Mechanism of 67Ga Accumulation in Normal Rat Liver Lysosomes

Optimized scintigraphic evaluation of infection and inflammation: role of single-photon emission computed tomography/computed tomography fusion imaging

Gallium-67 citrate and radiolabeled white blood cells have become standard inflammation/infection-seeking agents whereas other agents, such as (99m)Tc diphosphonates, commonly are used to infer an infectious process. These radiopharmaceuticals reflect physiologic and pathologic function rather than anatomical abnormality. In the clinical setting, it is often necessary to correlate these functional studies with anatomical imaging. The advent of single-photon emission computed tomography, as well as positron emission tomography, provides tomographic images for direct correlation to anatomic modalities such as computed tomography and magnetic resonance imaging. The methods by which these functional and anatomic imaging modalities are correlated include side-by-side, software, and hardware fusion. Clinically, fusion imaging has been applied primarily to oncologic and neurologic applications. The literature supports the premise that multimodality fusion would increase the specificity of the physiologic modality and increase the sensitivity of the anatomic modality. Our institution uses software fusion to aid in the diagnosis of infection and inflammation. Through case vignettes, we illustrate applications for single-photon emission computed tomography/computed tomography fusion for the diagnosis of infection and inflammation in multiple organ systems.

The role of radionuclides in primary musculoskeletal tumors beyond the 'bone scan'

Radionuclides represent a means of functional imaging, which is able to reflect the metabolic state of tissues. Recently developed radiotracers and older radiotracers with newer applications, imaged through single photon emission computed tomography (SPECT) and positron emission tomography (PET), can provide significant information in the diagnosis, grading, therapy response or recurrence of primary musculoskeletal tumors. The unique ability of these radiotracers to demonstrate non-invasively the efflux pump rate, which is a common reason of therapy failure, as well as the metabolic and proliferative rates of the tumors should be a powerful tool in the orthopaedic oncology in the evaluation of musculoskeletal tumors.

Current role of gallium scanning in the management of lymphoma

Gallium 67 scanning in the malignant lymphomas has been done, with variable success, for over 20 years. After initial enthusiasm, the technique fell into disrepute and it was not until the early 1980s that it enjoyed a revival. There have been many major contributions to the literature, both favourable and unfavourable. The reasons for the latter include: poor instrumentation (only single-pulse height analysis), low gallium 67 doses, impatient and careless scanning techniques, timing of the study after treatment (chemotherapy, radiation) and insensitive methods of confirmation of the presence or absence of disease ("truth"). Anatomical diagnostic techniques (computed tomography, plain X-radiography, magnetic resonance imaging and others) are incapable of distinguishing viable tumour in normal-size lymph nodes or necrotic/fibrotic residual masses. With improvements in instrumentation (triple-pulse height analysis, gamma camera resolution and tomographic techniques) gallium 67 can detect active tumour in residual masses and in normal-size nodes. This is due to gallium 67's unique ability to localize in viable tumour cells. It has greater than 90% sensitivity, specificity, accuracy and positive predictive value in patients with lymphoma. Its major contributions are in: staging (changing management of mediastinal disease, obviating the need for a laparotomy and clearly identifying stage IV disease); detecting relapse or residual, progressive disease (it establishes true complete remission and is often the first and only evidence of relapse before clinical evidence); predicting response to therapy (failure to convert to a negative scan post-treatment signals a poor prognosis and alternative therapy is required); and predicting outcome--prognosis (it is the only diagnostic modality to predict outcome accurately).

Gallium distribution in several human brain areas

Gallium is an element of increasing biological interest: It is involved in problems related to environmental pollution (Ga compounds are used in electronics industry) and to clinical treatments (Ga radionuclides are employed to detect neoplastic lesions). Moreover, since its chemical behavior is similar to that of aluminum, gallium could play a role in the health effects attributed to this element. Data on naturally occurring Ga levels in human samples from healthy subjects are scanty; regarding the brain, the only reliable values available in the literature were published by Hamilton in 1972/73. In this work, the gallium distribution in several human brain areas, evaluated by radiochemical neutron activation analysis (RNAA), was found to be dishomogeneous. The element concentration determined in dry samples was, in any case, lower than the ppb level.

67Ga binding to sulfated proteoglycan in normal and CCl4-damaged liver

The binding of 67Ga and 59Fe to sulfated proteoglycan in the normal and CCl4-damaged mouse livers have been studied by means of Sepharose CL-4B column chromatography in guanidine hydrochloride. 67Ga uptake in the liver was elevated to approximately 1.8 times that of the control 2 days after a single administration of CCl4. 67Ga was bound to two types of sulfated proteoglycan (average mol. wt 1,700,000 and 35,000) in the normal and CCl4-damaged liver. However, the percentage of 67Ga bound to sulfated proteoglycan (mol. wt about 1,700,000) in the CCl4-damaged liver was increased as compared with that in the normal liver. Papain digestion of these sulfated proteoglycan fractions caused the 67Ga radioactivities to shift to a low molecular weight fraction (about 10,000). Cellulose acetate electrophoresis of this fraction (mol. wt about 10,000) isolated from the normal and CCl4-damaged livers resulted in identifying heparan sulfate (HS). The 35SO4 incorporation into HS band isolated from the CCl4-damaged liver, as an indicator of HS synthesis, was increased compared with that of the normal liver. 59Fe was not bound to sulfated proteoglycan and its gel filtration pattern was evidently different from that of 67Ga.

Relation between the location of elements in the periodic table and tumor-uptake rate

The bipositive ions and anions, with few exceptions, indicated a low tumor uptake rate. On the other hand, compounds of Hg, Au and Bi, which have a strong binding power to protein, showed a high tumor uptake rate. As Hg2+, Au+ and Bi3+ are soft acids according to the classification of Lewis acids, it was thought that these ions would bind strongly to soft bases (R-SH, R-S-) present in tumor tissue. For many hard acids such as 85Sr2+, 67Ga3+, 181Hf4+, and 95Nb5+, tumor uptake rates are shown as a function of ionic potentials (valency/ionic radii) of the metal ions. Considering the present data and previously reported results, it was presumed that hard acids of trivalence, quadrivalence and pentavalence would replace calcium in the calcium salts of hard bases (calcium salts of acid mucopolysaccharides, etc.). Ionic potentials of alkaline metals and Tl were small, but the tumor-uptake rate of these elements indicated various values. As Ge and Sb are bound by covalent bonds to chloride, GeCl4 and SbCl3 behaved differently from many metallic compounds in tumor tissue.