Transcript Gallium Images- 67 PPT

67 Gallium
Looking at the Diagnosis
Lymphomas
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Hodgkin’s and Non-Hodgkin’s are two classes of
lymphomas.
Hodgkin’s Lymphomas have a specific cell called
Reed-Sternburg.
All other lymphomas not having that cell are classified
as Non-Hodgkin’s Lymphomas.
From that point, Hodgkin’s and Non-Hodgkin’s are
classified into subcategories depending on symptoms
and cell structure.
Lymphoma
Normal Gallium Image
4 months prior
Abnormal Thallium Image
4 months ago showing:
Active non-Hodgkin's lymphoma in the
axilla and the left neck
Patient refused treatment at the time
Lymphoma
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Current 67Ga image showed new
findings of active non-Hodgkin's
lymphoma in the left axilla and left
neck.
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Tl-201 imaging showed findings of
active non-Hodgkin's lymphoma in
the left neck and bilateral axilla.
Compared to the prior 210Tl exam,
current image indicates increase
intensity and further extension of
disease
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Chemotherapy was initiated
Study Evaluated
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Experience suggests that 67Ga uptake in nonHodgkin's lymphoma has a proportional relationship
between intensity of uptake (and involvement) to
disease grade. Furthermore non-Hodgkin's
lymphomas tend to be more avid for 201Tl than 67Ga.
Thus, the interpretation of the imaging studies was
that there was a mixed population of non-Hodgkin's
lymphoma cells, and that both the higher and lower
grade non- Hodgkin's lymphoma cells were
proliferating in the axilla and left neck.
Hodgkin’s Lymphoma
Lung - Infection
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Gallium provides a means of sensitive detection of
an active pulmonary infection.
The degree of gallium uptake correlates with the
degree of activity of the inflammatory site.
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Gallium uptake is seen in
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Active TB
Opportunistic infections
Diffuse infiltrative lung disease
Sarcoidosis
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A rare disease of unknown cause in which inflammation occurs in
lymph nodes and other tissues throughout the body, usually the
lungs, liver, skin and eyes.
Symptoms include fever and generalized aches. There may also be
enlargement of lymph nodes in the neck or elsewhere,
breathlessness, arthritis, or erythema nodosum (red purple
swellings on the legs)
Sarcoidosis
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Sarcoidosis
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Symptoms for acute sarcoidosis include fever and generalized aches.
There may also be enlargement of lymph nodes in the neck or
elsewhere, breathlessness, arthritis, or erythema nodosum (red purple
swellings on the legs)
Symptoms for chronic are fever, purple rash on the face, painful joints,
painful blood shot eyes, and areas of numbness.
Sometimes there are no symptoms.
90% of patients recover in two years. Corticosteroids are prescribed to
treat the disease.
When performing a gallium scan for sarcoidosis, you are looking for
the extent of involvement of the lymph nodes.
Sarcoidosis
Panda sign
Lambda sign - Λ
Lung Gallium
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A 49 year-old, diabetic male was
admitted 10 days prior to the scan
for debridement of his right foot
ulcer. Following the procedure the
patient had persistent fevers,
leukocytosis and worsening
respiratory function. A gallium
scan was requested to localize a
source of infection.
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Diagnoisis-Acute Respiratory
Distress Syndrome (ARDS)
Quantitative Lung Index
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Data is helpful in measuring the response to
therapy.
The degree and extent of abnormal uptake in
the lungs correlates with many lung
inflammatory disorders.
Abdominal Imaging with Gallium
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The abdomen is difficult to image with gallium
because after the first 24 hours, there may be colon
uptake due to excretion of the isotope.
Enemas can be administered to move the colon
contents.
If questionable area does not move and stays in the
same area post enema/laxative then this could be an
indication of disease.
111In or 99mTc-WBC may be the more appropriate
study when evaluating the abdominal processes
Liver Imaging with Gallium
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Gallium concentrates in hepatic abscesses and
neoplasms, but not in cysts hematomas, or non
infectious fluid collections.
In conjunction with 99mTc-sulfur colloid, a liver scan
should be done prior to a 67Ga scan (more specifically
the injection).
111 Indium and 99mTc labeled WBCs also localize in
hepatic abscesses, but not in cysts, hematomas, or non
infectious fluid collections.
