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The role of gallium-67 scintigraphy in comparing inflammatory activity between tuberculous and nontuberculous mycobacterial pulmonary diseases

ObjectiveThe purpose of this study was to compare the inflammatory activity of pulmonary lesions between active tuberculosis and nontuberculous mycobacterial (NTM) infection in acid-fast bacilli smear-positive non-HIV-infected patients using gallium-67 (67Ga) scintigraphy. Patients and methodsTwenty-four patients with culture-proven active pulmonary tuberculosis (PTB) and an additional 17 patients meeting the criteria of pulmonary NTM infection were enrolled into the retrospective study. The 67Ga uptake of the pulmonary lesion was assessed by visual scoring of uptake grade and semiquantitative region of interest analysis of the uptake ratio using the thoracic spine as a reference. Results 67Ga scans were positive in 23 of the 24 patients (95.8%) with PTB and in 12 of the 17 patients (70.6%) with pulmonary NTM infection. Twenty patients with active PTB had moderate or intense visual 67Ga uptake grade, whereas only three patients with pulmonary NTM infection had moderate visual 67Ga uptake grade. The semiquantitative pulmonary 67Ga uptake ratios in patients with active PTB and NTM infection were 1.17±0.28 (range: 0.77–1.86) and 0.79±0.12 (range: 0.60–1.03), respectively. The 67Ga uptake grade and ratio of active PTB were both significantly higher than NTM infection (both P<0.001). In the receiver operating characteristic curve analysis for predicting active PTB, the area under the curves of 67Ga uptake grade and ratio were 0.90±0.05 and 0.93±0.04, respectively (both P<0.001). ConclusionThe inflammatory activity of active PTB is significantly higher than that of pulmonary NTM infection in non-HIV-infected patients. 67Ga uptake grade and ratio could be used to predict active PTB in acid-fast bacilli smear-positive patients.