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Imaging of head and neck tumors with technetium(V)-99m DMSA. A new tumor-seeking agent.

Tumor scintigraphy, using Tc(V)-99m DMSA was performed on 76 patients with head and neck tumors. In 32 cases, SPECT also was performed. Tc(V)-99m DMSA was found to have a sensitivity of 75% (56 cases), a specificity of 85% (20 cases) and an accuracy of 78% on planar imaging. ECT studies showed accumulation of Tc(V)-99m DMSA in all 25 malignant cases studied. However, in benign tumors, four of seven cases (57%) showed radionuclide uptake. Tc(V)-99m DMSA has superior physical properties to Ga-67 and could be of use in the diagnosis of head and neck tumors.

Adult↗

Technetium-labelled leucocytes using diethyldithiocarbamate: preliminary report on in vitro studies.

Diethyldithiocarbamate (DDC) forms a lipid soluble complex with 99Tcm-pertechnetate which is rapidly incorporated into leucocytes in vitro. In seven healthy volunteers, a 'crude' leucocyte suspension was obtained by sedimnetaion and centrifugation and incubated with 99Tcm-DDC complex. Labelling efficiency was found to be 73 +/- 14% (SD). The mean activity remaining on the cells after hourly incubations with plasma was 77 +/- 5%. Percoll-saline differential cell analysis showed that 69 +/- 3% of the activity was associated with the granulocytes, 12 +/- 4% with the lymphocytes/monocytes, 11 +/- 4% with the platelets and 8 +/- 1% with contaminating erythrocytes (n = 3). The mean labelling efficiency decreased by 14% when the leucocyte count was reduced from 42 X 10(6) to 21 X 10(6) cells. Over the range 21 X 10(6) to 5.2 X 10(6) cells there was no decrease in labelling efficiency.

Ditiocarb↗

Management of common bile duct obstruction associated with spontaneous perforation of the biliary tree.

Spontaneous perforation of the extrahepatic biliary tree during infancy is an uncommon event. The cause of bile duct perforation is unclear, but one-quarter of reported cases have been associated with a stone or bile sludge obstructing the distal common bile duct. A 4-week-old girl had jaundice, and a DISIDA (99m technetium diisopropyl iminodiacetic acid) scan revealed perforation of the biliary tree. Exploratory surgery showed distal common bile duct obstruction with proximal perforation. No attempt was made to remove the obstructing lesion because of duct inflammation. Common bile duct obstruction persisted until week 5 after surgery when cholangiography revealed free flow of contrast into the duodenum through a common bile duct of normal caliber without a filling defect. In the presence of acute inflammation associated with perforation of the biliary tree, exploration of the common bile duct to relieve a distal obstruction could prove hazardous. Our case and a review of the literature suggest that the obstructing stone or sludge may pass spontaneously if managed expectantly.

Biliary Tract Diseases↗

[Quantitative renal scintigraphy with technetium-labelled dimercaptosuccinic acid in children].

Separate measurement of renal function is essential in children with urinary tract disease. This can be done satisfactorily by means of kidney scintigraphy with technetium 99m-labelled dimercaptosuccinic acid. A retrospective study of the records of 415 children, which comprised renal function tests, radiology and scintigraphy, confirmed the value of the radioisotope technique. Graphs of height, kidney uptake and kidney uptake density in relation to age were established, showing highly significant correlations with renal function tests and intravenous urography results, but many dissociations were encountered. Separate renal function evaluation by radioisotope scintigraphy seems to be more reliable than evaluation extrapolated from measurement of the cortical areas at intravenous urography. In vesico-ureteral reflux scintigraphy makes it possible to detect reflux nephropathy at an earlier stage than with other methods.

Age Factors↗

Synthesis of labelled small peptide complexes for imaging agents with technetium-99m and biodistribution in mice.

