The Role of Gallium (Ga-67) Scintigraphy in the Diagnosis of Sarcoidosis

A. B. Allard, J. Buscombe, D. P. Kidd

Department of Clinical Neurosciences, Royal Free Hospital, London, UK.
Department of Nuclear Medicine, Royal Free Hospital, London, UK.

DOI: 10.4236/mri.2014.33012                

Abstract

Purpose: To identify and interrogate the role of Gallium-67 scintigraphy in the diagnosis of Sarcoidosis. Methods: A retrospective study of 75 patients with suspected Sarcoidosis in a large teaching hospital with a specialist Sarcoidosis Centre. Results: Ga-67 scintigraphy in patients considered on clinical grounds to have Sarcoidosis is a useful and sensitive test, and furthermore, by relaxing the interpretation of gallium scintigraphy sensitivity may be increased (from 20% to 80%) for a relatively small drop in specificity. Conclusions: The sensitivity of diagnostic power may be increased with a change in diagnostic criteria at the expense of only a small drop in specificity. In the context of Neurosarcoidosis, our results support the theory that Ga-67 scintigraphy has value in identifying potential, asymptomatic biopsy sites outside of the CNS that may not be identified by other forms of imaging.

Keywords

Sarcoidosis, Neurosarcoidosis, Gallium Scintigraphy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mayock, R.L., Bertrand, P., Morrison, C.E. and Scott, J.H. (1963) Manifestations of Sarcoidosis—Analysis of 145 Patients, with a Review of Nine Series Selected from the Literature. The American Journal of Medicine, 35, 67-89. http://dx.doi.org/10.1016/0002-9343(63)90165-7
[2]	Joint Statement on Sarcoidosis (JSS) (1999) Statement on Sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) Adopted by the ATS Board of Directors and by the ERS Executive Committee. American Journal of Respiratory and Critical Care Medicine, 160, 736-755.
[3]	Kidd, D. and Beynon, H.L.C. (2003) Neurological Complications of Systemic Sarcoidosis. Sarcoidosis, Vasculitis and Diffuse Lung Diseases, 20, 85-94.
[4]	Rybicki, B.A., Major, M., Popovich Jr., J., Maliarik, M.J. and Iannuzzi, M.C. (1997) Racial Differences in Sarcoidosis Incidence: A 5-Year Study in a Health Maintenance Organization. American Journal of Epidemiology, 145, 234-241. http://dx.doi.org/10.1093/oxfordjournals.aje.a009096
[5]	Milman, N. and Selroos, O. (1990) Pulmonary Sarcoidosis in the Nordic Countries 1950-1981: Epidemiology and Clinical Picture. Sarcoidosis, 7, 50-57.
[6]	Pietinalho, A., Hiraga, Y., Hosoda, Y., Lofroos, A.B., Yamaguchi, M. and Selroos, O. (1995) The Frequency of Sarcoidosis in Finland and Hokkaido, Japan: A Comparative Epidemiological Study. Sarcoidosis, 12, 61-67.
[7]	Woodard, B.H., Rosenberg, S.I., Farnham, R. and Adams, D.O. (1982) Incidence and Nature of Primary Granulomatous Inflammation in Surgically Removed Material. The American Journal of Surgical Pathology, 6, 119-129. http://dx.doi.org/10.1097/00000478-198203000-00004
[8]	Sulavik, S.B., Spencer, R.P., Weed, D.A., Shapiro, H.R., Shiue, S.T. and Castriotta, R.J. (1990) Recognition of Distinctive Patterns of Gallium-67 Distribution in Sarcoidosis. Journal of Nuclear Medicine, 31, 1909-1914.
[9]	Schuster, D.M. and Alazraki, N. (2002) Gallium and Other Agents in Diseases of the Lung. Seminars in Nuclear Medicine, 32, 193-211. http://dx.doi.org/10.1053/snuc.2002.124178
[10]	Ota, K., Tsunemi, T., Saito, K., Yamanami, F., Watanabe, M., Irioka, T. and Mizusawa, H. (2009) 18F-FDG PET Successfully Detects Spinal Cord Sarcoidosis. Journal of Neurology, 256, 1943-1946.
[11]	Treglia, G., Taralli, S. and Giordano, A. (2011) Emerging Role of Whole Body 18F-Fluorodeoxyglucose Positron Emission Tomography as a Marker of Disease Activity in Patients with Sarcoidosis: A Systematic Review. Sarcoidosis, Vasculitis and Diffuse Lung Diseases, 28, 87-94.
[12]	Keijsers, R.G., Grutters, J.C., Thomeer, M., Du Bois, R.M., Van Buul, M.M., Lavalaye, J., Van den Bosch, J.M. and Verzijlbergen, F.J. (2011) Imaging the Inflammatory Activity of Sarcoidosis: Sensitivity and Interobserver Agreement of (67)Ga Imaging and (18)FDG PET. The Quarterly Journal of Nuclear Medicine and Molecular Imaging, 55, 66-71.