Diffuse Gallium-67 Accumulation in the Left Atrial Wall Detected Using SPECT/CT Fusion Images

Abstract

Gallium-67 scintigraphy is useful for detecting active inflammation. We show a 66-year-old female patient with atrial fibrillation and diffuse thickening of the left atrial wall due to acute myocarditis, who presented diffuse abnormal accumulation of gallium-67 in the left atrium on single photon emission computed tomography/computed tomography (SPECT/CT) fusion images. In the second gallium-67 scan 2 months after the first scintigraphy, the abnormal accumulation in the heart was no longer visible. Gallium-67 SPECT/CT images helped understanding the disease condition that temporary inflammation in the left atrium caused atrial fibrillation.

Diagnostic Efficacy of Cardiac Scintigraphy with 99mTc-Pyrophosphate for Latent Myocardial Inflammation in Patients with Atrial Fibrillation

“…We did not perform visual and semiquantitative assessments of the radiopharmaceutical accumulation in the left atrial walls because radioactive pool of blood in the left atrial cavity could be easily confused with the focal pathological accumulations, whereas histological sampling in this zone for comparative evaluation was not feasible. Nevertheless, Kotani et al [35] reported feasibility of visualization of the atrial myocardium based on SPECT/CT with Gallium-67. Authors reported that the use of this method was necessary to clarify localizations of radiopharmaceutical accumulation in cases when the accumulation was present on the planar images.…”

Dilated cardiomyopathy: a review of literature on clinical status and meta-analysis of diagnostic and clinical management

“…The contribution of nuclear imaging to the diagnosis of cardiomyopathies is limited except in the diagnosis and prognosis of sarcoidosis and TTR-associated amyloidosis [43]. Previously, thallium-201 and gallium-67 radionuclide scintigraphy provided diagnostic and prognostic assessment of sarcoidosis [46]. Accumulated gallium-67 is an indication of active inflammation associated with sarcoidosis or acute myocarditis.…”

“…After screening all the potential studies against the inclusion criteria, fourteen (14) studies investigating DCM diagnosis were included in the present meta-analysis [30,[46][47][48][49][50][51][52][53][54][55][56][57][58]. The studies were published between 1994 and 2017.…”

“…Cardiac CT angiography (SPECT or Multi-Detector CTA) was an uncommon imaging technique investigated by 14% of the studies. It was useful for assessing the extent of stenosis [46,48]. Finally, nuclear imaging and laboratory tests were less common studied by 14% and 7% of the studies respectively.…”

“…Cardiac CT angiography is less common in the diagnosis of DCM. However, Multi-Detector CTA provides valuable information on the extent of stenosis and a promising method to distinguish idiopathic from ischemic DCM [48] and SPECT provides information on alterations in arterial wall and enables differentiation of acute cardiac myocarditis or cardiac sarcoidosis from DCM [46]. The use of other tests such as nuclear imaging is very uncommon in the diagnosis of DCM.…”