Gallium in Liver Imaging
Anterior
Transverse
Posterior
Coronal
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Differentiating a
hepatoma from
surrounding tissue in a
cirrhotic liver
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Diagnosis
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Gallium-67 is taken up by
hepatoma cells giving a
"hot spot" or at least an
area of equal uptake to
surrounding liver
Renal Imaging with Gallium
 99mTc
renal imaging agents will show focal
abnormalities and usually diminished overall function
in the kidney with pyelonephritis or abscess.
Gallium imaging adds specificity.
 Gallium concentrates in active pyelonephritis, while normal
kidneys imaged 48 hours after gallium injection show no
uptake. Note – kidneys should only be seen at 24 hours.
Why?
 Gallium imaging can help in distinguishing lower urinary
tract infection from upper tract disease, or by diagnosing
both.
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Subcapsular Hematoma of the
Left Kidney
99mTc Renal
Gallium Scan
Patient diagnosed with subcapsular
hematoma of the left kidney on CT.
Because of recurrent episodes of
unexplained fever a Gallium Scan
was performed to rule out abscess
formation in the left perinephric
hematoma. There was no uptake in
the left kidney region. The right
kidney, however, showed intense
homogeneous Gallium uptake post
24 hours.
Gallium in AIDS Patients
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Gallium is useful in imaging patients who have
AIDS, because they can have a variety of
infections that will be detected on a whole body
gallium scan.
Disorders in AIDS Patients
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Pneumocystis carinii
pneumonia (PCP)
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infection; oral lesions which
adhere to oral mucosa
common herpes virus that usually
has no symptoms
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airborne, found in soil esp.
contaminated with pigeon
droppings--can cause meningitis
Herpes simplex
Hodgkin’s (malignant disorder of
the lymphoid tissue, more sever
than Non Hodgkin’s
Toxoplasmosis
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blue/red malignant skin tumors
that usually start at the feet then
spread
Lymphoma
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Cryptococcus
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Cytomegalovirus
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Kaposis Sarcoma
caused by single celled parasite;
symptoms dry cough and SOB
Candida esophagitis
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Caused by bacteria in rare meat
from infected animals
Myciobacterium
aviumintrcellulare (MAI)
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in family with tuberculosis
organism
Imaging PCP Patients
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If a patient is undergoing therapy for PCP the gallium
uptake can be less intense than those patients not
being treated.
Gallium is positive in the lungs in 100% of patients
with AIDS and PCP, who are asymptomatic.
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Shows the importance of a gallium scan in AIDS patients
with negative chest x-ray studies.
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It can be a baseline for future indications, severity and extent of
the infection, which can be used as a guideline for further
diagnostic interventions.
Gallium Scan in AIDS Patient
42 year old male, 3 week
history of fevers/sweats. No
respiratory symptoms such as
cough or sputum. Diagnosed
as HIV positive 5 years
earlier. CXR was normal.
Gallium scan revealed diffuse
lung uptake. Washings from
fibreoptic bronchoscopy
confirmed pneumocystis
carinii (PCP) infection.
Gallium in AIDS Imaging
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43 year old male with AIDS. SOB, non-productive cough, &
fever for 2 days. Chest x-ray showed bilateral interstitial and
alveolar infiltrates. Gallium scan to rule out pneumocystis carinii
pneumonia (PCP).
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Diffuse bilateral increased lung uptake suggestive of
Pneumocystis Carinii Pneumonia(PCP).
Bone Imaging With Gallium
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bone agents are sensitive in detecting the increased
bone blood flow and bone mineral turnover associated
with osteomyelitis, localizing the disease process 1-2
weeks before discernible radiograph changes take place.
 Three phase is useful in distinguishing between osteo and
cellulitis.
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But again, many bony abnormalities provoke a similar bone
response, including benign or malignant neoplasms, infarct
repair, trauma and post-surgical changes.
Bone/Gallium Scan
 99mTc-MDP
bone scan shows increased
activity in the left SI Joint.
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Ga 67 scan was positive in the same
region.
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Follow-up x-rays of the left femur showed
calcifications which appeared to be within
the marrow and suspicious of infarction.
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67Ga further identified an infection in the
same area.
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Blood cultures confirmed infection and
the patient was put on Ab therapy