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Changes in Results of Gallium-67-Citrate Scanning after Interferon Therapy for Chronic Hepatitis C

Third Department of Internal Medicine, Department of Public Health and Division of Nuclear Medicine, Osaka City University Medical School, Osaka, Japan

Correspondence: For correspondence or reprints contact: Susumu Shiomi, MD, Third Department of Internal Medicine, Osaka City University Medical School, 1-5-7 Asahimachi, Abeno-ku, Osaka 545, Japan.

ABSTRACT

Gallium-67 scanning is useful for early diagnosis and grading of interstitial lung disease. In a study of the side effects of interferon (IFN)on the lungs of patients with chronic hepatitis C, we performed ⁶⁷ Ga scanning before and after IFN therapy. Methods: The 66 subjects who underwent at least one scanning, before IFN therapy, were 8 patients with chronic persistent hepatitis (CPH), 21 with chronic aggressive hepatitis 2A (CAH-2A), 25 with chronic aggressive hepatitis 2B (CAH-2B) and 12 with cirrhosis. All had underlying hepatitis C viral infection. Of those patients, 20 were examined again within 1 mo after IFN therapy. Patients received an intravenous injection of 340 MBq ⁶⁷Ga-citrate and were imaged 72 hr later. ROIs were established for anterior views of the lungs (Lu), liver (U) and soft tissue of the upper arm as background (B). The counts per unit size of each region of interest were used in calculation of the ratios Lu/B and U/B. Results: The medians of Lu/B were 2.46 in CPH, 2.56 in CAH-2A, 2.50 in CAH-2B and 2.47 in cirrhosis. These differences were not statistically significant. The medians of Li/B were 6.42 in CPH, 6.14 in CAH-2A, 5.11 in CAH-2B and 4.03 in cirrhosis. The differences between the median U/B of cirrhotic patients and the medians for patients with CPH, CAH-2A and CAH-2B were significant. After therapy, Lu/B was higher than before in 16 of the 20 patients and lower in the four other patients; the overall rise was significant (Wilcoxon rank-sum test). Li/B was higher than before in 11 of the 20 patients and lower in the nine other patients. Conclusion: IFN caused uptake of the radionuclide to increase in most patients. This method showed changes in the accumulation of ⁶⁷Ga-citrate that could have been missed if the results had been inspected by eye. IFN can cause interstitial lung disease, but unlike other drugs with this side effect, the onset seems to be gradual enough to be detected quantitatively by ⁶⁷Ga scanning.

Key Words: gallium-67-citrate • interferon-alpha • hepatitis C • interstitial lung disease

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