Diagnostic value of gallium and bone scans in evaluation of extrapulmonary coccidioidal lesions

The value of 67Ga and methylene diphosphonate labeled with 99mTc in detecting extrapulmonary lesions was evaluated in 12 patients win whom disseminated nonmeningeal coccidioidomycosis developed after a single epidemic exposure in December 1977. Studies were performed with each radionuclide from 4 to 9 months after infection. Comparison of scintigraphy with radiography showed that eight of 14 osteolytic lesions identified by radiography were present on the bone and gallium scans; four were present only on the gallium scan, and two were undetected. Of 15 additional lesions present in both scanning procedures, eight were not present in matching roentgenograms and seven were in unstudied areas. Gallium scans detected seven of 14 soft tissue lesions. Few diagnostically confusing noninfectious lesions were observed. Because nuclear scanning detected almost all lesions present in radiographs and demonstrated otherwise unrecognized lesions, scans should be performed in all patients in whom coccidioidal dissemination is suspected.