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Monitoring Treatment Responses in Patients with Pulmonary TB Using Serial Lung Gallium-67 Scintigraphy

¹ Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, ROC.
² Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta Pei Rd., Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan, ROC.
³ Department of Nuclear Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, ROC.
⁴ Present address: Chest Division, Department of Internal Medicine, E-Da Hospital, Taiwan, ROC.

OBJECTIVE. Gallium-67 scintigraphy is more sensitive than chest radiography in a single concurrent detection of pulmonary tuberculosis (TB). As for inflammation, the intensity of pulmonary uptake of ⁶⁷Ga citrate theoretically is a function of the inflammation level in the lung. To maximize clinical applicability of ⁶⁷Ga scintigraphy in the evaluation of pulmonary TB, we prospectively assessed serial qualitative associations between intensity of the uptake of ⁶⁷Ga citrate and the severity of lung inflammation, reflected by the burden of Mycobacterium tuberculosis in the sputum of patients undergoing anti-TB chemotherapy.

SUBJECTS AND METHODS. Each enrolled patient had chest radiographic, microbiologic, ⁶⁷Ga imaging, and semiquantitation of sputum acid-fast bacillus (AFB) assessments before and at the third and sixth months after receiving anti-TB chemotherapy. The burden of pulmonary M. tuberculosis (presumably, in proportion to the semiquantitation of AFB in sputum) and the intensity of ⁶⁷Ga citrate uptake in the lung at each synchronized assessment were regarded as a paired variable. Odds ratios were obtained from odds (derived using generalized estimating equations) in favor of higher pulmonary ⁶⁷Ga uptake in differing scores of semiquantitation of sputum AFB. Linear trend for pulmonary ⁶⁷Ga citrate uptake corresponding to varied pulmonary M. tuberculosis burdens was assessed using contrast analysis of their odds ratios.

RESULTS. Thirty patients (24 men and six women) with pulmonary TB were enrolled. Eighty-six paired semiquantitations of sputum AFB-⁶⁷Ga-scintigraphic studies were collected. Twenty-six patients were cured of their pulmonary TB. The pulmonary ⁶⁷Ga uptake increased in proportion to the higher score of semiquantitation of sputum AFB (p = 0.009, for trend).

CONCLUSION. In patients with pulmonary TB, the higher the burden of M. tuberculosis in the lung, the higher the intensity of pulmonary ⁶⁷Ga citrate uptake. Serial ⁶⁷Ga-scintigraphy examinations are helpful in evaluations of the effectiveness of anti-TB therapy when assessments based on chest radiography are difficult.

Keywords: lung • nuclear medicine • radiography • scintigraphy • tuberculosis

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