Demonstration of reperfusion after thrombolysis with technetium-99m isonitrile myocardial imaging

Technetium-99m isonitrile myocardial perfusion imaging was employed in a patient undergoing thrombolytic therapy with recombinant tissue plasminogen activator for acute anteroseptal myocardial infarction. Technetium-99m isonitrile does not demonstrate significant myocardial redistribution after intravenous injection. The imaging agent was administered in the emergency room, prior to the initiation of thrombolytic therapy. The initial area at risk for infarction was visualized on images obtained after the patient had been effectively treated. Imaging performed 5 days later, after repeat injection of [99mTc]isonitrile, showed a smaller myocardial perfusion defect indicating salvage of myocardium. Thus, this technique offers promise as a noninvasive means of assessing the area at risk, the success of reperfusion, and the presence of salvaged myocardium, early in the course of acute myocardial infarction.     

Adsorption of technetium-99m tetrofosmin and technetium-99m furifosmin on plastic syringes

Some groups have reported that adsorption of radiopharmaceuticals on disposable plastic syringes can reach levels of almost 50%. This high loss of radioactivity stimulated us to carry out similar studies. Our measurements were done in combination with patient studies. Therefore, we used 2-ml syringes, all of the same brand. The radioactivity in the syringe was measured immediately before and after injection. a total of 500–600 MBq technetium-99m labelled tetrofosmin or technetium-99m furifosmin was administered to 48 patients using four different injection techniques (n = 6 for each technique with each tracer): with needles, 1 min blood incubation at 22°C, 10 or 30 min after preparation of the tracer; with butterflies, 1 min blood incubation at 22°C, 10 or 30 min after preparation of the tracer. Neither in syringes nor in needles or butterflies did more than 7% of the initial radioactivity remain. The entire residual activity in syringe plus needle or syringe plus butterfly together never exceeded the 9% limit. Furthermore, in a pilot study we measured the remaining radioactivity in the vial; here, too, we found no more than 14% of total radioactivity. These findings indicate that total retention of radioactivity during elution and application of ^99mTc-tetrofosmin and ^99mTc-furifosmin with material used in our setting does not approach relevant amounts. Received 6 May and in revised form 19 May 1998     

Artifactual reverse distribution pattern in myocardial perfusion SPECT with technetium-99m sestamibi

BACKGROUND: The reverse distribution pattern (RDP), in which resting perfusion imaging demonstrates a de novo or more marked regional defect than that present in stress images, is observed frequently in patients with a low likelihood of coronary artery disease. METHODS AND RESULTS: To determine whether this scan pattern is artifactual and to investigate its causes, we retrospectively evaluated scans in 202 patients with a low likelihood of coronary artery disease (77 men and 125 women) undergoing single-day rest/stress technetium-99m sestamibi single photon emission computed tomography (SPECT). The presence and location of RDP was correlated with relevant body habitus parameters. RDP was observed in 15.3% of patients. The finding was significantly more frequent in patients who were obese (P<.02 in men, P<.03 in women), in men with abdominal protuberance (P<.05), and in women with prominent breast "shadows" observed on planar projection images (P<.008). RDP was most frequent in the right coronary artery territory in men and the left anterior descending coronary artery territory in women. It was demonstrated by means of a cardiac SPECT phantom experiment that soft tissue attenuation effects were most evident in low count density SPECT studies with localized soft tissue attenuation, accounting for the higher than clinical observation of RDP in obese patients undergoing low-dose rest/high-dose imaging. CONCLUSIONS: RDP is a frequently encountered artifact in obese patients undergoing rest/stress Tc-99m sestamibi SPECT, particularly in men with abdominal protuberance and in women with large, dense breasts.     

