radiographs. In four patients who had been treated with radiotherapy or cytotoxic drugs, there was no uptake of isotope in the lesion. The isotope, however, identified the neoplasm accurately in 17 out of the 20 cases (85%). The relative distribution of isotope in neoplastic tissue and adjacent inflammatory reaction is discussed as well as those cases in which either the radiograph or the scan failed to demonstrate the malignant lesion. Gallium scanning in this study failed to indicate the extension of growth into the mediastinal glands.

Adenocarcinoma↗

PubMed1997

Effect of gallium nitrate therapy on Ga-67 scintigraphic detection of lymphoma: case report.

Ga-67 and abdominal CT scans of a 72-year-old woman who had malignant lymphoma before, during, and after gallium nitrate/hydroxyurea combination therapy are presented. Disappearance of Ga-67 uptake by the tumor during this treatment despite continuing CT evidence of disease and reappearance of Ga-67 scan abnormalities after cessation of therapy suggests that caution should be exercised when interpreting results of Ga-67 scintigraphy for the detection of tumor viability during gallium nitrate/hydroxyurea therapy.

Aged↗

PubMed1989

Gallium-67 scintigraphy in the detection of infected polycystic kidneys in renal transplant recipients.

Renal transplant recipients with underlying polycystic kidney disease (PKD) may present with recurrent urinary tract infection (UTI). This is often due to persistent infection in one or both of the native polycystic kidneys. It may be necessary to remove the infected kidney in order to remove the source of persistent infection. Gallium-67 scintigraphy was performed in 11 renal transplant recipients with underlying PKD. Positive studies were obtained in four recipients who had recurrent UTI. The scan also localized which of the kidneys (native or transplant) was the site of persistent infection. These four recipients subsequently had nephrectomy of the infected polycystic kidneys as suggested by the scan. Negative scans were obtained in seven recipients who did not have recurrent UTI. Gallium scintigraphy is a useful test for detecting and localizing the site of persistent UTI in renal transplant recipients with underlying PKD who present with recurrent UTI.

False Negative Reactions↗

PubMed1992

Gallium-67-citrate scanning in patients with sarcoid uveitis.

Gallium-67-citrate is useful for characterizing activity in patients with sarcoidosis. Gallium-67 uptake in bilateral symmetrical hilar lymphadenopathy and/or symmetrical salivary glands is typical of this clinical entity. Sarcoidosis is a systemic disease, and uveitis is considered the hallmark of ophthalmic sarcoidosis. We present two cases of ophthalmic sarcoidosis that shows uveal accumulation of 67Ga-citrate associated with clinical symptoms.

Citrates↗

PubMed1997

Primary adrenal lymphoma: gallium scintigraphy and correlative imaging.

Primary adrenal lymphoma is a rare entity, with only 16 cases reported in the last 40 yr. Although 67Ga scintigraphy has been extensively used to evaluate patients with other types of lymphomas, there are no reports of its use in patients with this disease entity. A man with primary adrenal lymphoma and no evidence of extraadrenal spread who was evaluated from presentation to remission with gallium scintigraphy and CT is presented. Gallium scintigraphy was valuable in assessing response to therapy.

Adrenal Gland Neoplasms↗

PubMed1998

Gallium-67 scintigraphy evaluation of therapy in non-Hodgkin's lymphoma.

UNLABELLED: Patients with diffuse large cell lymphoma may achieve complete remission (CR) after chemotherapy, and the time to reach CR may be predictive of treatment outcome. Partial remission, or recurrence from CR, is associated with poor survival. Gallium-67 imaging has proven to be useful in evaluating lymphoma patients. In tumor models, this radiotracer is an indicator of tumor viability. Gallium-67 uptake is seen only in avid and viable lymphoma tissue, not in fibrotic or necrotic tissue. In this study, we prospectively assessed the ability of this radiotracer to define residual disease. In addition, we evaluated the possibility of predicting the clinical outcome in patients with diffuse cell lymphoma on the basis of scan positivity during chemotherapy. METHODS: Thirty-three consecutive patients with histologically proven diffuse large cell lymphoma were investigated with 67Ga scintigraphy 48-72 hr after injection of 185-259 MBq 67Ga-citrate for staging and during follow-up after four to six cycles of intensive chemotherapy. Patients were monitored for a mean of 56.0 mo (range 7-90 mo), and they were restaged using physical examination, CT and all necessary imaging modalities. RESULTS: Patients were divided into two groups according to the positivity or negativity of 67Ga scan after four to six cycles of chemotherapy. Of the 33 patients studied, 14 (42.4%) showed persistent abnormal uptake of 67Ga-citrate after four to six cycles of chemotherapy. In this group, 9 patients (64.2%) died of lymphoma at a mean of 24.3 mo from presentation with the diagnosis (range 7-71 mo). Four patients had no evidence of disease at an average of 71.7 mo after diagnosis, and 1 patient was considered to be in partial remission. In the second group of 19 67Ga-negative patients, after four to six cycles of chemotherapy, 4 died and 15 are alive and considered to be in CR. A statistical analysis of the association between 67Ga scan results after four to six cycles of chemotherapy and survival was performed using the log-rank test; there was a statistically significant association between scan results and survival (p=0.00125). CONCLUSION: We conclude that 67Ga scintigraphy is an excellent predictor of residual tumor viability in lymphoma patients and that persistent positivity of the scan predicts poor outcome and may justify a change in treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1998

Intense muscle uptake of gallium-67 in a patient with sarcoidosis.

