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Gallium scans and serum angiotensin converting enzyme levels in talc granulomatosis and lymphocytic interstitial pneumonitis.

We have described two patients who had positive gallium lung scans with simultaneous elevation in serum angiotensin converting enzyme (SACE) levels. One patient had talc granulomatosis secondary to the intravenous injection of pentazocine, while the other patient had lymphocytic interstitial pneumonitis. We believe these are the first cases in which a positive gallium scan and elevated SACE levels were associated with these entities.

Adult↗

Gallium 67 uptake in thymic rebound.

We have reported a case of localized thymic enlargement and uptake of gallium 67 in a child who had received antineoplastic chemotherapy. The enlarged thymus showed normal histology, a picture consistent with thymic rebound after nonspecific stress. This case further demonstrates the need to consider thymic rebound as a cause of gallium 67 uptake in children with neoplastic diseases.

Antineoplastic Combined Chemotherapy Protocols↗

Prolonged murine cardiac allograft acceptance: characteristics of persistent active alloimmunity after treatment with gallium nitrate versus anti-CD4 monoclonal antibody.

We have treated DBA/2-->C57BL/6 murine cardiac allograft recipients with anti-CD4 monoclonal antibody or with gallium nitrate to promote long-term (>60 days) allograft survival. Within this period, all grafts developed histologic evidence of ongoing vascular and parenchymal tissue remodeling, including interstitial fibrosis and neointimal hyperplasia, which are characteristic of chronic allograft rejection. To evaluate residual alloimmunity associated with the pharmacologic avoidance of acute graft rejection and the development of chronic tissue remodeling, we subjected these graft recipients to a battery of histologic and immunologic tests. Similar test results were obtained for graft recipients treated with either of the two immunosuppressive agents. All long-surviving allografts displayed histologic evidence of ongoing microvascular endothelial activation and interstitial leukocytic infiltration. Reverse transcriptase-polymerase chain reaction analyses demonstrated intragraft expression of mRNAs for interleukin (IL)-1, IL-2, IL-4, IL-6, tumor necrosis factor, interferon-gamma, and transforming growth factor-beta. All recipients had limiting dilution analysis-detectable, graft-reactive cytolytic T lymphocytes and helper T lymphocytes in their spleens and grafts, and all produced high titers of graft-reactive alloantibodies. In general, these observations indicate that (1) a similar immune status is achieved in long-surviving allografts and their recipients when either anti-CD4 monoclonal antibody or gallium nitrate was used for antirejection therapy, (2) this immune status is characterized by continuous, long-term inflammatory and immune processes that are qualitatively similar to those observed during acute allograft rejection, and (3) no specific immune responses developed selectively in long-term graft recipients to account for the avoidance of acute graft rejection or the development of chronic tissue remodeling in the graft.

Animals↗

Symmetric bony involvement of the lower extremities with lymphoma demonstrated on gallium scintigraphy.

Primary or secondary lymphoma of the bone is uncommon. The sites of bony involvement include, in decreasing order of frequency, the spine, long bones, pelvis, ribs, and skull. A 66-year-old man with an atypical lineage of B-cell non-Hodgkin lymphoma is presented. The unusual initial presentation of the lymphoma included symmetric bony involvement of bilateral tibiae and the distal right femur, demonstrated on gallium-67 scintigraphy. The patient subsequently demonstrated resolution of the gallium-avid disease after treatment with fludarabine, cyclosporine, and ATG. This case also demonstrates the limitations of plain radiograph and the usefulness of MRI in the diagnosis of bony lymphoma.

Aged↗

Antineutrophil cytoplasmic antibody and gallium lung scintiscan in usual interstitial pneumonitis.

A 2 year old Chinese boy was reported in whom there was an association between usual interstitial pneumonitis (UIP) and serum antineutrophil cytoplasmic antibody of the classical cytoplasmic type (cANCA). The concentration of cANCA reflected disease activity and decreased during a 6-week course of prednisolone. The gallium lung scintiscan index correlated with his disease activity. Both the serum cANCA concentration and the gallium lung scan could be used to monitor responses to treatment in this patient with UIP.

Autoantibodies↗

Preschool sarcoidosis mimicking juvenile rheumatoid arthritis: the significance of gallium scintigraphy and skin biopsy in the differential diagnosis.

Preschool sarcoidosis occurring in children less than 6 years old is rare and characterized by the triad of skin, joint and eye manifestations without any pulmonary lesion. Because of similar clinical manifestations, the diagnosis of preschool sarcoidosis and juvenile rheumatoid arthritis (JRA) is confusing. A girl with preschool sarcoidosis, initially diagnosed and treated as having JRA, is reported here. Ophthalmologic examinations revealed posterior involvement of the eye. A gallium scintigram of the head showed panda appearance. Biopsy of the cutaneous lesion demonstrated non-caseating granuloma. Gallium scanning may be an important clue to correct diagnosis.