Comparative myocardial uptake of technetium-99 m sestamibi and technetium-99m tetrofosmin one hour after stress injection

Technetium-99m sestamibi and ^99mTc-tetrofosmin are at present the preferred tracers for simultaneous assessment of myocardial perfusion and function by gated single-photon emission tomography (SPET). The aim of this work was to compare sestamibi and tetrofosmin myocardial uptake 1 h after stress injection. Consecutive unselected patients were studied either with sestamibi or with tetrofosmin on a random basis, until at least 100 patients had been enrolled for each gender and tracer. Stress was obtained by dipyridamole or exercise or combined dipyridamole + exercise; in the latter cases, exercise was sustained for at least 1.5 min after tracer injection. Injected activity was similarly adjusted to body weight. For each patient, imaging began 60–75 min after injection. All SPET projections were summed; due to the acquisition technology (”roving zoom”, i.e. a mobile zoom), the heart always appeared at the centre of the frame in all projections and in the sum image. Thus minimal lung background contamination could be assumed in an elliptic region of interest placed over the heart on the sum image. Three indexes were analysed: total myocardial counts (Sum), mean myocardial pixel (Mean) and maximum myocardial pixel (Max). Four patient groups were analysed: males with sestamibi or tetrofosmin (MS: n = 189 and MT: n = 157), females with sestamibi or tetrofosmin (FS: n = 101 and FT: n = 104). MS and MT groups were comparable for physical variables, maximum heart rate and stress type, as were the FS and FT groups. Sum, Mean and Max were significantly higher with sestamibi (P = 0.0001 by ANOVA). Comparing MS vs MT and FS vs FT, mean values ± SD were as follows: for Sum (kcounts) 750±184 vs 652±166, and 707±202 vs 594±189; for Mean (counts) 4517±1171 vs 4107±898, and 4908±1119 vs 4144±1025; and for Max (counts) 6471±1654 vs 5794±1312, and 7318±1886 vs 6152±1684. The mean gain with sestamibi was +15%, +10% and +12% in males, and +19%, +18% and +19% in females. Similar differences were found within each stress type subgroup. No gender-specific effect was found for Mean, so the overall mean gain was calculated for Mean: +13% for sestamibi vs tetrofosmin. These findings are consistent with other published smaller sample series. Possible differences between tracers with regard to residual activity in syringes were ruled out by an additional experiment. In summary, we found significantly higher myocardial counts with sestamibi than with tetrofosmin, in males as well as in females. Received 10 February and in revised form 27 July 1998     

The effect of collateral flow and myocardial viability on the distribution of technetium-99m sestamibi in a closed-chest model of coronary occlusion and reperfusion

Myocardial uptake of technetium-99m sestamibi at low coronary flow rates overestimates blood flow, but the relative impact of flow and viability on 99mTc-sestamibi kinetics is unclear. The objective of this study was to determine the effect of myocardial viability and the degree of collateral blood flow on the uptake and retention of 99mTc-sestamibi by examining three animal models of coronary occlusion and reperfusion, each reflecting a different state of viability and collateral blood flow. Three closed-chest animal models were studied: canine (high collateral flow, preserved viability), porcine (low collateral flow, absent viability) and porcine with slowly occlusive coronary stents producing infarction and enhanced collateral blood flow (high collateral flow, absent viability). There were seven dogs, seven pigs and six pigs, respectively, in each animal model. Animals from all three models were subjected to a 40-min total left anterior descending artery (LAD) occlusion followed by 2 h of reperfusion. 99mTc-sestamibi and radiolabelled microspheres were injected during LAD occlusion 10 min prior to reperfusion. Animals were sacrificed after 2 h of reperfusion flow. Ex situ heart slice imaging to determine risk area was followed by viability staining to determine infarct size. Slices were subsequently sectioned into equally sized radial segments and placed in a gamma well counter. Risk area as determined by ex situ 99mTc-sestamibi imaging was not significantly different by model. Pathological infarct size differed significantly by model [canine = 1%+/-1% of the left ventricle (LV); porcine = 13%+/-8% LV; porcine with stent = 14%+/-7% LV; P = 0.002)]. Collateral blood flow by microspheres during occlusion tended to differ among models (overall P = 0.08), with the canine and porcine with stent models having relatively high flow rates compared with the acute porcine model. 99mTc-sestamibi activity correlated with microsphere blood flow in all three models, with r values for individual animals (n = 20) ranging from 0.86 to 0.96 (all P<0.0001). There was a significant difference in the regression line intercepts (P<0.0001) and slopes (P<0.01) among the three models comparing 99mTc-sestamibi uptake with myocardial blood flow. 99mTc-sestamibi uptake overestimated blood flow to a greater extent in the canine model (high flow with viability) than in the porcine model (low flow, absent viability). Despite enhanced collateral flow, there was significantly less overestimation of flow in the porcine stent model (high flow, absent viability). In conclusion, at low flow rates 99mTc-sestamibi activity overestimates myocardial blood flow. This effect is most pronounced in myocardium with significant collateral flow and preserved viability, consistent with over-extraction or redistribution of the tracer. The effect is markedly decreased in non-viable myocardium regardless of blood flow.     

