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Semiquantitative ⁶⁷Ga Scintigraphy as an Indicator of Response to and Prognosis After Corticosteroid Treatment in Idiopathic Interstitial Pneumonia

¹ Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
² Department of Respiratory Medicine, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
³ Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

The prognosis in some forms of idiopathic interstitial pneumonia (IIP), especially idiopathic pulmonary fibrosis (IPF) and fibrotic nonspecific interstitial pneumonia (NSIP), is still poor. A minority of patients will respond to immunosuppressive treatment. In patients with IPF or fibrotic NSIP, pulmonary ⁶⁷Ga scintigraphy may be useful for predicting response to therapy and prognosis. The objective of the present study was to evaluate whether semiquantitative ⁶⁷Ga scintigraphy can be used to predict responsiveness to therapy with high-dose corticosteroids in a well-defined population of patients with IIP (IPF and fibrotic NSIP). Methods: This study was performed in a tertiary referral center. We prospectively performed ⁶⁷Ga scintigraphy in 23 consecutive patients previously diagnosed with IIP (IPF and fibrotic NSIP) before and after treatment with 3 monthly courses of high-dose methylprednisolone. Lung function tests and bronchoalveolar lavage (BAL) were performed before and after these 3 courses, and patients were monitored for 1 y after the start of the treatment. Results: During follow-up, 5 patients died, none during the first 3 mo. Although pulmonary ⁶⁷Ga uptake significantly decreased after treatment (P = 0.001), there was no correlation between either initial ⁶⁷Ga uptake or change in ⁶⁷Ga uptake on treatment and 1-y prognosis. This finding was independent of prior immunosuppressive treatment, diagnosis of IPF or NSIP, or whether initial ⁶⁷Ga uptake was elevated or not. BAL cellularity was correlated with neither pulmonary ⁶⁷Ga uptake nor response to treatment. Conclusion: Pulmonary ⁶⁷Ga uptake cannot be used to predict response to corticosteroid treatment or prognosis in patients with IIP. Apparently, the (inflammatory) process influenced by treatment with methylprednisolone does not determine the progression of disease. This finding supports the hypothesis that although inflammation is present in IPF and fibrotic NSIP, it is neither the hallmark of the disease nor the major factor determining prognosis.

Key Words: pulmonary fibrosis • interstitial pneumonia • pulmonary ⁶⁷Ga scintigraphy • steroids • noninvasive techniques

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