Sarcoidosis has been associated with muscle involvement. In general, this involvement remains asymptomatic. The following case report demonstrates a patient with a 4-mo history of sarcoidosis who reported severe fatigue and slight muscular complaints at a regular checkup. Gallium scintigraphy indicated unexpected and unusually extensive muscular localizations of the disease. The latter findings were confirmed by examination of biopsy specimens. The importance of gallium scintigraphy lies in the possibility of wholebody screening for inflammation localizations, particularly when physical, laboratory, lung function and radiographic examinations fail to provide convincing evidence of active sarcoidosis. Furthermore, it can be helpful in the follow-up of the effect of supportive treatment.

Aged↗

PubMed1979

Gallium 67 scanning for the diagnosis of infection in children.

Gallium 67 scintigraphy was studied prospectively in 26 children with clinically suspected abscesses. Scan interpretation agreed with the clinical outcome in 21 patients (81%). The true-negative rate was 71% and the true-positive rate was 92%. False-positive scans were related to bleeding and bone infarcts. False-negative scans were related to neutropenia (less than 500 neutrophils/cu mm) and to lesions smaller than 1 cm. Gallium scanning is a safe and reliable method of diagnosis of infection in children, except for patients with neutropenia or whose lesions are smaller than 1 cm. Two-hour scans may be useful in some patients, particularly those with osteomyelitis.

Abscess↗

PubMed1976

Gallium-67 citrate scanning in Hodgkin's disease and non-Hodgkin's lymphoma.

Gallium-67 citrate scintigraphy was performed in 33 patients with Hodgkin's disease and 25 patients with non-Hodgkin's lymphoma. Three hundred twenty-eight sites of potential involvement were investigated. Confirmation of involvement was made by physical examination, roentgenographic evaluation and histopathologic examination of tissue obtained at diagnostic laparotomy. The results of scintigraphy correlated with all other clinicopathologic data in only 35% of patients, the true-positive rate being significantly higher above the diaphragm (61%) than below (40%). The overall true-positive and true-negative rates were 53 and 90%, respectively. A significant correlation existed between tumor histology and scanning accuracy; the true-positive rate in Hodgkin's disease was 74% compared to only 13% in patients with lymphocytic lymphoma. A similar variation of 67Ga concentration with tumor histology was also noted in 70 tissue specimens obtained from 28 patients at the time of diagnostic laparotomy or biopsy. The routine use of 67Ga-citrate to detect splenic involvement with tumor appeared to be precluded by the low true-positive and high false-negative rates of 57 and 27%, respectively. Gallium-67-citrate scintigraphy may be useful as an adjunct to established clinical staging procedures in untreated patients and in the detection of recurrent disease in treated patients. Our data indicate it is not sifficiently reliable to replace established methods presently used for clinical staging.

Adolescent↗

PubMed1979

Clinical toxicologic and pharmacologic studies of gallium nitrate.

Gallium nitrate, administered intravenously to patients with advanced cancer, produced renal functional abnormalities consistently at a dose of 750 mg/m2. The toxicity at that dose could be modified by fluid loading and osmotic diuresis. Pharmacokinetic studies revealed a biphasic half-life, (T 1/2 alpha = 87 minutes and T 1/2 beta = 24.5 hours). Osmotic diuresis reduced the urinary concentration of gallium but did not affect serum levels or clearance.

Anemia↗

PubMed1984

Sensitivity of chest radiography, computed tomography, and gallium scanning to metastasis of lung carcinoma.

To determine the efficacy of radiologic techniques in preoperative staging of the mediastinum for lung carcinoma, the authors studied 45 patients with chest films supplemented with oblique views, esophagrams, gallium scans, and computed tomograms (CT). They interpreted the studies and correlated surgical findings using a modified classification of lymph node regions. The mediastinum was positive on chest films in 14 of the 21 cases with pathologically proved mediastinal metastases (33% false-negative). Gallium scans in cases with a positive primary were positive in 12 of 15 cases with mediastinal or hilar metastases (20% false-negative). Computed tomography showed nodes over 1 or 1.5 cm in size in or adjacent to the biopsy-positive node region in 18 of 19 patients (5% false-negative), extranodal mediastinal involvement, and 9 of 10 proven hilar metastases. Computed tomography is a sensitive screening technique in patients who would otherwise require an invasive staging procedure, but is not highly specific (false-positive rate 38%).