The effect of collateral flow and myocardial viability on the distribution of technetium-99m sestamibi in a closed-chest model of coronary occlusion and reperfusion

Myocardial uptake of technetium-99m sestamibi at low coronary flow rates overestimates blood flow, but the relative impact of flow and viability on ^99mTc-sestamibi kinetics is unclear. The objective of this study was to determine the effect of myocardial viability and the degree of collateral blood flow on the uptake and retention of ^99mTc-sestamibi by examining three animal models of coronary occlusion and reperfusion, each reflecting a different state of viability and collateral blood flow. Three closed-chest animal models were studied: canine (high collateral flow, preserved viability), porcine (low collateral flow, absent viability) and porcine with slowly occlusive coronary stents producing infarction and enhanced collateral blood flow (high collateral flow, absent viability). There were seven dogs, seven pigs and six pigs, respectively, in each animal model. Animals from all three models were subjected to a 40-min total left anterior descending artery (LAD) occlusion followed by 2 h of reperfusion. ^99mTc-sestamibi and radiolabelled microspheres were injected during LAD occlusion 10 min prior to reperfusion. Animals were sacrificed after 2 h of reperfusion flow. Ex situ heart slice imaging to determine risk area was followed by viability staining to determine infarct size. Slices were subsequently sectioned into equally sized radial segments and placed in a gamma well counter. Risk area as determined by ex situ ^99mTc-sestamibi imaging was not significantly different by model. Pathological infarct size differed significantly by model [canine = 1%±1% of the left ventricle (LV); porcine = 13%±8% LV; porcine with stent = 14%±7% LV; P=0.002)]. Collateral blood flow by microspheres during occlusion tended to differ among models (overall P=0.08), with the canine and porcine with stent models having relatively high flow rates compared with the acute porcine model. ^99mTc-sestamibi activity correlated with microsphere blood flow in all three models, with r values for individual animals (n=20) ranging from 0.86 to 0.96 (all P<0.0001). There was a significant difference in the regression line intercepts (P<0.0001) and slopes (P<0.01) among the three models comparing ^99mTc-sestamibi uptake with myocardial blood flow. ^99mTc-sestamibi uptake overestimated blood flow to a greater extent in the canine model (high flow with viability) than in the porcine model (low flow, absent viability). Despite enhanced collateral flow, there was significantly less overestimation of flow in the porcine stent model (high flow, absent viability). In conclusion, at low flow rates ^99mTc-sestamibi activity overestimates myocardial blood flow. This effect is most pronounced in myocardium with significant collateral flow and preserved viability, consistent with over-extraction or redistribution of the tracer. The effect is markedly decreased in non-viable myocardium regardless of blood flow. Received: 18 October and in revised form 18 December 1999     