Arthritis, Juvenile↗

The role of high dose 67-gallium scintigraphy in staging untreated patients with lymphoma.

BACKGROUND: Gallium-67 (67Ga) scintigraphy has been reported to be of limited value in staging lymphoma patients. However, recent technical advances in radionuclide imaging have potentially enhanced the usefulness of this method. AIMS: The purposes of this study were to determine the current: (1) sensitivity and specificity and (2) impact on clinicians' treatment decisions of 67Ga scans performed at a teaching hospital. METHODS: There were 46 newly presenting patients with lymphoma (13 with Hodgkin's disease (HD) and 33 with non-Hodgkin's lymphoma [NHL]). Planar 67Ga scans were performed up to eight days following injection of 300 MBq (8 mCi) with images interpreted by consensus of two blinded observers; sensitivity and specificity were determined on a lesion by lesion basis in comparison to computed tomography (CT) scans, palpation of peripheral lymph nodes and abdominal lymphangiograms (n = 5). The contribution of 67Ga scans to clinicians' treatment decisions was also independently assessed by an experienced oncologist. RESULTS: Gallium-67 scan sensitivity and specificity were 80% and 96% for HD and 59% and 98% for NHL. Initial treatment plans were modified in three individuals (7%; 95% confidence intervals = 3-10%) due to lesions on the 67Ga scan not prospectively detected or considered equivocal on other tests. CONCLUSIONS: Only a small proportion of newly diagnosed lymphoma patients benefit from staging with state of the art planar high dose 67Ga imaging.

Adult↗

Increased parasellar activity on gallium SPECT is not specific for active cluster headache.

We have performed Gallium SPECT head scans in 30 successive cluster headache (CH) patients and in 7 migraineurs without aura. Parasellar hyperactivity was judged as present in 81% of chronic CH patients, 54% of episodic CH patients in an active period, 56% of episodic CH patients in remission and 71% of migraineurs. No significant correlations were found between the SPECT images and the duration of the disease, of cluster periods or of remissions. Increased parasellar activity on Gallium SPECT is thus not specific for CH, nor for the active period of episodic CH. The method lacks reliability for investigation of putative cavernous sinus inflammation.

Cluster Headache↗

Effect of bisphosphonates and gallium on dentin resorption in vitro.

Replacement resorption may follow the replantation of an avulsed tooth. Currently there is no effective treatment for replacement resorption. The purpose of this study was to investigate the effect of bisphosphonates and gallium nitrate, which have been shown to reduce bone resorption, on cells which resorb dentin. Osteoclast-like cells were obtained by culturing cells from prenatal chick tibeas. These cells were seeded onto slices of human dentin which had been soaked in either saline (control), or solutions of 10(-5) M 1-hydroxyethylidene-1, 1-bisphosphonic acid (EHBP), 10(-6) M dichloromethylene bisphosphonic acid (Cl2MBP), or 10(-6) M gallium nitrate. Resorption was measured by counting the number of resorptive lacunae produced by the cells. Results indicated that the experimental groups did not differ significantly from each other, but each exhibited significantly reduced resorption compared with saline controls (p < 0.01). These results suggested that the experimental treatment reduced dentinal resorption by the osteoclast-like cells, and that these agents might be useful to prevent or at least postpone replacement resorption in avulsed teeth.

Animals↗

Gallium scanning in sarcoidosis.

This study of 36 patients, 27 with sarcoidosis, confirms the avidity of mediastinal and pulmonary sarcoidosis for gallium-67. This procedure may prove useful in distinguishing enlarged hilar vessels from lymph nodes. Gallium scanning proved unsuccessful, however, in detection of clinically important extrathoracic sarcoidosis and appears to have limited applicability in the diagnosis of thoracic sarcoidosis.

Female↗

Gallium-67 localization in rat and mouse tumors.

Various nonosseous tumors in mice and rats concentrate gallium-67-ESR-586 preputial gland carcinoma, P-1798 lymphosarcoma, C3H/ HeJ mammary tumor, AKR/J thymic lymphoma, R-3259 giant cell sarcoma, Walker-256 carcinosarcoma, and a new transplantable neoplasm of rats. This last tumor showed the greatest affinity for galliun. Viable tumor cells are mainly responsible for uptake of gallium-67; autoradiographic studies indicate it is chiefly located in tumor cytoplasm.

Animals↗

Value of gallium scanning in seminoma of the testis.