AIM: To look for new heart or kidney imaging agents. Five new target chelators--2-N-(2'-s-triphenylmethylacetyl) amino-(N'-acetyl glycine) isovalericamide (MVG2), 2-N-(2'-s-triphenylmethylacetyl) amino-[N'-acetyl-(N"-butylacetaminde)] isovalericamide (MVGT), 2-N-(2'-s-tri-phenylmethylacetyl) amino-[N'-acetyl-(N"-cyclohexanylacetaminde)] isovalericamide (MVGH), 2-N-(2'-s-triphenylmethylacetyl) amino-[N'-acetyl-(N"-butylacetaminde)] phenyl propamide (MPGT) and 2-N-(2'-s-triphenylmethylacetyl) amino-[N'-acetyl-(N"-cyclohexanylacetaminde)] phenylpropamide (MPGH) were synthesized as primitive materials to explore the synthetic methods of polypeptides. METHODS AND RESULTS: All target chelators were identified on the basis of the spectroscopic data, such as IR, 1HNMR, 13CNMR and elementary analysis. Different active esters with mercaptoacetic acid as primitive materials were used to explore the biodistribution of Technetium-99m labelling chelators in mice. The chelators were labeled with Technetium-99m and further tested for the biological activity in mice. Values given in ID which is the percentage injected dose per organ was tested to explore new heart imaging agents. The ID was determined in vivo by biodistribution study. Tc-99m complexes 0.1 mL was injected into laterial tail vein of 3 anaesthetised rats. At 2, 5, 10, 30, 60 minutes post-injection, rats were sacrificed by decapitation, bled from the neck and the organs were removed. The radioactivities in various organs were determined in an automatic twin crystal gamma counter. Five new target chelators were labeled with Technetium-99m in high yield (> 95%). The bio-distribution resulted in mice indicate that 99Tcm-MVG2 has high kidney uptake, good retention, quick blood clearance and high activity ratios of kidneys to other tissues. 99Tcm-MVGT, 99Tcm-MVGH and 99Tcm-MPGT have better heart accumulation, but shorter retention, slower blood clearance and lower activity ratios of kidneys to other tissues. They were mainly metabolized through liver and kidney. CONCLUSION: 99Tcm-MVG2 will be a new potential renal function imaging agent and 99Tcm-MVGT, 99Tcm-MVGH and 99Tcm-MPGT will be new potential heart function imaging agents if their structure and activity relationships are further studied.

Animals↗

Technetium 99m sestamibi in the assessment of chronic coronary artery disease.

Extensive work has already been performed with regard to both planar and single photon emission computed (SPECT) technetium 99m sestamibi studies. Before widespread application of optimized acquisition and processing methods, clinical results between 99mTc sestamibi and thallium 201 were remarkably similar. It is anticipated that as techniques for 99mTc sestamibi planar and SPECT imaging become optimized, improvements in sensitivity and specificity for detection of coronary artery disease, over those observed with 201TI, might be forthcoming. This expectation is based on the improved image quality inherent in the use of the 99mTc agent with its higher count rate and higher energy. This improvement in image quality may be a principal reason for laboratories to switch from 201TI to 99mTc sestamibi imaging. It is anticipated that, with improved imaging characteristics, it will be easier for the average community hospital to obtain higher quality planar or SPECT imaging using 99mTc sestamibi rather than 201TI. In addition to improved image quality, the characteristics of 99mTc sestamibi allow gated planar or SPECT perfusion images to be obtained. It has been suggested that stress-gated SPECT sestamibi studies may provide all the information contained in a stress-rest nongated 99mTc sestamibi study, thereby potentially increasing patient throughput, a major concern with SPECT. Throughput can also be increased by using dual-isotope approaches with rest 201TI and stress technetium sestamibi acquisitions, employing either separate or simultaneous imaging with which the entire study can be accomplished in less than 2 hours. With simultaneous dual-isotope acquisition, camera time can be reduced by 50%. Finally, 99mTc sestamibi offers the advantage of the ability to perform first-pass exercise ventricular function and SPECT myocardial perfusion studies with a single injection of tracer. Regarding the assessment of myocardial viability, results to date suggest a very high degree of concordance between 201TI and 99mTc sestamibi studies using either planar or SPECT acquisition techniques. Correlative rest studies with both tracers will be of particular interest, as will preoperative and postoperative and position emission tomography correlation studies.

Aged↗

The localization of myocardial ischaemia with technetium-99m methoxy isobutyl isonitrile and single photon emission computed tomography.