A neutral technetium-99m complex for myocardial imaging

Technetium-99m-CDO-MeB [Bis[1,2-cyclohexanedione-dioximato(1-)- O]-[1,2-cyclohexanedione dioximato(2-)-O]methyl-borato(2-)- N,N',N',N',N',N'')-chlorotechnetium) belongs to a family of compounds generally known as boronic acid adducts of technetium dioxime complexes (BATOs). It has an intrinsic affinity for the myocardium, with negligible lung activity and rapid blood clearance. The uptake of 3.44% ID in rat heart at 1 min postinjection for [99mTc]CDO-MeB versus 3.03% for 201TI indicates high extraction of [99mTc]CDO-MeB by the myocardium. In dogs an ischemic defect is clearly seen in SPECT images obtained 10 min after injection of [99mTc]CDO-MeB. Tissue distribution data in rats show that [99mTc]CDO-MeB is excreted primarily in the feces and to a lesser extent in the urine. Approximately 80% of the activity is excreted within 24 hr after injection.     

Simultaneous technetium-99m MIBI angiography and myocardial perfusion imaging

Resting first-pass radionuclide angiography (FPRNA) was performed with the myocardial perfusion agent technetium-99m MIBI. In 27 patients, it was compared with technetium-99m diethylenetriamine pentaacetic acid FPRNA. A significant correlation was present in left (r = 0.93, p less than 0.001) as well as right (r = 0.92, p less than 0.001) ventricular ejection fraction measured with both radiopharmaceuticals. In 13 patients, MIBI derived segmental wall motion was compared with contrast ventriculography. A high correlation was present (p less than 0.001), and qualitative agreement was found in 38/52 segments. In 19 patients with myocardial infarction a significant correlation was present between MIBI segmental wall motion and perfusion scores (p less than 0.001). In ten patients with a history of myocardial infarction, 18 myocardial segments demonstrated diseased coronary vessels and impaired wall motion at contrast angiography. These segments were all identified by the MIBI wall motion and perfusion study. We conclude that MIBI is a promising agent for simultaneous evaluation of cardiac function and myocardial perfusion at rest.     

Effect of coronary reperfusion on technetium-99m methoxyisobutylisonitrile uptake by viable and necrotic myocardium in the dog

Technetium-99m hexakis-2-methoxyisobutyl isonitrile (^99mTc-MIBI) distribution is flow-dependent, permitting the imaging of coronary perfusion defects. However, the behaviour of this tracer in viable and necrotic tissues within the ischaemic area at risk is still being debated. In a clinically relevant canine model, dogs were submitted either to a 24-h permanent occlusion (group 1) of the left descending coronary artery (LAD) or to a 90-min LAD occlusion followed by 22.5 h reperfusion (group 2). ^99mTc-MIBI and radiolabelled microspheres were injected 3 h before sacrifice. After delimiting the area at risk and the infarct by Evans blue perfusion and triphenyltetrazolium chloride staining, heart slices were imaged by scintigraphy and tissue radioactivity measured in a gamma-counter. In the necrotic area of both groups, the ^99mTc-MIBI distribution was proportional to the myocardial blood flow, approximating a 1:1 ratio (identity line slope l, intercept 0) with highly significant correlation coefficients (group 1 r = 0.87, group 2 r = 0.86), whereas in the viable-ischaemic area of both groups, the data points are widespread above and below the identity line, indicating both over- and underestimations of blood flow in these tissue areas. These results were more pronounced following reperfusion as compared with permanent occlusion. Multiple linear regression analysis confirms differences (P < 0.001) in ⁹⁹Tc-MIBI distributions between the viable-ischaemic and the necrotic zones. Delineation of the ischaemic area at risk was possible only with permanent occlusion. A hypoper-fused area was observed after reperfusion but differs from the anatomical infarcted area. These results indicate that the ^99mTc-MIBI distribution is not significantly influenced by myocardial cell death, whereas the relationship of ^99mTc-MIBI to blood flow in the remaining viable-ischaemic myocardium salvaged by reperfusion appears more deeply affected. Therefore, the influence of tissue viability on the ^99mTc-MIBI distribution in the myocardium must be reconsidered in the light of these observations.Supported by grant IU-0027, Medical Research Council of CanadaPostdoctoral fellow of the Canadian Heart FoundationBursor from the Canadian Heart Foundation Offprint requests to: J.-G. Latour     

