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Gallium Uptake in Complicated Pancreatitis

A Predictor of Infection

¹ Department of Radiology, Shands Hospital at the University of Florida, 1600 S.W. Archer Rd., Gainesville, FL 32610.
² Present address: Mori, Bean, and Brooks, Department of Radiology, Baptist Medical Center, 800 Prudential Dr., Jacksonville, FL 32207.
³ Department of Surgery, Shands Hospital at the University of Florida, Gainesville, FL 32610.

View larger version (148K): [in a new window]   Fig. 1A. —47-year-old man with severe pancreatitis who had true-positive finding for infection on gallium study. CT scan shows fluid collection replacing pancreatic body and tail.

View larger version (110K): [in a new window]   Fig. 1B. —47-year-old man with severe pancreatitis who had true-positive finding for infection on gallium study. Gallium SPECT image shows intense activity in fluid collection (arrows) and expected activity in liver and spine.

View larger version (104K): [in a new window]   Fig. 1C. —47-year-old man with severe pancreatitis who had true-positive finding for infection on gallium study. Fusion image of CT scan and gallium study was helpful in localizing infection.

View larger version (146K): [in a new window]   Fig. 2A. —53-year-old man with severe pancreatitis and spiking fevers. CT scan reveals large fluid collection in pancreatic head and pericolonic inflammation around hepatic flexure.

View larger version (32K): [in a new window]   Fig. 2B. —53-year-old man with severe pancreatitis and spiking fevers. Axial gallium SPECT image shows no activity in pancreatic head, which was confirmed as uninfected at surgery. Activity around right colon is evident, and study was interpreted prospectively as colon activity and developing abscess.

View larger version (147K): [in a new window]   Fig. 2C. —53-year-old man with severe pancreatitis and spiking fevers. Follow-up CT scan shows more mature fluid collection (arrow) around right colon. Abscess was confirmed at surgery.

View larger version (135K): [in a new window]   Fig. 3A. —38-year-old man with severe pancreatitis who had true-negative finding for infection on gallium study. CT scan reveals large fluid collection in pancreatic bed that extends into left anterior pararenal space.

View larger version (46K): [in a new window]   Fig. 3B. —38-year-old man with severe pancreatitis who had true-negative finding for infection on gallium study. Axial gallium SPECT image shows lack of gallium uptake in fluid collection. Activity seen in liver, spleen, and spine is expected. Subsequent percutaneous drainage confirmed absence of infection.

View larger version (124K): [in a new window]   Fig. 4A. —55-year-old woman with severe pancreatitis and spiking fevers who developed catheter-introduced infection. On CT scan (not shown), fluid collection in pancreatic bed was observed. Drainage was performed before gallium scan was completed. Fusion image of CT scan and gallium study shows intense gallium activity along drainage catheter tract. Catheter has become dislodged and infected.

View larger version (110K): [in a new window]   Fig. 4B. —55-year-old woman with severe pancreatitis and spiking fevers who developed catheter-introduced infection. On CT scan (not shown), fluid collection in pancreatic bed was observed. Drainage was performed before gallium scan was completed. Fusion image of CT scan and gallium study obtained at different level of transparency to allow visualization of catheter in the gallium collection. Fluid collection shows no gallium uptake. Result of culture of fluid was negative; result of culture of catheter was positive for Candida organisms.

View larger version (137K): [in a new window]   Fig. 5A. —62-year-old woman with severe pancreatitis and clinical signs of sepsis. These images show importance of SPECT and CT fusion images in establishing anatomic location of gallium. CT scan shows rim-enhancing fluid collection (arrow) in left pararenal space and inflammatory changes around antral wall and lesser sac.

View larger version (111K): [in a new window]   Fig. 5B. —62-year-old woman with severe pancreatitis and clinical signs of sepsis. These images show importance of SPECT and CT fusion images in establishing anatomic location of gallium. Axial gallium SPECT image shows increased uptake in left anterior pararenal space and anteriorly in mid abdomen.

View larger version (121K): [in a new window]   Fig. 5C. —62-year-old woman with severe pancreatitis and clinical signs of sepsis. These images show importance of SPECT and CT fusion images in establishing anatomic location of gallium. Fusion image shows gallium in fluid collection, a finding confirmed as infection at CT-guided aspiration. Anterior gallium accumulation is located in stomach and lesser sac and is most likely due to surrounding inflammation from pancreatitis.

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