Yamaga L Y I, Benard G, Hironaka F H, Castro L G, Funari M G, de Castro C C, Guertzenstein C, Watanabe T, Buchpiguel C, Cerri G G, Shikanai-Yasuda M A
Department of Radiology, Hospital das Clínicas, São Paulo University School of Medicine, Capital, Brazil.
Eur J Nucl Med Mol Imaging. 2003 Jun;30(6):888-94. doi: 10.1007/s00259-003-1172-7. Epub 2003 Apr 23.
The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.
目前用于评估副球孢子菌病（PCM）病变范围的工具在检测亚临床病变方面可能价值有限。本研究的目的是验证镓 - 67全身扫描在评估65例活动性PCM患者疾病范围中的作用。将镓 - 67扫描结果与治疗前获得的临床评估、胸部X线摄影和/或高分辨率计算机断层扫描（CT）、腹部超声（US）或CT、喉镜检查、头部CT或磁共振成像（MRI）以及锝 - 99m亚甲基二膦酸盐骨扫描结果进行比较。通过影像学检查在21例患者（32%）中检测到临床未怀疑的病变，主要位于肺部（n = 11）、肾上腺（n = 6）以及浅表（n = 3）和深部淋巴结（n = 14）。镓 - 67扫描检测出100%的肺部亚临床受累病例。在显示肺部疾病方面，闪烁扫描优于胸部X线摄影（94%对81%）。镓 - 67扫描在所有临床怀疑的病例以及几乎所有未怀疑的病例中都显示出淋巴病变，并且在许多病例中还显示出比临床怀疑的更广泛的受累情况。在初步检测胸腹部淋巴结和骨骼受累方面，镓 - 67扫描与其他影像学检查结果具有良好的一致性。镓 - 67成像检测到大多数间接喉镜检查发现有活动性炎性病变的喉咽疾病病例。另一方面，镓 - 67扫描未能显示出腹部US/CT和头部CT/MRI检测到的大多数肾上腺和中枢神经系统病变。总之，镓 - 67成像对于评估PCM中疑似和未疑似病变的位置和范围是一种有用的工具。它可作为使用其他诊断程序之前的筛查方法，特别是在检测肺部、浅表和深部淋巴结以及骨骼受累方面。
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