title: Comparison of gallium scan, computed tomography, and magnetic resonance in patients with mediastinal Hodgkin's disease.
abstract: BACKGROUND
  In patients with Hodgkin's disease, the use of gallium-67 scintigraphy (Ga-67) compared to conventional staging and restaging techniques is still controversial. In particular, in a combined modality treatment with chemotherapy and radiotherapy given in sequence, its role in detecting active disease after chemotherapy may be useful in planning the subsequent radiotherapeutic strategy.
  
  
  METHODS
  From March 1990 to September 1994, 125 patients with previously untreated histologically proven Hodgkin's disease were enrolled in two different prospective trials according to clinical stage. Staging procedures included Ga-67, chest-abdominal computed tomography (CT), and/or magnetic resonance (MR). All three tests were performed in 53 patients at staging and in 47 at restaging. Results of Ga-67 at staging were compared to conventional procedures or pathological findings. Results of Ga-67, CT scan, and MR at restaging were compared to disease outcome during the follow-up. Finally a cost/benefit ratio for each test was determined.
  
  
  RESULTS
  At staging, Ga-67 showed lower sensitivity than CT and MR (90 vs. 96 and 100%, respectively) because of the number of false-negative images. Nevertheless, by using both CT and Ga-67 scan, the sensitivity is equal to that observed with MR (100%). At restaging, Ga-67 is superior to CT scan and equivalent to MR in detecting true negative patients (specificity: 98% vs. 45% vs. 92%).
  
  
  CONCLUSIONS
  As a single technique, Ga-67 scan cannot substitute for CT scan or MR in staging patients with Hodgkin's disease. Nevertheless, Ga-67 scan has an important role in defining complete remission after treatment and therefore in planning subsequent treatment. Considering the lower costs of CT scan plus Ga-67 ($320) versus MR alone ($810), the two tests may be considered procedures of choice in staging as well as in restaging patients with Hodgkin's disease.
authors.affiliation: Division of Medical Oncology A, Istituto Nazionale Tumori, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Devizzi
authors.forename: L
authors.initials: L
authors.lastname: Maffioli
authors.forename: V
authors.initials: V
authors.lastname: Bonfante
authors.forename: S
authors.initials: S
authors.lastname: Viviani
authors.forename: L
authors.initials: L
authors.lastname: Balzarini
authors.forename: M
authors.initials: M
authors.lastname: Gasparini
authors.forename: P
authors.initials: P
authors.lastname: Valagussa
authors.forename: E
authors.initials: E
authors.lastname: Bombardieri
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.forename: G
authors.initials: G
authors.lastname: Bonadonna
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005710:Gallium Radioisotopes; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics
chemical_list: D005710:Gallium Radioisotopes