The role of gallium-67 scintigraphy in diagnosing sources of fever in critically ill patients in ICU

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Introduction

The role of radionuclide imaging to diagnose sources of infection is rather confusing [1].The aim of this study was to evaluate the diagnostic value of gallium-67-scintigraphy in critically ill febrile patients and its impact on treatment and outcome.

Methods

Forty whole-body Ga-67 scans performed in 37 patients in a five year period (1994-1999) were retrospectively analyzed.

Result

34 patients were surgical and 3 medical with a median age 69 years and median APACHE II 23. All patients were febrile with systemic inflammatory response syndrome (SIRS) and all, except two, were ventilated for more than three days. Ga-67 scan was performed either within the first two weeks (median 7 day) because of no improvement of sepsis (group 1) or later than two weeks (median 22 day) because of the resurgence of SIRS (group 2). Group 1 consists of 24 patients with APACHE II 21, multisystemic organ failure (MSOF) in 6 patients and 5 exitus. Four from the 24 Ga-67 scans showed positive findings (two soft tissue abscesses, one intra-abdominal collection and one osteomyelitis) leading to changes in treatment and improvement of outcome. Group 2 consists of 13 patients with an APACHE II 24, MSOF and exitus in 7 patients. On the 16 Ga-67 scans performed in this group, only one showed retrosternal Ga fixation and had no impact on treatment and outcome.

False negative results were observed in 9 of 15 patients with known lung and thoracic pathology proved by other investigations. In spite of rather high sensitivity in patients with abdominal pathology, the results were non-specific.

Conclusion

Ga-67 scan in the critically ill may be helpful in localizing a pyrogenic focus in severe unimproving septic patients in the early phase after their admission. However, in patients with resurgence or sepsis in the late phase of hospitalization, Ga-67 scan appeared to be of very little diagnostic help and its value remains questionable.