The use of gallium-67 scintigraphy in the diagnosis of acute interstitial nephritis

Abstract

Background: Gallium-67 scintigraphy has been suggested as a noninvasive method to diagnose acute interstitial nephritis (AIN). However, its diagnostic performance and usefulness remain controversial. Methods: We retrospectively reviewed the charts of 76 patients who underwent gallium-67 scintigraphy for a suspicion of AIN. Patients were classified based on kidney biopsy and/or clinical probability of AIN. Gallium-67 scintigraphy results were reinterpreted blindly using both posterior planar and single photon emission computed tomography (SPECT) imaging. Intensity of radioisotope uptake in the kidney was graded from 0 to 5. Results: The diagnosis of AINwas confirmed in 23 patients and excluded in 44. Nine patients with an uncertain diagnosiswere excluded from subsequent analysis. A gallium-67 kidney uptake cutoff of 1 gave a negative predictive value of 100%, whereas a cutoff of 5 had an excellent specificity and positive predictive value for the diagnosis of AIN. When using a cutoff of 3, which had previously been used in the literature, we obtained a sensitivity of 61% and a specificity of 75% with posterior planar imaging. The results of both SPECT and posterior planar imaging modalities were comparable. Conclusions: Gallium-67 scintigraphymay be of interest in patients with a clinical suspicion of AIN, especially in thosewho are unable to undergo kidney biopsy. However, results need to be interpreted with caution and depend on the intensity of gallium- 67 kidney uptake.