title: The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease.
abstract: The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.
authors.affiliation: Department of Radiology, Hospital das Clínicas, São Paulo University School of Medicine, Capital, Brazil. itaya@einstein.br
authors.forename: L Y I
authors.initials: LY
authors.lastname: Yamaga
authors.forename: G
authors.initials: G
authors.lastname: Benard
authors.forename: F H
authors.initials: FH
authors.lastname: Hironaka
authors.forename: L G
authors.initials: LG
authors.lastname: Castro
authors.forename: M G
authors.initials: MG
authors.lastname: Funari
authors.forename: C C
authors.initials: CC
authors.lastname: de Castro
authors.forename: C
authors.initials: C
authors.lastname: Guertzenstein
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: C
authors.initials: C
authors.lastname: Buchpiguel
authors.forename: G G
authors.initials: GG
authors.lastname: Cerri
authors.forename: M A
authors.initials: MA
authors.lastname: Shikanai-Yasuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000000981:diagnostic imaging*; D010229:Paracoccidioidomycosis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D005710:Gallium Radioisotopes