Gallium scan
Gallium-67 scan | |
---|---|
Synonyms | Gallium imaging |
ICD-10-PCS | C?1?LZZ (planar) C?2?LZZ (tomographic) |
ICD-9-CM | 92.18 |
OPS-301 code | 3-70c |
MedlinePlus | 003450 |
A gallium scan is a type of
Gallium salts are taken up by tumors, inflammation, and both acute and chronic infection,[3][4] allowing these pathological processes to be imaged. Gallium is particularly useful in imaging osteomyelitis that involves the spine, and in imaging older and chronic infections that may be the cause of a fever of unknown origin.[5][6]
Gallium-68 DOTA scans are increasingly replacing octreotide scans (a type of
Gallium citrate scan
In the past, the gallium scan was the
infections, and it still sometimes locates unsuspected tumors as it is taken up by many kinds of cancer cells in amounts that exceed those of normal tissues. Thus, an increased uptake of gallium-67 may indicate a new or old infection, an inflammatory focus from any cause, or a cancerous tumor.It has been suggested that gallium imaging may become an obsolete technique, with
In infections, the gallium scan has an advantage over indium leukocyte imaging in imaging
Mechanism
The body generally handles Ga3+ as though it were
Lactoferrin is contained within leukocytes. Gallium may bind to lactoferrin and be transported to sites of inflammation, or binds to lactoferrin released during bacterial
Common indications
- Whole-body survey to localize source of fever in patients with fever of unknown origin.[20]
- Detection of immunocompromised patient.[21]
- Evaluation and follow-up of active lymphocytic or
- Diagnosing vertebral osteomyelitis and/or disk space infection where gallium-67 is preferred over labeled leukocytes.
- Diagnosis and follow-up of medical treatment of retroperitoneal fibrosis.
- Evaluation and follow-up of drug-induced pulmonary toxicity (e.g. Bleomycin, Amiodarone)
- Evaluation of patients who are not candidates for WBC scans (WBC count less than 6,000).
Note that all of these conditions are also seen in PET scans using the gallium-68.
Technique
The main (67Ga) technique uses
A common injection dose is around 150 megabecquerels.[25] Imaging should not usually be sooner than 24 hours as high background at this time produces false negatives. Forty-eight-hour whole body images are appropriate. Delayed imaging can be obtained even 1 week or longer after injection if bowel is confounding. SPECT can be performed as needed. Oral laxatives or enemas can be given before imaging to reduce bowel activity and reduce dose to large bowel; however, the usefulness of bowel preparation is controversial.[24]
10% to 25% of the dose of gallium-67 is excreted within 24 hours after injection (the majority of which is excreted through the kidneys). After 24 hours the principal excretory pathway is colon.[24] The "target organ" (organ that receives the largest radiation dose in the average scan) is the colon (large bowel).[23]
In a normal scan, uptake of gallium is seen in wide range of locations which do not indicate a positive finding. These typically include soft tissues,
Gallium PSMA scan
The positron emitting isotope, 68Ga, can be used to target
In December 2020, the U.S. Food and Drug Administration (FDA) approved 68Ga PSMA-11 for medical use in the United States.[28][29] It is indicated for positron emission tomography (PET) of prostate specific membrane antigen (PSMA) positive lesions in men with prostate cancer.[30][29] It is manufactured by the UCLA Biomedical Cyclotron Facility.[29] The FDA approved 68Ga PSMA-11 based on evidence from two clinical trials (Trial 1/NCT0336847 identical to NCT02919111 and Trial 2/NCT02940262 identical to NCT02918357) of male participants with prostate cancer.[29] Some participants were recently diagnosed with the prostate cancer.[29] Other participants were treated before, but there was suspicion that the cancer was spreading because of rising prostate specific antigen or PSA.[29] The trials were conducted at two sites in the United States.[29]
The FDA considers 68Ga PSMA-11 to be a first-in-class medication.[31]
Common indications
Gallium PSMA scanning is recommended primarily in cases of biochemical recurrence of prostate cancer, particularly for patients with low PSA values, and in patients with high risk disease where metastases are considered likely.[32][33]
Technique
An
Gallium DOTA scans
68Ga
In June 2016, Netspot (kit for the preparation of gallium Ga-68 dotatate injection) was approved for medical use in the United States.[39][40]
In August 2019, 68Ga edotreotide injection (68Ga DOTATOC) was approved for medical use in the United States for use with PET imaging for the localization of somatostatin receptor positive neuroendocrine tumors (NETs) in adults and children.[41][42][43]
The U.S. Food and Drug Administration (FDA) approved 68Ga edotreotide (DOTATOC) based on evidence from three clinical trials (Trial 1/NCT#1619865, Trial 2/NCT#1869725, Trial 3/NCT#2441062) of 334 known or suspected neuro-endocrine tumors.[42] The trials were conducted in the United States.[42]
Gallium (68Ga) oxodotreotide was approved for medical use in Canada as Netspot in July 2019,[44] and as Netvision in May 2022.[45]
Radiochemistry of gallium-67
Gallium-67 citrate is produced by a cyclotron. Charged particle bombardment of enriched Zn-68 is used to produce gallium-67. The gallium-67 is then complexed with citric acid to form gallium citrate. The half-life of gallium-67 is 78 hours.
Radiochemistry of gallium-68
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