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Thallium-201 Scintigraphy for Assessment of a Gallium-67-Avid Mediastinal Mass Following Therapy for Hodgkin's Disease

Departments of Radiology, Pediatric Oncology and Nuclear Medicine, Hackensack Medical Center, Hackensack, New Jersey

Correspondence: For correspondence or reprints contact: Evan W. Harris, MD, Department of Radiology, Hackensack Medical Center, 30 Prospect Ave., Hackensack, NJ 07601.

ABSTRACT

Differentiating thymic rebound from recurrent tumor may be difficult in pediatric patients following chemotherapy for Hodgkin's disease. We present a patient who had both a negative ⁶⁷Ga scan and computed tomography (CT) of the chest at diagnosis and demonstrated gallium avidity and CT evidence of a new mediastinal mass at the completion of chemotherapy. There was, however, no other clinical or laboratory evidence of disease recurrence. Thallium-201 imaging was subsequently performed and demonstrated no significant radionuclide accumulation within this anterior mediastinal mass. CT shows only the presence of a mass, but not it's nature. Gallium-67 scintigraphy, while used widely as an indicator of tumor viability, may demonstrate increased uptake in cases of thymic rebound. Thallium-201 imaging has previously been shown to demonstrate increased uptake in mediastinal malignancy. Conversely, no significant mediastinal uptake of ²⁰¹Tl, as in this case, provides additional supportive evidence for a benign mediastinal entity such as thymic rebound.