Clinical Value of Gallium-67 Scintigraphy in the Investigation of Fever ok Inflammation of Unknown Origin in the Ultrasound and Computed Tomography Era

Abstract

Gallium scintigraphy was performed in 54 consecutive patients hospitalized for exploration of fever or inflammation of unknown origin, in whom thorough initial exploration did not yield any clue. Only in 28 patients (51.8%) could a definite diagnosis be established. The positive gallium scintigraphy results were clinically rated as valuable, questionable or valueless according to their contribution to the diagnosis. Gallium scintigraphy was positive in 22 patients (40%) and deemed valuable in 13 patients (24%). A final diagnosis could be ascertained in 77% of the cases with a positive scintigram. In contrast a cause of fever or inflammation was found only in 34% of the cases with a negative scintigram. Gallium scintigraphy is valuable as an early localizing investigation rather than a last resort test in patients with fever or inflammation of unknown origin. A positive scintigram increases the chances of establishing a final diagnosis.

Use of immunoscintigraphy in the diagnosis of fever of unknown origin

“…The disadvantages of using 6VGa are its excretion in the bowel, multipeak high-energy photons with impaired image quality, and low specificity due to its avidity for malignancies, particularly lymphomas. When 67Ga has been used in patients with FUO, a wide range of sensitivities has been reported, from 34% to 75% [9,[23][24][25][26][27][28]. The use of labelled leucocytes with mIn-oxine or 99~Tc-hexamethylpropylene amine oxime gives sensitivities of 80%-100% and specificities of 75%-99% for the detection of infectious diseases [29][30][31][32][33][34][35][36].…”

Tuberculous epididymo‐orchitis presenting as pyrexia of unknown origin during acute myeloid leukaemia consolidation therapy

“…PUO remains a significant diagnostic challenge, particularly in the setting of haematological malignancy. Early reports showed gallium‐67 whole‐body scintigraphy to be useful in this setting, with one study reporting a definite yield in 52% of 54 consecutive patients 1 . More importantly, no other diagnostic procedure could show a cause in 34% of cases with a negative scintigram.…”

“…Early reports showed gallium-67 whole-body scintigraphy to be useful in this setting, with one study reporting a definite yield in 52% of 54 consecutive patients. 1 More importantly, no other diagnostic procedure could show a cause in 34% of cases with a negative scintigram. Other workers have also reported similar yields in approximately 50% of tested cases, causes ranging from the myeloproliferative and lymphoproliferative malignancies to infections.…”

Nuklearmedizinische Diagnostik prolongierter Fieberzustände

“…Aufgrund einer Anreicherung in akuten und chronischen Entzündungen und Tumoren [62,148] wurde 67 Ga-Zitrat im Angloamerikanischen Sprachraum bis vor kurzem als Tracer der ersten Wahl bei der Abklärung von FUO angesehen [114]. In den Studien mit 67 Ga-Zitrat bei FUO-Patienten wurden in der Regel, abweichend von der für die 111 In-Leukozytenszintigrafie angewandten Befundinterpretation, solche Szintigramme als richtig positiv angesehen, bei denen der Nachweis eines für das Fieber verantwortlichen tumorösen oder entzündlichen Fokus gelang [24,35,55,71,74,80,96,99,133,138]. Der prozentuale Anzahl der Scans, die wesentlich zur endgültigen Diagnose beitrugen, lag in den publizierten Serien zwischen 12 und 48 % (im Median bei 28 %) und somit höher als bei Verwendung von 111 In-markierten Leukozyten [24,35,55,71,74,80,96,99,133,138].…”