Parathyroid scintigraphy: comparison of technetium-99m methoxyisobutylisonitrile and technetium-99m tetrofosmin studies

We report the preliminary results of a prospective study demonstrating tetrofosmin uptake in surgically and histologically proven parathyroid adenomas. In ten patients with primary chronic hyperparathyroidism, parathyroid imaging was performed using (1) technetium-99m methoxyisobutylisonitrile (MIBI) and (2)^99mTc-1,2-bis(bis(2-ethoxyethyl)phosphino)ethane (tetrofosmin) within a time interval of 3–5 days. Both tracers correctly identified the parathyroid adenomas by focal prolonged tracer retention. On visual inspection image contrast was generally higher with MIBI than with tetrofosmin in all the patients studied. Tetrofosmin showed a slower elimination from the parathyroid adenomas than MIBI in six of the ten cases. Our preliminary results show that tetrofosmin, like MIBI, as a feasible, sensitive tracer for parathyroid scintigraphy. For routine use, the rapid kit preparation without heating and the lower radiation dose to the patient make tetrofosmin an alternative tracer for parathyroid scintigraphy. Further evaluation is needed to determine which of the two tracers is the more sensitive for the detection of parathyroid adenomas, and which tracer properties better reflect the degree of endocrine activity.[/p]     

Effect of coronary reperfusion on technetium-99m methoxyisobutylisonitrile uptake by viable and necrotic myocardium in the dog.

Technetium-99m hexakis-2-methoxyisobutyl isonitrile (99mTc-MIBI) distribution is flow-dependent, permitting the imaging of coronary perfusion defects. However, the behaviour of this tracer in viable and necrotic tissues within the ischaemic area at risk is still being debated. In a clinically relevant canine model, dogs were submitted either to a 24-h permanent occlusion (group 1) of the left descending coronary artery (LAD) or to a 90-min LAD occlusion followed by 22.5 h reperfusion (group 2). 99mTc-MIBI and radiolabelled microspheres were injected 3 h before sacrifice. After delimiting the area at risk and the infarct by Evans blue perfusion and triphenyltetrazolium chloride staining, heart slices were imaged by scintigraphy and tissue radioactivity measured in a gamma-counter. In the necrotic area of both groups, the 99mTc-MIBI distribution was proportional to the myocardial blood flow, approximating a 1:1 ratio (identity line slope 1, intercept 0) with highly significant correlation coefficients (group 1 r = 0.87, group 2 r = 0.86), whereas in the viable-ischaemic area of both groups, the data points are widespread above and below the identity line, indicating both over- and underestimations of blood flow in these tissue areas. These results were more pronounced following reperfusion as compared with permanent occlusion. Multiple linear regression analysis confirms differences (P less than 0.001) in 99mTc-MIBI distributions between the viable-ischaemic and the necrotic zones. Delineation of the ischaemic area at risk was possible only with permanent occlusion. A hypoperfused area was observed after reperfusion but differs from the anatomical infarcted area.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative scanning of thyroid nodules with technetium-99m pertechnetate and technetium-99m methoxyisobutylisonitrile

