The article by Ebright et al is admirable in attempting to follow-up a considerable number of cases in which 67Ga was employed to obtain clinical correlation. Discussion of the appropriateness of ordering the study is particularly commendable.
The serious problem with the article is the method employed for imaging. A single 48-hour view, using 67Ga is simply an unacceptable technique and guarantees false-positive results. For example, the entire gastrointestinal (GI) tract secretes 67Ga.1 Several articles have indicated that cathartics are of no value in clearing the bowel of gallium.2,3 The background is still high at 48 hours, as is shown in Fig 1 of the article, so that target-to-background ratios often are unacceptably low at this time. At 48 hours, abdominal or pelvic activity usually is caused by intraluminal gut gallium.
Follow-up scans are absolutely mandatory to determine if this material clears from the intestine,
Silberstein EB. To the Editor.—. Arch Intern Med. 1982;142(7):1408. doi:10.1001/archinte.1982.00340200178040