Whole-body scanning using gallium-67-citrate gave consistently accurate tumour localisation in patients with seminoma of the testis. Thirteen out of 15 scans performed in patients with disseminated seminoma in relapse gave good imaging in all disease areas. Scans in patients with teratoma of the testis were less consistently positive; of nine scans performed in patients with disseminated teratoma seven were entirely negative and two scans lightly imaged large disease masses in two patients. In eight patients with combined (seminoma and teratoma) tumours the scan seemed to reflect the dominant tumour type at the time of scanning. In one of these patients the scans changed from positive to negative, being positive when seminoma was the dominant tumour and negative when a teratoma developed. Gallium-67-citrate scanning is useful in managing seminoma of the testis, both for determining the extent of disease present at initial presentation and for routine follow-up. It may be useful in the differential diagnosis of combined tumours when tumour masses are greater than 2 cm in diameter.

Adult↗

Pulmonary uptake in 67-gallium citrate scintigraphy-the 'negative heart' sign.

Diffuse pulmonary uptake in 67-gallium citrate (67-Ga) scintigraphy occurs in a large number of neoplastic and inflammatory conditions. Discrimination between normal and abnormal 67-Ga uptake over the chest can be difficult and a simple visual method for identifying abnormal studies is described. A series of 39 gallium scintigrams was retrospectively reviewed by the authors and reported without knowledge of the patients' clinical condition. Subsequent clinical follow up was obtained to establish the accuracy of the scintigram interpretation. Comparison of pulmonary uptake with that over the cardiac area is recommended as a simple and reliable method of confirming that the level of pulmonary activity is abnormal. In highly abnormal cases the cardiac area is seen as a 'negative heart' image due to the considerably increased activity in the lungs. This sign is best seen with abnormal diffuse uptake but is also seen with abnormal focal uptake. Care must be taken, as the sign may be masked, if uptake over the cardiac area itself is increased.

Gallium Radioisotopes↗

Role of gallium 67 thoracic scintigraphy in the diagnosis and staging of patients suspected of bronchial carcinoma.

Gallium 67 (67Ga) lung scanning was performed in 100 consecutive cases in which because of the history, clinical data, or abnormal radiological findings, a bronchial carcinoma was suspected. This study allows the conclusion that a negative as well as a positive scan is an important element in the diagnosis of some cases of bronchial carcinoma. The method is most helpful in the preoperative diagnosis of circumscribed peripheral shadows and in the assessment of suspected hilar enlargement; it may even visualise hidden malignant tumours. Gallium 67 scanning is also valuable in the assessment of hilar and mediastinal involvement in the presence of a proven primary lung tumour. This study supports the view that in the presence of a negative mediastinal scan the patient may be spared mediastinoscopy and be referred directly for operation.

Carcinoma, Bronchogenic↗

Renal localization of gallium-67 citrate.

Renal localization of 67Ga citrate has been observed in 1.7% of 2,000 whole-body gallium scans in three major diseases: lymphoreticular neoplasms, leukemia, and malignant melanoma. Correlation of this finding with autopsy data in 13 cases revealed 9 with tumor and 2 with an inflammatory process. Findings in two cases were normal. In the remaining patients, correlation with abnormal urograms and laboratory data was poor. Nevertheless, gallium localization in the kidneys may be the first indicator of renal involvement with either tumor or inflammation.

Citrates↗

Gallium-67 scintigraphy in multisystem malignant melanoma.

In a prospective study of the value of gallium-67 scintigraphy in cases of multisystem malignant melanoma, 69 scans were obtained for 36 patients. No abnormality was found in 18 scans; in only 3 was there other evidence of disease. Of 54 sites of disease demonstrated by scintigraphy, 40 were correlated with other investigations: biopsy (5), surgery (7), autopsy (7), radiographic (13), or clinical (8). Metastatic melanoma was found in 37 (69%) of the sites; no such disease was found in 3 (5.7%). The life expectancy of patients with an abnormal scan was shorter than that of patients with a normal scan. Gallium studies reliably indicated the extent of multisystem melanoma, and are of value in clinical management.

Aged↗

Peritoneal localization of gallium-67.

Diffuse abdominal localization of 67Ga was found in two patients with peritonitis; one due to M. tuberculosis, and the other presumably pyogenic, following multiple perforations of the small bowel due to necrotizing ulcerating enteritis. After 7 months of antituberculous treatment of the first patient, a normal gallium distribution was noted. It is suggested that gallium scanning may be useful in the diagnosis of peritonitis and perhaps of other serosal infections.

Adult↗

Renal lymphoma imaged by ultrasound and gallium-67.

Lymphomatous involvement of the kidneys, usually a secondary process, may be seen as single or multiple sonolucent or weakly echogenic masses on ultrasound. The majority of these patients have a known diagnosis of lymphoma and are being evaluated for change in nodal mass size, flank pain, and/or deteriorating renal function. Occasionally, these masses are discovered on an excretory urogram and are further investigated with ultrasound. The ultrasound findings may be confirmed with gallium scanning. Five such cases are presented along with the ultrasonic and gallium scan findings.

Adult↗