Thyroid imaging was performed using technetium-99m methoxyisobutylisonitrile and technetium-99m pertechnetate in 58 patients. The ^99mTc-pertechnetate scans showed a total of 77 nodules: 60 cold, 13 hot and 4 of normal activity. There was no ^99mTc-MIBI accumulation in 46.4% of ^99mTc-pertechnetate cold nodules; 27 (45%) of these nodules showed ^99mTc-MIBI uptake with the same intensity as the surrounding normal tissue, and five (8.6%) became hot with ^99mTc-MIBI. Of the ^99mTc-pertechnetate hot nodules 11 (84.6%) could not be differentiated from the normal extranodular tissue on the ^99mTc-MIBI scan. The histopathology of 34 surgically removed nodules proved that increased, normal or decreased ^99mTc-MIBI accumulation is not specific for thyroid malignancy and that the ^99mTc-MIBI uptake depends mainly on the viability of thyroid tissue.Correspondence to: I. Földes     

Comparison of technetium-99m pyrophosphate and technetium-99m methylene diphosphonate with variable amounts of stannous chloride in the detection of acute myocardial infarction

The authors prospectively compared the ability of Tc-99m pyrophosphate (PYP) and Tc-99m methylene diphosphonate (MDP) to detect acute myocardial infarctions. The agents used were PYP (12 mg) with 3.4 mg of stannous chloride, MDP (10 mg) with 1.0 mg of stannous chloride, and MDP (10 mg) with 3.4 mg of stannous chloride. Imaging was performed on three consecutive days on 34 patients with proven myocardial infarctions, using the same agent on the first and third days of the study and an alternate agent on the second day. Agents were assigned randomly to each of six groups of patients. First images were obtained an average of 3.7 days (range, one to six days) following myocardial infarction. Seventeen of 23 patients (75%) had images positive for acute myocardial infarction with Tc-99m PYP, whereas only two of 21 patients (9.5%) had positive studies with Tc-99m MDP with 3.4 mg of stannous chloride and one of 24 patients (4.2%) had positive studies with Tc-99m MDP and 1.0 mg of stannous chloride. All three myocardial infarctions detected by Tc-99m MDP were extensive and transmural. When MDP and PYP were both positive in the same patient, the apparent size of the myocardial infarction was much smaller with the MDP. It is concluded that MDP can detect only large myocardial infarctions, has poor localization in the infarcted tissue, and varying the stannous chloride content of the preparation does not improve the ability of MDP to detect acute myocardial infarctions.     

Detection of radiation-induced myocardial damage by technetium-99m sestamibi scintigraphy

A prospective study was initiated to assess the side-effects of postoperative adjuvant radiotherapy in patients with left-sided early breast cancer. Twelve patients with early breast cancer were examined before and a year after radiotherapy. Echocardiography, ECG and bicycle ergometry stress test with technetium-99m sestamibi myocardial perfusion scintigraphic were carried out to assess changes in regional myocardial blood flow. Six of the 12 patients had new fixed scintigraphic defects after radiotherapy (as compared with the preradiation examination). The localization of the defects corresponded well with the irradiated volume of the left ventricle. These defects were probably due to microvascular damage to the myocardium. Neither ECG changes nor left ventricular segmental wall motion abnormalities could be detected by echocardiography. To our knowledge this study is the first to show that radiation-induced microvascular damage to the myocardium may be detected by perfusion scintigraphy. This may limit the use of scintigraphy in diagnosing coronary artery disease in patients treated with thoracic radiotherapy. Long-term follow-up is necessary to assess whether the presence of microvascular damage is a prognostic sign for the development of radiation-induced coronary artery disease.     

Effect of renal maturation on the clearance of technetium-99m mercaptoacetyltriglycine

