The role of gallium-67 in the clinical evaluation of sarcoidosis.
Explore the source record for details and available documents.
Bone Diseases↗
Biomedical subjects
C Bekerman
Publications and source records attributed to C Bekerman.
Radiation-induced tumors of the head and neck following childhood irradiation. Prospective studies.
Nodules were found in 1108 subjects who received childhood radiation for benign conditions of the cervical area at our institution. This is 37.5% of 2958 subjects, out of a total of 5379, for whom there is follow-up information. Of the 848 subjects who have had thyroidectomies, 297 (35.0%) had thyroid cancer. In addition to thyroid tumors, salivary, neural, and probably parathyroid tumors also occurred as a late consequence of childhood radiation. Prospective studies of the subjects indicate that thyroid nodules are continuing to occur at a constant rate. The measurement of serum thyroglobulin is helpful in identifying individuals for whom the risk of developing a nodule is increased. Follow-up of patients with nonsurgically-treated nodules indicates that some of their nodules are progressive. At the present time there is no indication that radiation-induced cancers behave differently than ones in other settings. However, some of their characteristics, especially their multicentricity and occurrence in younger individuals, indicate that continued follow-up is necessary. On the basis of the data generated by the follow-up program at our institution and programs elsewhere, recommendations for screening, treatment, and follow-up are made. The recommendations stress the importance of estimating risk based on radiation dose, previous tumors, and serum thyroglobulin, in arriving at clinical decisions for these subjects.
Adult↗
Gastric ulcer localization by direct in vivo labeling of sucralfate. Work in progress.
We developed and evaluated a new procedure for imaging gastric ulcer disease with technetium 99m-labeled sucralfate. The new method employs direct in vivo labeling of sucralfate instead of in vitro labeling using human serum albumin, as previously reported in the literature. Tests using hydrochloric acid and a rabbit ulcer model showed the efficacy of the direct in vivo labeling technique and the ability of the tagged material to bind to ulcers, respectively. In 26 studies using humans with sucralfate labeled directly in vivo, 15 gave true-negative results and 11 gave true-positive results. Of 14 studies using humans with in vitro labeled sucralfate, three gave true-negative results, three gave true-positive results, and the results of eight were either false-negative or could not be interpreted because of high levels of activity remaining in the stomach. We suggest that the direct in vivo labeling method significantly improves the sucralfate gastric ulcer imaging technique.
Aluminum↗
The value of gallium-67 scanning in pulmonary tuberculosis.
We studied 59 patients presumed to have pulmonary tuberculosis to determine whether gallium-67 citrate scintigraphy could improve diagnostic accuracy and help clinical decision making for empiric treatment pending culture results. The sensitivity of 67Ga scintigraphy was 95% and the specificity 27%. Our positive predictive value of 69% does not contribute substantially to increase the prior probability of diagnosis in settings similar to ours. The existence of a false negative rate essentially precludes the use of the scan to rule out active disease. The use of the scan for clinical decisions in pulmonary tuberculosis is not recommended.
Evaluation Studies as Topic↗
Prospective serum thyroglobulin measurements in assessing the risk of developing thyroid nodules in patients exposed to childhood neck irradiation.
We examined 327 patients with a history of cervical radiation treatment for benign conditions and followed them for an average of 5.6 yr. These patients were selected because they initially had normal examinations and normal serum thyroglobulin levels. Of the 327 patients, 48 developed thyroid nodules, and an additional 30 had other clinical changes in their thyroids. Serum thyroglobulin increased by 4.0 +/- 0.6 (+/- SEM) ng/ml in those who remained normal, by 13.4 +/- 5.2 ng/ml in those who were no longer normal, and by 17.1 +/- 8.2 ng/ml in those who developed nodules. We conclude that increasing levels of serum thyroglobulin identify patients who should be examined and followed more carefully for thyroid nodules and thyroid cancer.
Age Factors↗
The role of gallium-67 in the clinical evaluation of cancer.
This review is based primarily on historic data, and it examines the indications for and limitations of gallium-67 scanning in the evaluation of patients with neoplasms. The use of gallium-67 scans is discussed according to tumor type, and data from the most representative and comprehensive studies are included. The results described, some of which were obtained primarily with older imaging techniques, should be regarded as representing the minimum that can be expected from application of this imaging procedure.
