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Will thallium-201 replace gallium-67 in salivary gland scintighaphy ?. J Nucl Med 1996; 37:1819-1823. Purpose:.

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will thallium 201 replace gallium 67 in salivary gland scintighaphy

Will thallium-201 replace gallium-67 in salivary gland scintighaphy ?

J Nucl Med 1996; 37:1819-1823

purpose
Purpose:
  • We investigated and compared finding on combined99mTcpertechnetate-201Tl with those 99mTc pertechnetate-67Ga scintiscans to elucidate the advantages of 201Tl in detecting various salivary glands disorders.
methords
Methords:
  • We studied 23 patients: 6 had sialadenitis , 12 had benign tumors and 5 had malignant tumors. All but four patients had undergone 99mTc (before and lemon stimulation), 201Tl ( early and delay ) and 67Ga imaging.
sialadenitis
Sialadenitis
  • The criterion for diagnosis of sialadenitis was various degrees of diffuse 99mTcuptake with positive67Ga accumulation, all but one patient with sialadenitis fulfilled this criterion.
  • If we consider various degrees of diffuse 99mTc uptake and early diffuse uptakewithout retention of 201Tl as criterion for sialadenitis , five of six patients fulfilled
slide6
67Ga, 201Tl scan results show that both agents have similar sensitivity in detecting sialadenitis, but 201Tl has the advantages and convenience and time-efficiency
  • 67Ga: 72 hr after injection
  • 201Tl: 2-4 hr after injection
benign tumor
Benign tumor
  • Except for Warthin’s and oncocytoma, most tumors appear as cold defects on 99mTc scan.
  • Of the 9 benign cold lesions on 99mTc scan, 67Ga depicted fivefalse-positive scans, whereas 201Tl demonstrated various degrees of uptake without retention on delay images for all patients except one
malignant tumor 1
Malignant tumor (1)
  • Of the five malignant cold lesions on 99mTc scan, both 67Ga and delay 201Tl imaging had two false-negative results. 201Tl detected the tumor as well as lymph node metastasis in one patient.
  • In detecting malignant tumor, both 201Tl and 67Ga had similar results, but 201Tl detected cystic change in one patient.
malignant tumor 2
Malignant tumor (2)
  • Delayed 201Tl scan and 67Ga scan are compared for all patients, the sensitivity and specificity in detecting malignancy :
  • 201Tl: SEN=60%(3/5) SPE=73%(11/15)

PPV=43%(3/7) NPV=85%(11/13)

  • 67Ga: SEN=60%(3/5) SPE=47%(8/17)

PPV=25%(3/12) NPV=80%(8/10)

conclusion
Conclusion:
  • 67Ga scan were nonspecific in differentiating benign from malignant tumor due to high uptake by inflammation
  • 201Tl has already shown its potential to differentiate benign from malignancy and retention of 201Tl in tumor2-4 hr after injection increases the probability of malignancy.
  • Both 201Tl and 99mTc scan can be performed within asingle day
conclusion11
Conclusion:
  • 99mTc / 201Tl imaging of salivary gland disorders may be superior to 99mTc / 67Ga imaging due to sensitivity and specificity in detecting malignancy, conveniencefor both patients and technologists.