Comparison between gallium-68 citrate positron emission tomography-computed tomography and gallium-67 citrate scintigraphy for infection imaging

Tatiana Segard, Laurence M.J.A. Morandeau, Marina L. Dunne, James O. Robinson, Ronan J. Murray, Elizabeth A. Geelhoed, Roslyn J. Francis

Research output: Contribution to journalArticle

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Abstract

Background: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET–CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the ‘gold standard’ nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. Aims: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET–CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Methods: Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET–CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. Results: 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga-67 citrate scintigraphy and 69% for Ga-68 citrate PET–CT, a specificity of 79% for Ga-67 citrate and 67% for Ga-68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. Conclusion: The sensitivity and specificity of Ga-68 citrate PET–CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET–CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.

Original languageEnglish
Pages (from-to)1016-1022
Number of pages7
JournalInternal Medicine Journal
Volume49
Issue number8
DOIs
Publication statusPublished - 1 Jan 2019

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Radionuclide Imaging
Infection
Fever
Joints
gallium citrate
Positron Emission Tomography Computed Tomography
Bone and Bones
Physicians
Multicenter Studies
Prospective Studies
Radiation

Cite this

@article{21aaa352de734729a596f8123f301c71,
title = "Comparison between gallium-68 citrate positron emission tomography-computed tomography and gallium-67 citrate scintigraphy for infection imaging",
abstract = "Background: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET–CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the ‘gold standard’ nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. Aims: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET–CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Methods: Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET–CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. Results: 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81{\%} for Ga-67 citrate scintigraphy and 69{\%} for Ga-68 citrate PET–CT, a specificity of 79{\%} for Ga-67 citrate and 67{\%} for Ga-68 citrate and were concordant for 76{\%} of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. Conclusion: The sensitivity and specificity of Ga-68 citrate PET–CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET–CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.",
keywords = "fever of unknown origin, infection, Ga-67 citrate, Ga-68 citrate, PET–CT",
author = "Tatiana Segard and Morandeau, {Laurence M.J.A.} and Dunne, {Marina L.} and Robinson, {James O.} and Murray, {Ronan J.} and Geelhoed, {Elizabeth A.} and Francis, {Roslyn J.}",
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Comparison between gallium-68 citrate positron emission tomography-computed tomography and gallium-67 citrate scintigraphy for infection imaging. / Segard, Tatiana; Morandeau, Laurence M.J.A.; Dunne, Marina L.; Robinson, James O.; Murray, Ronan J.; Geelhoed, Elizabeth A.; Francis, Roslyn J.

In: Internal Medicine Journal, Vol. 49, No. 8, 01.01.2019, p. 1016-1022.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison between gallium-68 citrate positron emission tomography-computed tomography and gallium-67 citrate scintigraphy for infection imaging

AU - Segard, Tatiana

AU - Morandeau, Laurence M.J.A.

AU - Dunne, Marina L.

AU - Robinson, James O.

AU - Murray, Ronan J.

AU - Geelhoed, Elizabeth A.

AU - Francis, Roslyn J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET–CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the ‘gold standard’ nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. Aims: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET–CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Methods: Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET–CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. Results: 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga-67 citrate scintigraphy and 69% for Ga-68 citrate PET–CT, a specificity of 79% for Ga-67 citrate and 67% for Ga-68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. Conclusion: The sensitivity and specificity of Ga-68 citrate PET–CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET–CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.

AB - Background: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET–CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the ‘gold standard’ nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. Aims: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET–CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. Methods: Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET–CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. Results: 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga-67 citrate scintigraphy and 69% for Ga-68 citrate PET–CT, a specificity of 79% for Ga-67 citrate and 67% for Ga-68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. Conclusion: The sensitivity and specificity of Ga-68 citrate PET–CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET–CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.

KW - fever of unknown origin, infection

KW - Ga-67 citrate

KW - Ga-68 citrate

KW - PET–CT

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U2 - 10.1111/imj.14231

DO - 10.1111/imj.14231

M3 - Article

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SP - 1016

EP - 1022

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JF - Internal Medicine Journal (Print)

SN - 1444-0903

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