Semi-quantitative evaluation of gallium-67 scintigraphy in lupus nephritis

Abstract

Within nuclear medicine there is a trend towards quantitative analysis. Gallium renal scan has been reported to be useful in monitoring the disease activity of lupus nephritis. However, only visual interpretation using a four-grade scale has been performed in previous studies, and this method is not sensitive enough for follow-up. In this study, we developed a semi-quantitative method for gallium renal scintigraphy to find a potential parameter for the evaluation of lupus nephritis. Forty-eight patients with lupus nephritis underwent renal biopsy to determine World Health Organization classification, activity index (AI) and chronicity index (CI). A delayed 48-h gallium scan was also performed and interpreted by visual and semi-quantitative methods. For semi-quantitative analysis of the gallium uptake in both kidneys, regions of interest (ROIs) were drawn over both kidneys, the right forearm and the adjacent spine. The uptake ratios between these ROIs were calculated and expressed as the "kidney/spine ratio (K/S ratio)" or the "kidney/arm ratio (K/A ratio)". Spearman's rank correlation test and Mann-Whitney U test were used for statistical analysis. Our data showed a good correlation between the semi-quantitative gallium scan and the results of visual interpretation. K/S ratios showed a better correlation with AI than did K/A ratios. Furthermore, the left K/S ratio displayed a better correlation with AI than did the right K/S ratio. In contrast, CI did not correlate well with the results of semi-quantitative gallium scan. In conclusion, semi-quantitative gallium renal scan is easy to perform and shows a good correlation with the results of visual interpretation and renal biopsy. The left K/S ratio from semi-quantitative renal gallium scintigraphy displays the best correlation with AI and is a useful parameter in evaluating the disease activity in lupus nephritis.

Serial Non-Invasive Assessment of Antibody Induced Nephritis in Mice Using Positron Emission Tomography

“…Conventional nuclear medicine imaging approaches using 67 Ga-citrate, 111 In or 99m Tc-labeled leukocytes or IgG have also been used in clinical practice to detect inflammation, but they suffer from major limitations such as prolonged imaging time (up to 48 h or more) and handling of potentially infected blood products. While gallium-67 scintigraphy has shown potential in the assessment of active lupus nephritis based on its affinity for inflammatory lesions [24]–[27], the image quality is less optimal than that of PET and the need for delayed imaging requires at least 2 patient visits delaying diagnosis. In contrast currently nearly all PET scanning is performed on dual modality PET-CT instruments that permit functional and anatomic (changes in renal size and surrounding edema) assessments to be made within a period of about 2 hours.…”

A high-fibre diet in combination with bisacodyl for bowel preparation in gallium renal scintigraphy

“…Gallium renal scan is also a valuable predictor of response to therapy in patients with lupus nephritis [3]. Quantitative analysis of gallium renal uptake by the measurement of kidney/spine ratios shows a better correlation with disease activity than does visual interpretation [4].…”

“…At our institute, we have found that gallium renal imaging is very useful for the monitoring of lupus nephritis [1±3]. However, the physiological accumulation of gallium in the bowel often complicates the interpretation of gallium scintigrams in the abdominal and pelvic regions [4,5].…”

Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant

“…García et al (1984) observed that 50% of the patients without nephropathy had a mild kidney uptake (lower than liver uptake). The capacity of 67 Gallium to accumulate in active inflammation areas has been shown to be of value in diagnosis of renal inflammation (Wood et al, 1978;Linton et al, 1980;Kumar et al, 1976;Mendez et al, 1980;Yen et al, 1999), particularly in acute conditions (Lin et al, 2000). The exact mechanism of binding in inflammation sites is not well defined.…”