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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:.

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

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

  2. 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.

  3. 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.

  4. Results and Discussion:

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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)

  10. 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

  11. 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.

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