Thirty-two patients with suspected coronary artery disease were studied by single photon emission computed tomography (SPECT) imaging with oblique reconstructions of the myocardium following the intravenous administration of technetium-99m methoxy isobutyl isonitrile at peak exercise. All patients also underwent three-vessel coronary angiography. The SPECT technique produced very detailed images allowing easy delineation of localized myocardial defects. Segmental myocardial uptake defects were compared with diseased vessels as shown at angiography. A good correlation was shown between right coronary artery (RCA) disease and mid and proximal inferior segments and between left circumflex (LCx) artery disease and mid and proximal lateral segments, allowing accurate localization of a defect to one of these two vessels' territories. Sensitivity and specificity of detection of disease of the RCA and LCx artery were high. Defects associated with a lesion of the left anterior descending vessel were more variable.

Adult↗

Calculation of relative glomerular filtration rate and correlation with delayed technetium-99m DMSA imaging.

The relative renal uptake of Tc-99m DMSA was compared with the relative glomerular filtration rate (GFR) in ten patients with serum creatinines ranging from 0.3 to 2.5 mg/dl. Relative GFR was based on the renal uptake of Tc-99m DTPA determined by two methods: 1) integrating the counts from 1 to 3 minutes postinjection and correcting for background. 2) Totalizing the individual renal counts in a single 15-second frame from 2:45 minutes to 3:00 minutes postinjection and correcting for background. The two methods of determining relative DTPA uptake showed excellent correlation, r = 0.98. Relative DMSA uptake determined at 24 hours post-injection using computer-assisted regions of interest showed excellent correlation with the relative GFR determined by either the integral or single-frame method, r = 0.98. The addition of background subtraction for the DMSA images at 24 hours did not improve the correlation.

Adolescent↗

99Tcm (v) DMSA: the pituitary sign.

Technetium-99m (99Tcm) (v) dimercaptosuccinic acid (DMSA) is a new tumour imaging agent which has been used to evaluate head and neck tumours. It has a normal head and neck biodistribution to include the lacrimal glands, nasal mucosa and the blood-pool. Seventy-seven patients were studied of whom 63 had a head and neck malignancy. Of these patients, 19 (25%) exhibited positive accumulation of radioactivity in the region of the pituitary gland and this was a constant finding in those followed-up after treatment. Biodistribution studies in forty New Zealand white rabbits confirmed pituitary accumulation of 99Tcm (v) DMSA. The pituitary gland region should be included in the normal biodistribution of 99Tcm (v) DMSA.

Adult↗

Role of technetium 99m methoxyisobutylisonitrile single photon emission tomography in the evaluation of thrombolysis in acute myocardial infarction before and after admission to hospital. Multicenter Study Group "Etude MIBI (EMIBI)".

To investigate initial perfusion status in acute myocardial infarction, methoxyisobutylisonitrile (MIBI) was administered by the rescue physicians. Thirty-nine patients received the radiopharmaceutical at home or upon arrival at the hospital. Diagnosis was confirmed in 30 patients, and 19 emergency thrombolyses were performed. Initial single photon emission tomography (SPET) analysis was constantly abnormal in confirmed myocardial infarction sometimes before direct electrocardiographic signs. MIBI-SPET was normal in non-coronary syndromes. MIBI uptake improved after thrombolysis (P less than 0.001) but also after heparin therapy (P less than 0.05). SPET improvement demonstrated myocardial salvage earlier than wall motion studies. MIBI administration at the patient's home allowed very early perfusion imaging when thrombolysis was performed at home. MIBI-SPET has the potential use of comparing thrombolytic agents or at home versus in hospital thrombolysis.

Ambulances↗

Aqueous fluoride and the preparation of [99mTc(CO)3(OH2)3]+ and 99mTc-carborane complexes.

A method for the preparation of eta5-metallocarborane complexes of technetium-99m in water was developed. The key to the procedure is the use of aqueous sodium or potassium fluoride, which prevents premature degradation of the Tc(I) starting material used to prepare the carborane complexes. Solid-phase extraction was used to purify Tc-metallocarboranes derived from both ortho and meta isomers, which were isolated in good to excellent yields in high radiochemical purities. In conjunction with these studies, a series of fluoride-based "kits" were developed to produce the key precursor [99mTc(CO)3(H2O)3]+ in the absence of any other stabilizing ligand. Using this approach, [99mTc(CO)3(H2O)3]+ could be prepared directly from 99mTcO4- under a range of pH values, including neutral pH, which affords the opportunity to develop one-pot labeling procedures for base-sensitive targeting vectors.

