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PubMed1985

Mechanism of gallium-67 accumulation in inflammatory lesions.

Multiple factors contribute to the accumulation and retention of gallium-67 in inflammatory lesions. Adequate blood supply is essential. Gallium-67, mainly in the form of transferrin-Ga-67 complex, is delivered to the inflammatory lesions through capillaries with increased permeability. At the site of inflammation, some Ga-67 is taken up by leukocytes and bacteria when they are present. In addition, Ga-67 may also bind to lactoferrin and bacterial siderophores. Multiple contributing factors often coexist at any given inflammatory lesion. The nature and intensity of the inflammation affects the relative contribution of these factors. Thus, there may be situations in which all the contributing factors are present, but in such a low intensity that they escape clinical detection by Ga-67 scans. On the other hand, there may be situations in which one or more contributing factors are missing, such as in patients with agranulocytosis, while they are readily detected by Ga-67 scans.

Biological Transport↗

PubMed1985

Phase II trial of gallium nitrate in patients with advanced malignant melanoma.

A phase II trial of gallium nitrate (250-300 mg/m2/day for 7 consecutive days) was conducted in patients with metastatic melanoma. Therapy was well-tolerated, but only one of 31 evaluable patients experienced a partial regression. Further evaluation of gallium nitrate at this dose and schedule is not warranted in patients with malignant melanoma.

Abdominal Neoplasms↗

PubMed1977

Gallium-68 labeled red cells and platelets: new agents for positron tomography.

Red cells and platelets are labeled with Ga-68 by preparing the tga-68-hydroxy-quinoline (oxide) complex and mixing the complex with the separated cellular components. The complex is prepared by first breaking the Ga-68 EDTA chelate with concentrated hydrochloric acid, adsorption of the galluim on a strong anionic ion-exchange column, and elution of the gallium activity with distilled water. Oxine is added, the oxine complex extracted into chloroform, and--following evaporation and dissolution--the solution is added to either red cells or platelets that have been centrifuged from whole blood, washed, and suspended in normal saline. After 15 min of incubation , labeling efficiencies of greater than 90% and yields of 7 mCi are obtained from 18 mCi of Ga-68 EDTA eluted from the generator. After injection of the gallium-labeled red cells in dogs, excellent blood pool images were obtained by positron tomography. The distribution corresponded to that of 11CO-labeled red cells. When labeled platelets were injected into dogs with experimentally induced intimal injury of on carotid artery, the area of injury was clearly visualized 40 min after tracer injection.

Animals↗

PubMed1979

The gallium "bone scan" in acute leukemia.

A 15-year-old boy with acute leukemia had a gallium-67 scan that was virtually identical to his technetium-99m pyrophosphate bone scan, except for lack of renal visualization. The quality of the radiopharmaceutical was assured by the normal appearance of gallium scan performed in another patient on the same day and with the same radionuclide batch. This extensive osseous uptake was probably due to bone-marrow replacement by leukemia cells and is a pattern that should be recognized as indicating a diffuse marrow-infiltrating disease.

Acute Disease↗

PubMed1978

Imaging the bowel with technetium--an aid in gallium studies.

Three cases are present to demonstrate the usefulness of oral or rectal technetium-99m preparations in locating the stomach and bowel in relation to abnormal accumulation of gallium-67 within the abdomen. In this way, the concentration of gallium in an abscess or a tumor may be distinguished from its physiologic excretion into the bowel.

Abdomen↗

PubMed1978

Early diagnosis of disc-space infection using Gallium-67.

A 4-year-old boy had had progressive central lumbar pain and hamstring spasm. He had a normal lumbar-spine x-ray except for minimal L-5, S1 spondylolysis, but gave an abnormal gallium-67 scan in the region of the low lumbar spine. Eight weeks following intensive antibiotic therapy, confirmation of the diagnosis of disc-space infection was established by roentgenographic studies that demonstrated narrowing of the L 4-5 intervertebral disc space. A technetium-99m diphosphonate bone scan, performed concurrently with the gallium-67 study, was normal.

Bacterial Infections↗

PubMed1983

Administration of gallium nitrate by continuous infusion: lack of chronic nephrotoxicity confirmed by studies of enzymuria and beta 2-microglobulinuria.

