Joung-Liang Lan

Tc-99m Albumin Scintigraphy To Monitor the Effect of Treatment in Protein-losing Gastroenteropathy

PURPOSE Tc-99m albumin scintigraphy is a noninvasive method for detecting protein-losing gastroenteropathy. METHODS Seven patients with protein-losing gastroenteropathy were evaluated with Tc-99m albumin scintigraphy. In addition, Tc-99m albumin scintigraphy was used to monitor the effect of treatment in five of these seven patients. The scintigraphic results were compared with serum albumin levels. RESULTS All seven patients had positive results in the pretreatment images. Changes in scintigraphic findings in the five treated patients correlated well with changes in serum albumin level. CONCLUSION Tc-99m albumin scintigraphy is useful not only for diagnosing protein-losing gastroenteropathy but also for monitoring the effect of treatment.

Value of Gallium-67 Scintigraphy in Monitoring the Renal Activity in Lupus Nephritis

In this study, we evaluated the relationship between the gallium uptake in the kidneys and the results of renal biopsy. The renal uptake of gallium in 32 patients with lupus nephritis were evaluated according to the classification of the World Health Organization, the activity index (AI), and the chronicity index (CI). AI was significantly higher in patients with a positive gallium scan when compared with patients with a negative gallium scan (p = 0.0007). However, change in gallium uptake was not related to the CI or WHO classification (p = 0.68 and p = 0.79 respectively). Of the 16 patients with AI > or = 9, 13 (81.25%) had a positive gallium scan, while only 3 (18.7%) of the patients with AI < 9 had a positive scan. In addition, all patients (100%) with AI > or = 11 showed a positive gallium scan. We conclude that renal imaging with gallium has a good correlation with AI, and may be a useful alternative to renal biopsy in patients with lupus nephritis.

Demonstration of necrotizing fasciitis on Ga-67 scans in a patient with systemic lupus erythematosus

A 17-year-old girl with a history of systemic lupus erythematosus with lupus nephritis for 6 years was found to have progressive superficial tenderness over the medial aspect of the right thigh. In addition, darkening of the skin of the right thigh with an ecchymosis-like appearance developed in the following hours. Ga-67 scans performed to evaluate inflammation of the skin revealed increased uptake in the involved areas. Skin biopsy was performed, and the pathologic diagnosis was necrotizing fasciitis.

Lupus cystitis on Ga-67 scans.

A 46-year-old woman with systemic lupus erythematosus had hematuria, fever, and proteinuria. She was transferred to the nuclear medicine department for evaluation of the disease activity of lupus nephritis. A Ga-67 scan showed increased radioactivity in both kidneys. Active nephritis was suggested. Furthermore, increased Ga-67 uptake in the wall of the urinary bladder was also noted. Lupus cystitis was indicated. A bladder biopsy confirmed the diagnosis.

Does Image Time Affect Semi-Quantitative Result of Gallium-67 Renal Scan?

Purpose: Gallium renal imaging has been reported to be useful in monitoring disease activity and predicting the response to therapy in lupus nephritis. Gallium imaging is usually performed 48-72 h following administration of the 67Ga-citrate. The aim of the present study was to determine whether the imaging time affects the semi-quantitative result of gallium renal scintigraphy.Methods: One hundred and twenty-two patients with lupus nephritis underwent gallium renal imaging at both 48 h and 72 h post injection of 111 MBq (3 mCi) 67Gacitrate. For semi-quantitative analysis of the gallium uptake in the kidneys, regions of interest (ROI) were drawn over the left kidney, the left forearm and the adjacent spine. The uptake ratios were calculated and expressed as ”Kidney/Spine ratio (K/S ratio)” or ”Kidney/Arm ratio (K/A ratio)”.Results: The correlation of both the left K/S ratios and the left K/A ratios from the 48-h and 72-h renal images was excellent. The mean left K/S ratio obtained from 48-h and 72-h images was 0.969 and 0.964 (P = 0.241). Whereas, the mean left K/A ratio from 48-h and 72-h images was 3.421 and 3.547 (P = 0.000043).Conclusions: There is no statistical difference of the left K/S ratios from 48-h and 72-h images. However, the left K/A ratio was significantly affected by the imaging time.