Multiplane gallium tomography in assessment of occupational chest diseases

Our plain-English summary of Multiplane gallium tomography in assessment of occupational chest diseases, by E.M. Cordasco, J. O'Donnell, W. MacIntyre, et al (American Journal of Industrial Medicine, 1990).

The study

• Authors: E.M. Cordasco, J. O'Donnell, W. MacIntyre, S. Demeter, L. Gonzalez, M. Eren, W. McMahon, D. Burns, D.H. Feiglin
• Journal: American Journal of Industrial Medicine
• Published: 1990;17(3):285-97
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000008).

Abstract

Gallium-67 scintigraphy is helpful in the evaluation of inflammatory, respiratory diseases. Single-photon emission computed tomography (SPECT) provides three-dimensional tomographic reconstruction of radioisotope distribution in the body. The addition of SPECT to gallium-67 scanning in 27 patients demonstrated an improvement in the sensitivity for detecting the presence and extent of interstitial occupational lung disease. This technique may provide earlier detection of parenchymal lung changes than can the chest x-ray and planar scanning in some patients with asbestosis. Findings in six patients with asbestosis are reported.

In plain English

This Cleveland Clinic Foundation study tested whether adding a three-dimensional technique (SPECT) to gallium-67 lung scans improved detection of inflammation in occupational lung diseases. The authors scanned 27 patients with biopsy-confirmed occupational lung disease, including asbestosis, silicosis and mica and kaolin pneumoconiosis, and 10 controls without lung disease. Most patients showed more lung gallium-67 activity than the controls. The authors reported that SPECT was more sensitive than conventional flat (planar) scans, 96% compared with 82%, and that scan results matched the clinical picture and lung function tests in 22 patients (84%). The scans could not distinguish the different diseases, although uptake in asbestosis patients was mainly in the lower lungs. Among six asbestosis patients described as relatively early cases, lung function tests were abnormal in five, and in those five SPECT showed uptake better than planar scans. The article did not state which asbestos fiber types were involved. The authors concluded the technique appeared promising but needed further study, and listed cost and its inability to identify the specific cause as drawbacks.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical imaging study (preliminary case series with controls) comparing gallium-67 SPECT with planar gallium-67 scans, with two illustrative case reports
• Who was studied: 27 patients with documented occupational lung disease, all with biopsy confirmation, studied over nine months at the Cleveland Clinic Foundation, plus 10 controls with no clinical lung disease. Table I lists 14 diagnoses of asbestosis among the diagnoses. A subgroup of six asbestosis patients, described as relatively early clinical cases, had been referred by family physicians and/or attorneys because of their exposure histories.
• Exposure: Occupational lung diseases including asbestosis (asbestos fiber type not stated), silicosis, mica pneumoconiosis, kaolin pneumoconiosis, polyvinyl chloride-plasticizer pneumonitis, tungsten-cobalt pneumonitis and farmer's lung. The test exposure was an intravenous injection of 6 to 10 millicuries of gallium-67 citrate, with scanning at least 48 hours later.
• Main results:
  • In most patients, gallium-67 activity in the lungs was increased compared with the 10 normal controls.
  • SPECT scans had 96% sensitivity compared with 82% for planar scans (denominator not stated).
  • The degree of abnormal gallium-67 activity correlated with the clinical presentation and pulmonary function test results in most patients, given as 22 (84%).
  • Neither the degree of uptake nor its distribution distinguished the different diseases. The one pattern seen was a mainly basal (lower-lung) distribution in the patients with asbestosis.
  • Among the six asbestosis patients in Table II, pulmonary function tests were abnormal in five, mainly showing a restrictive pattern. In these five, SPECT was better than planar scanning at documenting gallium-67 uptake.
  • In two asbestosis patients, bronchoalveolar lavage showed no increase in neutrophils or lymphocytes, while their SPECT scans were moderately positive. The authors described this as a lack of correlation with lavage.
• The authors' conclusion: The authors concluded that gallium-67 SPECT appeared promising but needed further study. They described it as a non-invasive, accurate way to evaluate the inflammatory component of some occupational lung diseases, superior to planar scanning, and said it may detect parenchymal lung changes earlier than chest x-ray and planar scanning in some patients.
• Limitations the authors state:
  • The authors named moderately high cost and inability to identify the specific causative lesion as the main disadvantages.
  • The authors said the mismatch between lavage and SPECT findings could reflect oversensitivity of the gallium scans or inadequate lavage sampling.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Occupational Lung Disease, Chest X-Ray.

Related studies

• Gallium-67 citrate imaging studies of the lung — C. Bekerman, P.B. Hoffer, et al. (1980)
• Gallium scanning in differentiating malignant from benign asbestos-related pleural disease — A.S. Teirstein, P. Chahinian, et al. (1986)
• Pulmonary uptake of gallium-67 in asbestos-exposed humans and sheep — R. Bégin, A. Cantin, et al. (1983)
• Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure — G.L. Delclos, D.G. Flitcraft, et al. (1989)
• Gallium scanning in peritoneal mesothelioma — R.R. Armas, S.J. Goldsmith (1985)
• Unexpected gallium uptake in benign pulmonary pathology. Report of two cases — R.G. McLean, D. Choy, et al. (1984)

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