Boron Compounds↗

Extension of the single amino acid chelate concept (SAAC) to bifunctional biotin analogues for complexation of the M(CO)3(+1) Core (M = Tc and Re): syntheses, characterization, biotinidase stability, and avidin binding.

Biotin and avidin form one of the most stable complexes known (K(D) = 10(-15) M(-1)) making this pairing attractive for a variety of biomedical applications including targeted radiotherapy. In this application, one of the pair is attached to a targeting molecule, while the other is subsequently used to deliver a radionuclide for imaging and/or therapeutic applications. Recently, we reported a new single amino acid chelate (SAAC) capable of forming stable complexes with Tc(CO)3 or Re(CO)3 cores. We describe here the application of SAAC analogues for the development of a series of novel radiolabeled biotin derivatives capable of forming robust complexes with both Tc and Re. Compounds were prepared through varying modification of the free carboxylic acid group of biotin. Each 99mTc complex of SAAC-biotin was studied for their ability to bind avidin, susceptibility to biotinidase, and specificity for avidin in an in vivo avidin-containing tumor model. The radiochemical stability of the 99mTc(CO)3 complexes was also investigated by challenging each 99mTc-complex with large molar excesses of cysteine and histidine at elevated temperature. All compounds were radiochemically stable for greater than 24 h at elevated temperature in the presence of histidine and cysteine. Both [99mTc(CO)3(L6)]+1 [TcL6; L6 = biotinylamidopropyl-N,N-(dipicolyl)amine] and [99mTc(CO)3(L12a)]+1 (TcL12; L12 = N,N-(dipicolyl)biotinamido-Boc-lysine; TcL12a; L12a = N,N-(dipicolyl)biotinamide-lysine) readily bound to avidin whereas [99mTc(CO)3(L9)]+1 [TcL9; L9 = N,N-(dipicolyl)biotinamine] demonstrated minimal specific binding. TcL6 and TcL9 were resistant to biotinidase cleavage, while TcL12a, which contains a lysine linkage, was rapidly cleaved. The highest uptake in an in vivo avidin tumor model was exhibited by TcL6, followed by TcL9 and TcL12a, respectively. This is likely the result of both intact binding to avidin and resistance to circulating biotinidase. Ligand L6 is the first SAAC analogue of biotin to demonstrate potential as a radiolabeled targeting vector of biotin capable of forming robust radiochemical complexes with both 99mTc and rhenium radionuclides. Computational simulations were performed to assess biotin-derivative accommodation within the binding site of the avidin. These calculations predict that deformation of the surface domain of the binding pocket can occur to accommodate the transition metal-biotin derivatives with negligible changes to the inner-beta-barrel, the region most responsible for binding and retaining biotin and its derivatives. The biological activity and biodistribution of the technetium complexes TcL6, TcL9, and TcL12a were examined in an avidin tumor model. In the avidin bead tumor localization model, TcL6 demonstrated the most favorable localization with a 7:1 ratio of avidin bead implanted muscle versus normal muscle, while TcL9 exhibited a 2:1 ratio. However, TcL9 displayed no specificity for avidin.

Amino Acids↗

Simultaneous measurement of myocardial perfusion and ventricular function during exercise from a single injection of technetium-99m sestamibi in coronary artery disease.

New radiopharmaceuticals permit simultaneous assessment of myocardial perfusion and left ventricular function using a single tracer injection. The purpose of this study was to quantitate the relation between myocardial perfusion and function at rest and during exercise in patients with documented coronary artery disease (CAD). A rest first-pass radionuclide angiocardiogram (RNA) was recorded in 51 patients with CAD during injection of 10 mCi of technetium-99m (Tc-99m) sestamibi, and tomographic perfusion images were obtained 60 minutes later. A treadmill test was then performed, and on attainment of an exercise end point a second first-pass RNA was recorded with 30 mCi of Tc-99m sestamibi. Tomographic images reflecting myocardial perfusion during exercise were obtained 1 hour later. Tomographic perfusion defect size, quantified using modifications of the Cedars-Sinai program, correlated directly with end-systolic volume and inversely with ejection fraction at rest and during exercise. However, perfusion defect size often varied widely in patients with similar left ventricular function. This independence between measurements of perfusion and function suggests that simultaneous assessment of the 2 physiologic variables could improve the diagnostic and prognostic information of radionuclide tests.

