Gallium-67 lung imaging and pulmonary clearance of 99mTc-DTPA aerosol in patients with amiodarone pneumonitis.

The aim of this study was to compare gallium-67 citrate lung imaging with the pulmonary clearance of 99mTc-DTPA (technetium 99m diethylenetriaminepentaacetic acid) in 9 patients with amiodarone pneumonitis (8 males and 1 female, aged 58 to 76 years). The diagnosis of amiodarone pneumonitis was based on clinical and radiological grounds in all patients, and histological changes in seven. The mean values for the effective half-life of the pulmonary clearance of 99mTc-DTPA aerosol were below the normal range in all 9 patients, and lower than the values obtained previously for patients on a long-term amiodarone regimen without side effects. Positive gallium-67 accumulation was demonstrated in 7 of the 9 patients. Two patients had negative gallium-67 imaging and increased alveolar-capillary 99mTc-DTPA clearance; with corticosteroid therapy and discontinuation of amiodarone, their radiological changes and clearance became normal within 120 days. In conclusion, when compared to gallium-67 lung imaging, the 99mTc-DTPA aerosol clearance is more advantageous because it is a much faster test than the gallium scan. This is essential for those patients suspected of amiodarone pneumonitis who need specific therapy as soon as possible. Moreover, the 99mTc-DTPA aerosol clearance test appears to be a more useful diagnostic tool because it is positive even in those patients who have normal gallium-67 lung imaging.