technetium-tc-99m-gluceptate and Lung-Diseases

Forty-two patients with diffuse infiltrative lung diseases were imaged with Ga-67 citrate and Tc-99m glucoheptonate (GH). Twenty patients had sarcoidosis, six had fibrosis, six had tuberculosis, nine had lung infiltration, and one had pleural empyema. The main difference between Ga-67 and Tc-99m GH was the much greater uptake of Ga-67 in sarcoidosis than that of Tc-99m GH. Fifteen patients with sarcoidosis had positive Ga-67 scans but only six had positive Tc-99m GH scans. The results in other diffuse infiltrative lung diseases were almost equal with Ga-67 and Tc-99m GH. Although Tc-99m GH is less expensive and simpler to use, it is not an adequate substitute for Ga-67 in diffuse infiltrative lung diseases.

Topics: Gallium Radioisotopes; Humans; Lung Diseases; Organotechnetium Compounds; Radionuclide Imaging; Sarcoidosis; Sugar Acids; Technetium

Sixty-five patients with suspected or proven pulmonary malignancy were examined with [67Ga]citrate and [99mTc]glucoheptonate ([99mTc]GH) scintigraphy. In the final diagnosis 39 had primary lung carcinoma, four metastases in lung, mediastinum, and pleura from carcinomas elsewhere, and 22 benign pulmonary diseases. The sensitivity in the detection of pulmonary malignancies was 91% with 67Ga and 95% with [99mTc]GH. The intensity of uptake was somewhat greater with 67Ga than with [99mTc]GH in almost all malignant lung tumor groups. The specificity to detect malignant tumors was 82% with both radiopharmaceuticals. Irradiation and chemotherapy seemed to decrease 67Ga uptake but not [99mTc]GH uptake. Only four of 22 benign diseases showed accumulation of both 67Ga and [99mTc]GH. The intensity of uptake in benign processes was almost equal with that in malignant diseases, but most malignant processes were better delineated than the benign lesions. There were many differences between 67Ga and [99mTc]GH uptake, which suggest different mechanisms of accumulation of these agents. It is concluded that some 67Ga studies could be replaced by cheaper and more practical [99mTc]GH.

Topics: Diagnosis, Differential; Gallium Radioisotopes; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Organotechnetium Compounds; Pleural Neoplasms; Radionuclide Imaging; Sugar Acids; Technetium

We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.

Topics: Adenocarcinoma; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Histoplasmosis; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium

Sixty-three patients aged 21-80 yr were examined. Tc-99m glucoheptonate (Tc-GH) scintigraphy was performed in 32 patients: 26 with primary lung carcinoma; six with metastases in lung, mediastinum, and pleura from carcinomas elsewhere; eight with benign pulmonary diseases; and 23 without known pulmonary disease. Tc-GH accumulated in 23 of 26 primary pulmonary carcinomas as active foci. The specificity of Tc-GH scans for neoplasm detection was higher than that of chest radiographs. The visualization of malignant tumors was much better in the late Tc-GH images (5-6 hr) than in the early (1 hr). Metastases from other carcinomas were positive in four of six patients, but they were considerably better detected in the radiographs, except in one patient with metastatic hepatocellular carcinoma. Neoplasms or their metastases in the hilar and mediastinal regions were better detected in the Tc-GH scans than in the chest radiographs. Only one of eight benign lung processes was visualized (as a weak diffuse accumulation of Tc-GH in hilar scar formation), and 23 patients without pulmonary disease had no pathological foci.

Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Humans; Lung Diseases; Lung Neoplasms; Mediastinal Neoplasms; Middle Aged; Organotechnetium Compounds; Pleural Neoplasms; Radionuclide Imaging; Sugar Acids; Technetium