Diagnostic Errors↗

PubMed1986

Gallium scanning and tomography in the preoperative evaluation of lung cancer.

Discrepant reports on the utility of gallium scanning in the preoperative evaluation of patients with lung cancer prompted a prospective study of the test. The authors studied 47 patients with lung cancer who underwent preoperative gallium scanning and frontal tomography of the mediastinum. Both tests were found to be most accurate in predicting the presence of mediastinal metastases among patients with squamous cell carcinoma. Both test may help direct surgical planning in patients with known squamous cell carcinoma of the lung.

Carcinoma, Squamous Cell↗

PubMed1986

Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy.

Experience with 16 sequential patients with Stage IA/IIA supradiaphragmatic Hodgkin's disease who had no evidence of intra-abdominal disease using high-dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high-dose, whole-body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.

Adult↗

PubMed1991

Continuous infusion gallium nitrate for patients with advanced refractory urothelial tract tumors.

A Phase I-II trial of gallium nitrate was conducted in 40 patients with bidimensionally measurable urothelial tract tumors who had failed to respond to combination chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin. Partial responses were observed in 4 of 23 patients (17.4%) who received 350 mg/m2/d or more for 5 days by continuous intravenous infusion. In two additional patients who received 350 mg/m2/d or more, a minor response and a mixed response were observed. The median duration of response was 4 months (range, 2 to 8 months). A dose-response relationship was suggested because no responses were observed in 17 patients who received less than 350 mg/m2/d. Myelosuppression was minimal. The dose-limiting toxic reaction was a reversible optic neuropathy that occurred in 3 of 11 patients who received 400 mg/m2/d. Further evaluation of infusional gallium nitrate is warranted in patients with urothelial tract malignant tumors.

Adult↗

PubMed1985

Gallium-67 citrate imaging in underground coal miners.

Twenty-two underground coal workers with 27 or more years of coal dust exposure were studied with gallium-67 citrate (Ga-67) imaging. Radiographic evidence of coal workers pneumoconiosis (CWP) was present in 12 subjects. The Ga-67 scan was abnormal in 11 of 12 with, and 9 of 10 without, CWP. The Ga-67 uptake index was significantly correlated with total dust exposure (p less than 0.01) and approached significant correlation with the radiographic profusion of the nodules (0.10 greater than p greater than 0.05). There was no correlation between Ga-67 uptake and spirometric function, which was normal in this group of patients; furthermore, increased lung uptake of gallium did not indicate a poor prognosis in subjects no longer exposed to coal dust. While coal dust exposure may be associated with positive Ga-67 lung scan in coal miners with many years of coal dust exposure, the scan provided no information not already available from a careful exposure history and a chest radiograph. Since Ga-67 scanning is a relatively expensive procedure we would recommend that its use in subjects with asymptomatic CWP be limited to an investigative role and not be made part of a routine evaluation.

Aged↗

PubMed1990

Multiplane gallium tomography in assessment of occupational chest diseases.

Gallium-67 scintigraphy is helpful in the evaluation of inflammatory, respiratory diseases. Single-photon emission computed tomography (SPECT) provides three-dimensional tomographic reconstruction of radioisotope distribution in the body. The addition of SPECT to gallium-67 scanning in 27 patients demonstrated an improvement in the sensitivity for detecting the presence and extent of interstitial occupational lung disease. This technique may provide earlier detection of parenchymal lung changes than can the chest x-ray and planar scanning in some patients with asbestosis. Findings in six patients with asbestosis are reported.

Adult↗

PubMed1993

A diagnostic approach to asbestosis, utilizing clinical criteria, high resolution computed tomography, and gallium scanning.

Seventy-five individuals known to have significant exposure to asbestos were evaluated by physical exam, pulmonary function tests (PFT), chest radiographs, high resolution computed tomography (HRCT), gallium-67 scanning, and various laboratory exams. Sixteen subjects met three of the following four criteria and were considered to have clinical asbestosis: 1) bibasilar rales, 2) FVC < 80% of predicted, 3) DLCO < 80% of predicted, and 4) an abnormal chest radiograph. Evaluations which included HRCT and Ga scanning detected pulmonary disease in these asbestos-exposed individuals in many cases where other modalities were unable to demonstrate significant abnormalities. While only 21% of the subjects satisfied commonly accepted criteria for the diagnosis of asbestosis, 75% had evidence of disease by both HRCT and gallium scanning. These data suggest that it may be time to include HRCT and Ga scanning when evaluating asbestos-exposed individuals, especially in cases where evaluations by physical exam, PFTs, and chest radiographs are non-diagnostic.

Adult↗