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Decreased radiopharmaceutical uptake was noted on both bone and gallium scans in the case of acute hematogenous osteomyelitis of the right ilium (acetabular roof). This combination of findings is probably rare. The mechanism of decreased gallium uptake is unknown, but may be related to decreased blood flow.
The appearance of gallium-67 images in bone infarction was studied in nine patients with sickle cell disease and correlated with the bone scan findings. Gallium uptake in acute infarction was decreased or absent with a variable bone scan uptake, and normal in healing infarcts, which showed increased uptake on bone scan. The significance of these findings is discussed.
Diffuse abdominal localization of gallium was found in two patients with peritonitis, one due to M. tuberculosis and the other presumably pyogenic. Gallium scanning may be useful in the diagnosis of peritonitis and perhaps of other serosal infections.
The osseous lesions of disseminated coccidioidomycosis may be detected by bone but not by gallium scintigraphy or vice versa. This case emphasizes the need for performing both bone and gallium scans to avoid missing potentially serious bone lesions.
Two cases in which pulmonary gallium uptake was demonstrated in benign conditions are reported. In one, the abnormality permitted localization of a benign mesothelioma, while in the other patient it was associated with pulmonary fibrosis resulting from therapeutic irradiation. These cases extend the causes of gallium accumulation in which neither malignancy nor infection is responsible.
Ga-67 (3 mCi) was used in 11 patients to diagnose and locate an eventual infection of their synthetic vascular prostheses. In seven cases, an area of gallium uptake was found and the infection confirmed by surgery and bacteriology. In the remaining four cases, no uptake of gallium was found and the absence of infection was confirmed.
Diffuse pulmonary uptake by bone-seeking radiopharmaceuticals has been reported previously but, in the same patient, would pulmonary uptake of Ga-67 citrate yield clinically meaningful results? A patient with hypercalcemia and renal failure in whom bone scintigraphy demonstrated striking diffuse bilateral pulmonary uptake, but subsequent gallium imaging demonstrated no evidence of pulmonary uptake greater than body background, is discussed. We conclude that pulmonary uptake of gallium cannot be attributed to calcium deposition and should carry the same clinical significance in regard to inflammatory and malignant lesions as would be assigned to patients without pulmonary calcific deposits.
A 46-year-old man who had undergone apical cardiac aneurysmectomy with a ventriculotomy graft and implanted automatic cardioverter-defibrillator electrodes, presented with fever, left-sided pleuritic chest pain, and a draining sinus. A Ga-67 scan was performed to aid in determining whether the infection was limited to the chest wall or if it had penetrated deeper to the cardiac structures. Uptake of gallium within the cardiac region, in association with minimal rib uptake of Tc-99m MDP, strongly supported the existence of infection within the pericardium. CT scan demonstrated a pericardial collection which under CT-guided aspiration proved to be purulent. Definitive surgical drainage was performed, and the patient was discharged 4 weeks postoperatively. Ga-67 imaging can provide an accurate and relatively rapid means of localizing infection in the postcardiotomy patient. A thorough bibliography of pericardial gallium uptake is provided.
Gallium imaging may play an important role in both initial evaluation and in follow-up in patients with metastatic melanoma. We present a case where the patient had gallium-avid metastatic melanoma. SPECT proved helpful in the initial evaluation.
A case of heterotopic ossification (myositis ossificans) secondary to the central nervous system complications of acquired immune deficiency syndrome (AIDS) is reported. Because of the overwhelming suspicion of infection in this patient, this diagnosis was not considered until a gallium scan revealed the typical findings of heterotopic ossification. Because of the increasing utilization of gallium imaging in the AIDS population, every imaging specialist should be aware of this potential disorder.
The gallium scans of seven AIDS patients who cultured positive for atypical mycobacterium were reviewed. Six cultured positive for Mycobacterium avium intracellulare, while one for Mycobacterium xenopi. A patchy uptake pattern of gallium in the lungs of these patients was identified.
The literature on gallium imaging in mycosis fungoides is limited and conflicting. A case of mycosis fungoides with increased uptake of Ga-67 in clinically noninfected skin lesions is reported. The literature regarding mycosis fungoides and gallium imaging is reviewed.
Twenty-two painful hip prostheses were studied prospectively with plain radiography, aspiration and arthrography, Tc-99m phosphate bone imaging, and gallium imaging to evaluate loosening, infection, or both and to compare the accuracy of these modalities. Fifteen prostheses were revised yielding 14 loose femoral and eight loose acetabular components. Five proved to have infected prostheses. Arthrograms, plain radiographs, and bone scans are highly sensitive in detecting loosening of the femoral component. This study confirmed a previous retrospective study in demonstrating that accuracy of diagnosis of an abnormal acetabular component using all four modalities is less than that for the femoral component. In infected prostheses, phosphate bone imaging showed high sensitivity of a pattern that accurately diagnosed all the infected cases, whereas gallium imaging missed one case.
Gallium concentration was demonstrated in a dissecting aneurysm of the aortic arch, imaged approximately 2 weeks after dissection. Concentration of gallium was apparently due to the inflammatory reaction associated with the organizing intramural hematoma.
Ga-67 imaging has not been very successful in the detection of esophageal carcinoma. In most reports, sensitivity for the primary tumor ranged from 25-61%, but imaging had been done only in anterior and posterior (A-P) projections. We performed gallium scans in 30 patients with esophageal carcinoma, adding lateral views to the routine A-P projections, to study the effect of lateral views on tumor detection. The A-P views detected only 57% of the tumors while the right lateral visualized 89%, and the left lateral detected 100%. Some lesions may be hidden by the sternum and the spine in the routine A-P views. Previous disappointments with Ga-67 imaging of esophageal carcinoma were probably due to this technical factor. Being gallium-avid, esophageal tumors deserve further studies with this agent to determine the role of Ga-67 imaging in this condition. These studies should be performed with multiple views of the thorax or, better yet, with SPECT imaging of the chest, to circumvent the problem of sternum and spine interference.
In a patient with an ovarian dysgerminoma, intense uptake of gallium-67 citrate was demonstrated. This report indicates that dysgerminoma should be added to the list showing abnormal accumulation of gallium-67 citrate in the abdomen.
Nephrotic syndrome, although rare, is recognized as one of the paraneoplastic syndromes. A patient with documented Hodgkin's disease showed increased uptake of Ga-67 in the cortex of both kidneys in addition to multiple sites of lymphomatous involvement. The patient was not receiving chemotherapy or any nephrotoxic drugs, and no other reasons that may account for renal uptake of gallium could be identified. The final clinical diagnosis was nephrotic syndrome as an unusual paraneoplastic syndrome of Hodgkin's disease. Gallium imaging was able to detect multiple sites of lymphoma and the renal uptake due to the associated nephrotic syndrome.
Bone and gallium scans of the sinus regions were performed in 32 patients presenting with frontal sinusitis. Bone scans, classified according to 99Tcm-methylenediphosphonate (MDP) distribution patterns indicated both active and resolving sinusitis as well as surgically related bone trauma. Gallium scan uptake intensity correlated well, however, with final outcome and differentiated between active and resolving sinusitis, more specifically than corresponding bone scans. Thus combined studies appear to have a significant role in the diagnosis and management of patients suspected for frontal sinusitis.