ABSTRACT
It is possible to evaluate the activity of sarcoidosis by means of 67 Ga scintigrams and radiographs. In known sarcoid with lung involvement, the scintigram can differentiate between the granulomatous and fibrous stage. The granuloma, which is reversible and requires treatment, must be distinguished from fibrosis, which causes permanent damage. In the early stages of treatment, the scintigram is more sensitive than the radiograph. When treatment is stopped, the scintigram is better than the radiograph in demonstrating the need for renewed therapy. Evidence of fibrosis on the radiograph, with increased activity on the scintigram, indicates the need for further treatment. 67Ga can also demonstrate enlarged hilar nodes and mediastinal nodes which are not visible on the radiograph.
Subject(s)
Lung Diseases/diagnosis , Sarcoidosis/diagnosis , Adrenal Cortex Hormones/therapeutic use , Gallium Radioisotopes , Humans , Lung/diagnostic imaging , Lymph Nodes/diagnostic imaging , Recurrence , Sarcoidosis/drug therapy , Tomography, X-Ray ComputedABSTRACT
Hundred nine unselected patients with metastatic renal cell carcinoma have been stratified into 3 groups according to their type of metastasis: 17 patients with sceletal involvement only, 67 patients with visceral metastases, and 21 patients with a mixed type of metastasis. Four patients with a locoregional pattern of recurrence were not included in the analysis. The survival data (evaluated by life table analysis and a modified Wilcoxon-Rang-test) revealed a better prognosis for patients presenting exclusively with osseous metastases compared to the group with visceral metastases. The patients with osseous metastases showed a median survival time from diagnosis of 29.9 months compared to 11.6 months in patients with visceral involvement. Considering only patients whose metastases have been detected after a period of latency post nephrectomy, there is a further increase in the survival in favour of the patients with sceletal metastases and the difference to the group with visceral metastases becomes statistically highly significant.
Subject(s)
Adenocarcinoma/secondary , Kidney Neoplasms , Abdominal Neoplasms/mortality , Abdominal Neoplasms/secondary , Adenocarcinoma/mortality , Adult , Aged , Bone Neoplasms/mortality , Bone Neoplasms/secondary , Female , Humans , Male , Middle Aged , Prognosis , Time FactorsABSTRACT
Gallium scintigraphy enables the following statements: 1. It is possible to establish the existence of an active granulomatosis both in the acute and in the chronic stage I, as well as the granulomatous pulmonary infiltration of stage II. 2. A therapy-induced or spontaneous regression of granulomatosis is associated with a reduced and later on absent deposition of 67Ga. 3. Signs of fibrosis visible on x-ray film do not exclude the continued presence of granulomatous pulmonary infiltrations. Such a granulomatosis can progress and thus produce further fibrosing and hence functional disorders up to the development of pulmonary heart disease (cor pulmonale.) It follows from this that in such cases corticoid treatment must be continued or resumed. 4. Reduced or no longer apparent storage of 67Ga under therapy does not represent a safeguard against relapse. X-ray controls chould be performed after discontinuation of corticoid therapy in order to discover, if any, discrete signs of recurring granulomatosis. In such cases, gallium scintigraphy can clearly show the revival of granulomatosis. 5. In our opinion, gallium scintigraphy is mandatory in all pulmonary affections.
