The value of gallium-67 and thallium-201 whole-body and single-photon emission tomography images in dialysis-related β2-microglobulin amyloid

Abstract

The aim of this study was to investigate the value of gallium-67 and thallium-201 whole-body and single-photon emission tomography (SPET) images in long-term dialysis patients in whom dialysis-related beta 2-microglobulin amyloid (beta 2-MA) was clinically suspected. Twenty-three patients who had received dialysis for at least 10 years were included in the study. A technetium-99m methylene diphosphonate (MDP) whole-body scan was performed in all of the patients. If there was any MDP accumulation in the articular and/or peri-articular region, 67Ga and 201Tl whole-body and SPET images were then acquired. If any 67Ga and/or 201Tl uptake was observed, a CT-guided biopsy was done. In those patients who had articular and/or peri-articular uptake of 99mTc MDP, 67Ga and/or 201Tl and who were pathologically proven to have beta 2-MA, 99mTc MDP, 67Ga and 201Tl whole-body scans and SPET were carried out again, both 3 months and 1 year after initiation of treatment. This served to evaluate the therapeutic effect and allowed comparison with the clinical findings. Of the 23 patients, eight had abnormal 99mTc MDP uptake. Among these eight, six had intense 99mTc MDP, 67Ga and 201Tl uptake in the articular and peri-articular regions before medication. Three months after the start of treatment, there were very marked decreases in uptake on both the 67Ga and 201Tl scans but less obvious changes in uptake of 99mTc-MDP. In comparison with the other clinical manifestations such as limitation in range of motion, the more the painful disability improved, the less was the uptake on both 67Ga and 201Tl scans. There were virtually no differences in uptake pattern between the three scans of each radiopharmaceutical obtained for each patient in both 3 months and 1 year after initial of treatment. It is concluded that 99mTc-MDP whole-body bone scan can both detect active and pre-existing inactive deposits of beta 2-MA. 67Ga and 201Tl scans are helpful to differentiate active from inactive deposits of beta 2-MA and to evaluate the therapeutic effect on these patients. SPET images are usually needed to distinguish articular and periarticular lesions from bone lesions.

90Y bremsstrahlung emission computed tomography using gamma cameras

“…In contrast, one BECT image can be acquired in 33 min using the sum window, and one whole-body BECT image can be acquired in 132 min using about 1,000 MBq. This acquisition time is comparable to the 130 min required for whole-body SPECT imaging of bone and tumors using 925 MBq 99m Tc [31]. The acquisition time of 132 min for the sum window is realistic for 90 Y whole-body BECT imaging compared with SPECT.…”

“…The triple energy window (TEW) method has been used to reduce the scattered photons in SPECT imaging using radionuclides having a single photon peak [28][29][30][31]. However, it is impossible to distinguish scattered photons Relationships between activity and count rate.…”

Imaging in the Dialysis Patient: Nuclear Medicine Studies in the Dialysis Patient

“…The radionuclide bone scan in Aβ 2 M amyloidosis is neither specific nor very sensitive (47). Imaging with gallium 67 citrate or Tl‐201 chloride has been reported to be accurate in evaluating the activity and response to therapy of such lesions (48).…”

Diagnosis of Systemic Amyloid Diseases

“…Gallium-67 and thallium-201 single-photon emission tomography has been used to study dialysis amyloidosis [52]. This technique was compared to imaging with technetium-labeled methylene diphosphonate.…”