Enzymuria and beta 2-microglobulinuria are sensitive markers of injury to renal tubular cells. We evaluated these markers in 41 patients with advanced malignant lymphoma who received gallium nitrate administered as a continuous infusion during a recent phase I-II study. In contrast to our findings with cisplatin, we observed no significant increase in enzyme excretion or beta 2-microglobulinuria in these patients even after long-term treatment. Our results indicate that gallium nitrate administered by infusion does not produce cumulative renal tubular toxicity.

Acetylglucosaminidase↗

PubMed1978

Steroid-induced suppression of gallium uptake in tumors of the central nervous system: concise communication.

The effect of steroids given in greater than replacement doses on the gallium and technetium glucoheptonate brain scan is evaluated by comparing the relative sensitivity of both radiopharmaceuticals in patients both on and off steroids. The study shows a significant steroid effect on the sensitivity of 95% to 64% following steroids. Steroids did not significantly alter the sensitivity of the technetium glucoheptonate study. The superiority of the TcGH brain scan over the gallium citrate brain scan in the steroid population suggests a difference in the uptake mechanism for the two radiopharmaceuticals.

Brain Neoplasms↗

PubMed1984

Phenolic aminocarboxylic acids as gallium-binding radiopharmaceuticals.

The phenolic aminocarboxylic acids ethylenediamine di [o-hydroxyphenylacetic acid] (EDDHA) and N,N'-bis [2-hydroxybenzyl] ethylenediamine N,N'-diacetic acid (HBED) form gallium complexes having high stability constants which enable them to resist exchange of gallium with plasma transferrin. 67Ga complexes were synthesized with these ligands, placing substituent groups in the phenolic ring to direct excretion via the renal or hepatobiliary route. The amount of 67Ga-Br-EDDHA excreted via the hepatobiliary route was comparable with that of some of the 99mTc agents. Excretion of 67Ga-Br-HBED was similar but with delayed transit from the liver. 67Ga COOH-EDDHA was excreted exclusively via the renal route. These findings provide a basis for developing new 67Ga or 68Ga radiopharmaceuticals, the latter for use in positron emission tomography, using these phenolic aminocarboxylates.

Animals↗

PubMed1980

Scintigraphic evaluation of primary bone tumors. Comparison of technetium-99m phosphonate and gallium citrate imaging.

A prospective investigation of two different radionuclide imaging techniques for the skeleton--technetium-99m phosphonate and gallium-67 citrate--was carried out prior to biopsy in fifty-five patients with primary bone tumors of the extremities and limb girdles. The study showed that the technetium-99m phosphonate scans were not useful in separating benign from malignant lesions or in defining reliably the local extent of malignant tumors. Gallium scans were more accurate in delineating the local extent of malignant tumors and may provide better indentification of benign tumors.

Bone Neoplasms↗

PubMed1981

Tricatecholamide analogs of enterobactin as gallium- and indium-binding radiopharmaceuticals.

Isopropyl N-substituted tricatecholamide analogs of enterobactin have been found to form gallium and indium complexes with very high stability constants and to exhibit in vivo characteristics significantly different from gallium- or indium-transferrin and EDTA. The 3,4-DiP-LICAMS and TiP-MECAMS complexes were found to clear primarily through the kidneys, whereas the less polar 3,4-DiP-LICAM complex was eliminated through the liver. The rationale for developing new metal-binding analogs with larger organic groups attached to the amide nitrogens is discussed.

Animals↗

PubMed1984

The role of gallium scanning in the detection of bone and joint sepsis.

The value of gallium ((67)Ga) scanning in the diagnosis of septic disease of bone or joint was assessed in 34 patients. The results show a sensitivity of 60 per cent and specificity of 64 per cent. The low accuracy of this method for the detection of bone and joint sepsis (62 per cent) means that gallium scanning can be used only as an adjunct to other investigative techniques.

Adolescent↗

PubMed1983

Pseudomembranous colitis: a possible role for Gallium scanning.

A case of antibiotic-associated pseudomembranous colitis is presented in which the Gallium scan was the first diagnostic modality to alert the clinicians to the existence of an inflammatory bowel process. The mechanism of localization of the radiopharmaceutical in inflammatory bowel disease is discussed. Although colonoscopy is far more specific and should be the first-line diagnostic tool used in assessing the presence of pseudomembranous colitis, Gallium scanning may have a role in the follow-up of treatment and in cases of relapse.