Adult↗
Is routine hepatic flow study cost effective? A case of hepatic cavernous hemangioma evaluated with dynamic flow study and delayed blood pool images.
A case of hepatic hemangioma was evaluated with radionuclide hepatic flow study, static scans, blood pool images, and angiography. The hemangioma appeared "avascular" on the hepatic flow study. Blood pool image with technetium 99m human-serum albumin was diagnostic in findings and quality for cavernous hemangioma.
Adult↗
Thyroid imaging agents: a comparison of I-123 and Tc-99m pertechnetate.
Tc-99m pertechnetate and I-123 were used to perform thyroid scanning in 122 patients with history or clinical evidence of thyroid disease. Thyroid scans were abnormal in all patients, while thyroid palpation was abnormal in all but 19. The quality of thyroid imaging was similar with both agents in 42%, better with I-123 in 18%, and better with Tc-99m in 7%. In the remaining 33% (40 cases), there were discrepancies between Tc-99m and I-123 images. The most frequent discrepancies were "hot" or "warm" lesions on Tc-99m scans that were "cold" or normal on I-123 scans. Results from this study indicate that neither Tc-99m nor I-123 is always superior to the other as a thyroid imaging agent.
Adult↗
Gallium 67 citrate scanning and serum angiotensin converting enzyme levels in sarcoidosis.
Gallium 67 citrate scans and serum angiotensin converting enzyme (ACE) levels were obtained in 54 patients with sarcoidosis and analyzed in relation to clinical manifestations. 67Ga scans were abnormal in 97% of patients with clinically active disease (n = 30) and in 71% of patients with inactive disease (n = 24). Serum ACE levels were abnormally high (2 standard deviations above the control mean) in 73% of patients with clinically active disease and in 54% of patients with inactive disease. Serum ACE levels correlated significantly with 67Ga uptake score (r =.436; p less than .005). The frequency of abnormal 67Ga scans and elevated serum ACE levels suggests that inflammatory activity with little or no clinical expression is common in sarcoidosis. Abnormal 67Ga scans were highly sensitive (97%) but had poor specificity (29%) to clinical disease activity. The accuracy of negative prediction of clinical activity by normal scans (87%) was better than the accuracy of positive prediction of clinical activity by abnormal scans (63%). 67Ga scans can be used to support the clinical identification of inactive sarcoidosis.
Adult↗
Angiotensin-converting enzyme in serum and in bronchoalveolar lavage in sarcoidosis.
Angiotensin-converting enzyme (ACE) determinations were made in serum and in bronchoalveolar lavage fluid in 20 controls and in 28 patients with sarcoidosis. Serum ACE was significantly higher in patients with active sarcoidosis (54.3 +/- 19.0 SD nmol/ml/ min; n = 24) compared to controls (25.7 +/- 8.2; n = 20) or to patients with inactive sarcoidosis (23.6 +/- 7.3; n = 4). In contrast, ACE in bronchoalveolar lavage fluid was similar in nonsmoking controls (16.4 +/- 7.3 nmol/ml/min/macrophage; n = 8), smoking controls (10.4 +/- 11.9; n = 7); nonsmoking active sarcoidosis patients (16.7 +/- 14.6; n = 10), smoking sarcoidosis patients (17.9 +/- 8.4; n = 6) and inactive sarcoidosis patients (14.5 +/- 8.2; n = 3). Since ACE has been demonstrated by immunofluorescence in mononuclear phagocytes in granulomas, the authors speculate that macrophages recovered by alveolar lavage are not activated and do not reflect sarcoid alveolitis at the tissue level.
Bronchi↗
Sequential scintigraphic staging of small cell carcinoma.
