Thallium-201 Imaging in Evaluation of Hodgkin’s Disease Simin Dadparvar, MD, Raihan Hussain, MD, Fabio Esteves, MD, Jian Q. Yu, MD, Ravinder K. Grewal, MD, Soroosh Arif, MD, Ray Cruz, MD, Chatur J. Barbaria, MD, Kathleen Woods, BS, Michael J. Styler, MD, Philadelphia, Pennsylvania PURPOSE 67 study is more sensitive than Tl 201 in the detection of disease. There is no significant difference in accuracy and negative pre- The role of Ga 67 in the evaluation of Hodgkin’s disease has dictive value between the two studies. Therefore, we recommend been widely established. Tl 201 has been used to evaluate a Tl 201 imaging in the initial evaluation and assessment of pa- wide variety of malignant lesions. This prospective study was tients’ response to radiation therapy and/or chemotherapy. (Can- performed to evaluate the role of Tl 201 imaging in Hodgkin’s cer J 2002;8:469–475) disease at the time of initial presentation and in the assessment of response to therapy, relapse, and remission. KEY WORDS Hodgkin’s disease, Tl 201 scintigraphy, Ga 67 scintigraphy, stag- METHODS ing, relapse, remission, human Fifty-one consecutive patients (23 female, 28 male) with known Hodgkin’s disease underwent 111 Tl 201 and Ga 67 studies. Thallium-201 chloride demonstrates activity in a wide The age range was 16–56 years (mean age, 34.7 years). The variety of neoplastic entities, including Hodgkin’s dis- histopathologies included nodular sclerosis (in 31 cases), mixed ease. 1–7 Tl 201 is preferentially taken up by active tumor cellularity (in 12), lymphocytic predominant (in five), lymphocytic cells. 8 depletion (in one), and unknown (in two). All patients underwent The mechanism for Tl 201 accumulation in tumors whole-body imaging after intravenous injection of 3 mCi of Tl 201 is unclear. Tl 201 is considered to behave like potassium chloride and 10 mCi of Ga 67 citrate. Comparison with Ga 67 im- biologically and resembles alkali metals, which concen- aging, anatomical imaging (computed tomography and/or mag- trate in tumors. Tl 201 concentration in tumors depends netic resonance imaging),and clinical correlation were performed. on many different factors, including blood flow, tumor viability, tumor type, sodium-potassium pump, co- RESULTS transport system, calcium ion exchange, vascular imma- The combined analysis of all various histologies demonstrated turity with leakage, and increased cell membrane perme- that a comparison of Tl 201 with Ga 67 scintigraphy revealed a ability. 9 Kaplan and coworkers 10 reported that Tl 201 sensitivity of 0.76 versus 0.89; a specificity of 0.96 versus 0.73, scans reflected a viable tumor burden more accurately an accuracy of 0.86 versus 0.81, a positive predictive value of than other radionuclide studies. 0.95 versus 0.77, and anegative predictive value of 0.81 versus There is limited information on Tl 201 accumulation 0.87. Tl 201 imaging was similar in sensitivity, specificity, and in lymphoma. 3,4,7,11,12 This prospective study was per- accuracy among the nodular sclerosis and the mixed-cellularity formed to evaluate the role of Tl 201 imaging of Hodg- Hodgkin’s disease. kin’s disease at the time of initial staging, as an assessment of response to therapy, at the time of known relapse, and for surveillance during remission. Compari- CONCLUSION son with Ga 67 imaging, anatomic imaging (computed Tl 201 imaging offers more specificity with a higher positive tomography [CT] and magnetic resonance imaging predictive value in the diagnosis of Hodgkin’s disease. The Ga [MRI]), and clinical correlation were performed. From the Division of Nuclear Medicine, Departments of Radiologic Sciences and Medical Oncology, Hahnemann University Hospital, Broad and Vine Streets, MS 309, Philadelphia, Pennsylvania. PATIENTS AND METHODS Received on June 28, 2002; accepted for publication August 1, 2002. Patient Population No benefits in any form have been or will be received from a commer- cial party related directly or indirectly to the subject of this article. The patient population consisted of 51 consecutive pa- Reprint requests: Simin Dadparvar, MD, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 34th and Spruce Streets, tients (23 female, 28 male) with known Hodgkin’s dis- Philadelphia, PA 19104. ease who underwent 111 sets of studies. The age range Copyright q 2002 Jones and Bartlett Publishers, Inc. of the patients was 16–56 years (mean age, 34.7 years). 469