Clindamycin↗

PubMed1978

[The value of gallium 67 citrate in the diagnosis and localisation of deep-seated abdominal abscesses (author's transl)].

Six French Departments of Nuclear Medicine have pooled their results of Gallium 67 citrate scanning, carried out with the aim of demonstrating an abcess. Two hundred and thirty five examinations were performed. During the postoperative period, an abcess was correctly localised in 83 cases out of 89. For the 188 patients undergoing the examination, the reliability was 92%. In cases of suspicion of a subphrenic abcess, precise diagnosis was obtained in 19 cases out of 21. In 35 patients with an infectious syndrome in the absence of surgery, scanning gave an accurate diagnosis in 33. In 12 patients who had recently had a renal transplant, scanning revealed a purulent collection in 5 cases. By virtue of the affinity of Gallium for any inflammatory process, echotomography must always be performed after the isotope scan in order to confirm the presence or absence of a fluid collection in the region of the zone of increased uptake. These atraumatic techniques, easy to carry out, should provide clinicians with precious information when an infectious process within the abdomen is being sought.

Abdomen↗

PubMed1983

Gallium-67 scanning in the diagnosis of postoperative sternal osteomyelitis: concise communication.

Sternal osteomyelitis is an uncommon but serious complication of the median sternotomy incision. Definite diagnosis is clinically difficult and radionuclide scanning is of uncertain value in the early postoperative period. We conducted a prospective blind study of gallium scanning in the early period after cardiac surgery and reviewed clinically diagnosed cases that also had scans. Clinical status and scan interpretation were each independently assessed by three raters. Thirty-eight scans included six true positives, five true negatives (no sternotomy) and 27 post-sternotomy, clinically uninfected patients. Using categories of high, medium, and low for scan interpretation, the radiologic assessors agreed 90% of the time. Normal postoperative Ga-67 uptake could usually be differentiated from uptake by an infected sternum. The test had a sensitivity of 83% and specificity 96%. If the clinical (pretest) likelihood of sternal osteomyelitis is 30%, then the gallium scan will have a 90% positive predictive value and a 93% negative predictive value. This study of observer variation and validity indicates that Ga-67 scanning may be useful in confirming the diagnosis of poststernotomy sternal osteomyelitis.

Adult↗

PubMed1984

Gallium-67 citrate localization in the heart secondary to constrictive pericarditis with myocardial fibrosis.

Scintigraphy has demonstrated gallium-67 accumulation within the heart in pericarditis and cardiomyopathies of various kinds. We present a case report of a 63-yr-old man with multisystem disease who showed extensive myocardial uptake of Ga-67 by scintigraphy. At autopsy, constrictive pericarditis with myocardial fibrosis was found. Gallium-67 localization has not been documented previously in myocardial fibrosis accompanying constrictive pericarditis.

Cardiomyopathies↗

PubMed1983

Failure of Gallium-67 scintigraphy to identify reliably noninfectious interstitial nephritis: concise communication.

Gallium-67 scintigraphy has been reported to be useful in the diagnosis of noninfectious interstitial nephritis. We studied 12 patients with Ga-67 citrate that were diagnosed as having noninfectious interstitial nephritis on renal biopsy. Only seven of the twelve patients with interstitial nephritis on biopsy were scan-positive. Gallium-67 scintigraphy may not reliably identify noninfectious interstitial nephritis.

False Negative Reactions↗

PubMed1983

Gallium nitrate in malignant lymphoma: a Southwest Oncology Group study.

Gallium nitrate was evaluated by the Southwest Oncology Group in 38 patients with malignant lymphoma, both Hodgkin's disease and non-Hodgkin's lymphoma. Treatment was administered every 2 weeks at a dose of 700 mg/m2, with acceptable toxicity. Seven partial responses (18%) with a duration of 3-11 months were seen: one of seven in Hodgkin's disease and six of 26 in diffuse non-Hodgkin's lymphoma. No responses were noted in nodular types. Gallium nitrate has activity in lymphomas and should be combined with more active drugs for patients who have undergone less intensive prior therapy.

Adolescent↗