To investigate the effect of growth and maturation on the global kidney clearance of technetium-99m mercaptoacetyltriglycine (^99mTc-MAG3), we investigated 509 children who attended for^99mTc-MAG3 renography in our department. In order to estimate the normal maturation of the kidney, only children who were classified as “normal” using diagnostic criteria were included in this study (n=109). Kidney clearance was calculated using a gamma camera technique and a 20-min blood sample. There was a progressive increase in the clearance of^99mTc-MAG3 thoughout childhood and into adolescence (mean clearance value below 2 month was 31.4 ml/min, mean clearance value above 12 years was 287 ml/min). When clearance was normalised to body surface area (BSA) a different pattern was seen, with a progressive increase from 3 weeks of age (mean value <0.2 years: 208 ml/min/1.73 m²) to a plateau at the end of the first year of life (mean value >2 years: 303 ml/min/1.73 m²). Maturation of the kidney as defined by the normalised clearance of^99mTc-MAG3 is therefore complete by the end of the 1st year of life, after which any change in non-corrected clearance values may be attributed to growth. To investigate the appropriate normalisation factor for^99mTc-MAG3 clearance in children, clearance values were compared to height, weight and BSA. The relationships were described using a linear model; the correlation coefficients demonstrated that BSA has the highest strength of relationship with^99mTc-MAG3 clearance. Body surface area may be used over 1 year of age to normalise the clearance values of^99mTc-MAG3 Surprisingly, when clearance values are normalised to BSA, 68% of the mature clearance value is achieved at the age of <2 months of life.     

Phytate technetium-99m versus dextran 500 technetium-99m in the sentinel lymph node biopsy

PURPOSE: To study which of the two most used radiopharmaceutical drugs for the sentinel lymph node (SLN) biopsy procedure (dextran 500 99mTc and phytate 99mTc) best defines the SLN and migrates less to other lymph nodes. MATERIAL AND METHODS: Thirty-two rats, separated into two groups, underwent lymphoscintigraphy examination with either dextran or phytate followed by sentinel (popliteal), lumbar, and inguinal lymph node biopsy. Radiation was detected with a gamma probe. RESULTS: The statistical study indicated count rates significantly higher in the SLN than in the other basins for both the dextran (P<0.01) and phytate groups (P<0.001). There was no statistically significant difference concerning SLN absorption in either group (P=0.2981). In the dextran group, migration occurred to 1.5 lymphatic basins with counting higher than 10% of that found in the SLN versus 0.8 in the phytate group (P=0.0023). Migration was thus higher in the dextran group (P=0.0207). CONCLUSION: There was no statistically significant difference between dextran and phytate in the SLN identification, but the phytate migrated to fewer lymphatic basins beyond the SLN and with less intensity.     

Comparison of technetium-99m pyrophosphate and technetium-99m DTPA aerosols for SPECT ventilation lung imaging

Although [99mTc] diethylenetriaminepentaacetic acid (DTPA) is currently the most widely used radioaerosol, rapid alveolar clearance limits its usefulness for single photon emission computed tomography (SPECT) ventilation lung imaging. Previous research has shown that [99mTc]phosphate compounds have high alveolar deposition and slow clearance and thus provide suitable aerosols for pulmonary ventilation studies. We have compared the pulmonary retention and blood levels of [99mTc]pyrophosphate (PYP) and [99mTc]DTPA in eight normal nonsmoking male volunteers. These two radioaerosols have comparable pulmonary deposition. Technetium-99m PYP, however, has a much slower pulmonary clearance which allows sufficient time (20 or more minutes) for SPECT data acquisition using a single-headed rotating gamma camera. While the radiation absorbed dose to the lungs for [99mTc]PYP (0.31 rad/mCi) is greater than for [99mTc]DTPA (0.11 rad/mCi), it is at a clinically acceptable and safe level.     

Discordant uptake of technetium-99m DISIDA and technetium-99m sulfur colloid in an amebic abscess

Hepatobiliary imaging in a patient with an amebic abscess showed an early cold defect that later showed rim enhancement. A Tc-99m SC scan did not show prominent flow (making hepatoma unlikely) and showed the previously noted defect to appear larger and without rim enhancement. The differential damage to Kupffer cells and hepatocytes or edema may account for these findings. Amebic abscess should be included in the differential diagnosis of lesions that give increased Tc-99m IDA but cold Tc-99m SC images.