Thirty patients with small cell carcinoma (SCC) of the lung were sequentially staged following a history and physical exam with liver, bran, bone, and gallium-67 citrate scans. Scintigraphic evaluation disclosed 7 of 30 patients (23%) with advanced disease, stage IIIM1. When Gallium-67 scans were used as the sole criteria for staging, they proved to be accurate and identified six of the seven patients with occult metastatic disease. Gallium-67 scans proved to be accurate in detecting thoracic and extrathoracic metastases in the 30 patients with SCC, especially within the liver and lymph node-bearing area. The diagnostic accuracy of gallium-67 fell in regions such as bone or brain. Despite the limitations of gallium-67 scanning, the authors conclude that these scans are useful in staging patients with SCC and should be the initial scans used in staging such patients.
Aged↗
Gallium 67 scans in small cell carcinoma.
Explore the source record for details and available documents.
Carcinoma, Small Cell↗
Scintigraphic evaluation of sarcomata in children and adults by Ga67 citrate.
Gallium-67 scans were performed on 32 patients with adult and childhood sarcomata as part of clinical staging studies. Gallium-67 scans proved to be highly accurate in assessing sites of disease in patients with malignant schwannoma, Ewing's sarcoma, and rhabdomyosarcoma. Gallium-67 scans were inaccurate in determining sites of disease in patients with other types of sarcomata. It is concluded that Gallium-67 scanning is a useful adjunct to clinical staging in selected patients with sarcomata.
Adolescent↗
The diagnostic significance of gallium lung uptake in patients with normal chest radiographs.
Nine patients were encountered with normal chest radiographs, but diffuse bilateral lung uptake of 67Ga-citrate. They were divided into three groups. The first consisted of 6 patients who had lymphoma or leukemia and had had multiple cycles of chemotherapy. Here, abnormal uptake may have resulted from a toxic effect of the drugs or from a low-grade, subclinical infectious process. The 2 patients in the second group were drug addicts and a subradiographic interstitial inflammatory reaction was probably responsible for abnormal uptake. The last patient had diffuse uptake of 67Ga-citrate throughout the lungs two weeks before lymphomatous infiltrates became radiographically visible.
Adult↗
Scintigraphic evaluation of childhood malignancies by 67Ga-citrate.
The utility and limitations of 67Ga scintigraphy in children with solid tumors were evaluated. Thirty-five patients with malignancies (13 lymphoreticular neoplasms, 11 soft-tissue sarcomas, 8 neuroblastomas, and 3 primary bone tumors) had a 67Ga-citrate scan as part of their clinical evaluation. The sensitivity and specificity of the test were analyzed for the different tumor types. The overall sensitivity of the 67Ga-citrate scan for the lymphoma group was 87%. Higher values were obtained for the mediastinal and abdominal regions. Ninety-three per cent of the involved sites were correctly identified by 67Ga scintigraphy in the soft-tissue sarcoma group. Small lung metastases, however, were missed on scan. Thus, 67Ga scans should be complemented with chest radiographs and whole chest tomograms for both initial evaluation and follow-up in those patients. 67Ga had low sensitivity for neuroblastoma.
Adolescent↗
Diagnostic significance of persistent colonic gallium activity: scintigraphic patterns.
One hundred and forty-eight gallium scans were reviewed to determine the diagnostic significance of colonic gallium activity and its relationship to colonic disease. Location or intensity of the activity was unchanged during the course of the radionuclide study in 25 patients imaged more than once. Of those patients who had colonic gallium activity that did not change in location or intensity during the study, 9 had proved colonic disease. The patterns of colonic activity were either focal or diffuse. These distinct patterns, however, cannot distinguish benign from malignant disease.
Adult↗
Scintigraphic evaluation of lymphoma: a comparative study of 67Ga-citrate and 111In-Bleomycin.
Sequential whole-body scans with both 67Ga-citrate and 111In-bleomycin were performed for 14 patients undergoing staging for Hodgkin's disease or other lymphomas. A comparison or these scans gave a sensitivity in detecting the pathologically-proved tumor sites of 84% for 67Ga-citrate and only 56% for 111In-bleomycin. In 12 patients, the gallium scan demonstrated the lesions more clearly; in the others, the uptake of the two radionuclides was equal. In no case was a clinically diagnosed or histologically proved lesion identified by 111In-bleomycin that was not also demonstrated by 67Ga-citrate. 111In-bleomycin does not complement the 67Ga-citrate scan in the scintigraphic evaluation of lymphomas.
Adolescent↗