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Gallium-67 scintigraphy: a cornerstone in functional imaging of lymphoma

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Abstract

Until recently, gallium-67 scintigraphy (GS) has been the best available functional imaging modality for evaluating patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). The diagnostic accuracy of GS in detecting lymphoma is based on optimisation of the imaging protocol, knowledge of potential physiological and benign sites of 67Ga uptake, and the Ga avidity characteristics of the individual lymphoma. As 67Ga is a tumour viability agent, the role of GS is primarily at follow-up. A residual mass persisting on CT after treatment poses a common clinical dilemma: it may indicate the presence of viable lymphoma, which requires further treatment, or it can be benign, consisting of only fibrotic and necrotic tissues. GS can successfully differentiate between these conditions. Routine follow-up with GS may allow early diagnosis of recurrence and early institution of treatment. Reversion of a positive GS to a negative test, and the rapidity with which this occurs has a high predictive value for the outcome of the individual patient. Lymphoma showing a normal GS early during treatment has a better prognosis than lymphoma with persistence of pathological findings. Other tumour-seeking single-photon emitting agents, such as thallium-201, technetium-99m methoxyisobutylisonitrile and indium-111 octreotide, have been investigated in lymphoma, primarily as an alternative to GS in specific clinical settings, but are of limited value. The role of radioimmunoscintigraphy is gaining importance in conjunction with radioimmunotherapy. Fluorine-18 fluorodeoxyglucose (FDG) imaging of lymphoma using either dedicated or camera-based PET systems is gradually replacing GS for assessment of lymphoma. FDG overcomes some of the limitations of GS while sharing its tumour viability characteristics. The extensive clinical knowledge and experience accumulated over three decades with GS in lymphoma provides a solid background as well as a model for the assessment of new functional imaging techniques.

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Acknowledgement

The authors wish to dedicate this paper to their teacher and mentor, Professor Dov Front, MD, PhD. His pioneering work on the role of nuclear medicine as a functional imaging modality for monitoring response to treatment and prediction of outcome has been best illustrated in the numerous contributions on the value of 67Ga scintigraphy for the evaluation of lymphoma. These contributions represent the model for present and future studies assessing the clinical value of a new generation of functional imaging techniques.

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  1. Department of Nuclear Medicine, Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Einat Even-Sapir

  2. Department of Nuclear Medicine, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, 35254, Haifa, Israel

    Ora Israel

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  1. Einat Even-Sapir
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  2. Ora Israel
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Correspondence to Ora Israel.

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Even-Sapir, E., Israel, O. Gallium-67 scintigraphy: a cornerstone in functional imaging of lymphoma. Eur J Nucl Med Mol Imaging 30 (Suppl 1), S65–S81 (2003). https://doi.org/10.1007/s00259-003-1164-7

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