Combined 67Ga citrate and 99Tcm-human immunoglobulin imaging in human immunodeficiency virus-positive patients with fever of undetermined origin.
Patients infected with the human immunodeficiency virus (HIV) suffer from serious and life-threatening infections. These patients often present with pyrexia but without localizing signs. Despite its high sensitivity in identifying focal infection 67Ga citrate scintigraphy lacks specificity; lymphoma and solid tumours may also be imaged. This presents particular problems in HIV-positive patients with pyrexia where the differential diagnosis is often between infection and lymphoma. In an attempt to improve the specificity of radionuclide imaging in these patients a combination of 67Ga citrate and the new agent 99Tcm-labelled human immunoglobulin (99Tcm-HIG) was used in 25 patients who were sequentially imaged with the two agents. Fourteen patients had 29 sites of microbiologically confirmed infection; 67Ga citrate identified 27 sites and 99Tcm-HIG identified 16 sites. Seven of the nine sites visualized with 99Tcm-HIG, but positive with 67Ga citrate, were intrathoracic. Abnormal concentration of 67Ga citrate, not due to infection, occurred at eight sites; five lymphoma, one gout, one recent fracture and one patient with prominent bone marrow islands. 99Tcm-HIG showed increased concentration of tracer in only one of the patients with lymphoma. A combination of 67Ga citrate and 99Tcm-HIG imaging in HIV-positive patients with pyrexia of unknown origin enables a differentiation between infection and lymphoma to be made more readily. The poor sensitivity of 99Tcm-HIG in the chest will limit its sole use in this patient group.
Institute of Nuclear Medicine, University College and Middlesex School of Medicine, London, UK.
J R
JR
Buscombe
R F
RF
Miller
D
D
Lui
P J
PJ
Ell
D000328:Adult; D002951:Citrates; D019343:Citric Acid; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging* / Q000209:etiology; D005710:Gallium Radioisotopes; D006679:HIV Seropositivity / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007136:Immunoglobulins; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013667:Technetium
D002951:Citrates; D005710:Gallium Radioisotopes; D007136:Immunoglobulins; C065376:technetium Tc 99m immunoglobulin; D019343:Citric Acid; D013667:Technetium