Clinical value of gallium-67 SPECT scintigraphy in the diagnostic and therapeutic evaluation of retroperitoneal fibrosis: a prospective study.
BACKGROUND
Gallium-67 (67Ga) scintigraphy may be useful in evaluating patients with retroperitoneal fibrosis (RPF), but a systematic assessment of its value is lacking.


OBJECTIVE
Prospective evaluation of the value of 67Ga scintigraphy in assessing active RPF disease and in predicting treatment response.


METHODS
Thirty-four patients with nonmalignant RPF treated with tamoxifen underwent 67Ga scintigraphy at baseline and--if baseline gallium scan was positive--at 3 months follow-up. Gallium scans were visually scored according to pathologic 67Ga-uptake compared to normal bone marrow 67Ga-uptake. Results were correlated with other (follow-up) measurements. Value of (follow-up) 67Ga scintigraphy in predicting treatment response was also assessed.


RESULTS
Gallium scans were positive in 24 patients (71%). Mass thickness was greater in patients with positive gallium scan compared with patients with negative gallium scan (P = 0.006). Visual gallium score correlated with mass thickness (P = 0.006). Visual gallium score decreased significantly following tamoxifen treatment (P < 0.0001). Decrease in visual gallium score correlated with decreases in C-reactive protein and erythrocyte sedimentation rate (P = 0.019) and with decrease in mass thickness (P < 0.01). Positive predicting value (PPV) of positive baseline gallium scan was 0.71; PPV of negative follow-up gallium scan in patients with initial positive scan was 0.89. 67Ga scintigraphy detected extra-abdominal involvement in one patient and recurrent active disease in two symptomatic patients with normal acute-phase reactants and stable residual mass.


CONCLUSIONS
67Ga scintigraphy is useful in assessing (recurrent) activity of RPF disease and in evaluating treatment response in patients with initial positive gallium scan.
van Bommel
E F H
EF
Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands. e.f.h.vanbommel@asz.nl
Siemes
C
C
van der Veer
S J
SJ
Han
S H
SH
Huiskes
A W L C
AW
Hendriksz
T R
TR
D000368:Aged; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012185:Retroperitoneal Fibrosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D012680:Sensitivity and Specificity; D013629:Tamoxifen / Q000627:therapeutic use; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
D004965:Estrogen Antagonists; D005710:Gallium Radioisotopes; D013629:Tamoxifen; D002097:C-Reactive Protein