Coronary Disease↗

Perfusion and mechanical analysis with technetium-99m 2-methoxy-isobutyl-isonitrile in a case of dilated cardiomyopathy.

With technetium-99m 2-methoxy-isobutyl-isonitrile (99mTc-MIBI), regional wall thickening in a patient with dilated cardiomyopathy was analyzed by the first component Fourier method. The regional wall thickening was compared with thallium-201 and 99mTc-MIBI SPECT imaging. Thallium-201 SPECT images showed mildly reduced perfusion in the posterior wall and redistribution in the septum, whereas 99mTc-MIBI images showed heterogeneous accumulation around the left ventricular circumference. By means of phase analysis, diffusely decreased wall thickening and discontinuity of percent wall thickening in neighboring segments were observed throughout the left ventricle. Regional wall motion and wall thickening correlated roughly. However, discrepancies between the mechanical function and myocardial perfusion, and discrepancies in regional myocardial perfusion between thallium-201 and 99mTc-MIBI were observed.

Aged↗

An evaluation of the uptake of technetium-99m (v) dimercaptosuccinic acid in patients with squamous carcinoma of the head and neck.

A new imaging agent, Technetium-99m (Tc99m) (v) Dimercaptosuccinic acid (DMSA), has recently been developed which has been used to evaluate head and neck tumours. Twenty-four patients were studied of whom 21 had histologically proven SCC of the head and neck. The remaining 3 had benign lesions. Planar imaging of patients with primary disease revealed a sensitivity of 83% and a 75% specificity. The results of planar imaging of patients with cervical metastases yielded a 92% sensitivity and 100% specificity. Seven patients also had single photon emission computerized tomography (SPECT) which improved the image quality, spatial resolution and sensitivity of the investigation. Tc99m (v) DMSA imaging provides a cheap and rapid means of investigating head and neck SCC. This study suggests further work is indicated to assess its role in diagnosis and subsequent management.

Adult↗

Renal handling of technetium-99m DMSA: evidence for glomerular filtration and peritubular uptake.

The finding of an enhanced excretion of [99mTc]dimercaptosuccinic acid (DMSA) in patients with tubular reabsorption disorders prompted us to investigate the role of filtration in the renal handling of [99mTc]DMSA. Our studies in human serum indicated that binding to serum proteins was approximately 90%. Chromatography of human urine and studies in rats showed that the complex was excreted unaltered into the urine. Renal extraction of [99mTc]DMSA in a human volunteer was 5.8%. Continuous infusion of [99mTc]DMSA in 13 individuals with normal renal function gave the following results (mean +/- s.d.): plasma clearance of [99mTc]DMSA 34 +/- 4 ml/min, urinary clearance of [99mTc]DMSA 12 +/- 3 ml/min. The calculated filtered load of [99mTc]DMSA closely resembled the urinary clearance, whereas the plasma clearance was about three times faster. This indicates that peritubular uptake accounts for approximately 65% and filtration for approximately 35% of the renal handling of [99mTc]DMSA.

Animals↗

The adsorption of 99Tcm dimercaptosuccinic acid onto injection vials.

It is common practice to dispense radiopharmaceuticals into empty sterile vials for dispatch to the departments where they are to be administered. It has been noted that on withdrawal of technetium-99m dimercaptosuccinic acid injections (99Tcm-DMSA) which have been dispensed into such vials, the activities obtained are lower than expected. To explain this phenomenon, the adsorption of 99Tcm-DMSA onto commercially available, empty, sterile vials has been investigated. The 99Tcm-DMSA solutions were prepared using kits from two manufacturers and were tested in vials from two manufacturers and the original kit vials. Adsorption of 99Tcm in one DMSA/vial combination after storage for 4 h was 49.6% (+/- 4.5% S.E.M.), but typically, adsorption was approximately 12% after 4 h. Although rate of adsorption was found to vary with storage conditions, no conditions satisfactorily overcame the effect. In vials from one manufacturer, the 99Tcm adsorption was predominantly on the glass, while in vials from the other, it was predominantly on the rubber stopper. It is concluded that the compatibility between vials and radiopharmaceuticals must be investigated in the hospital radiopharmacy.

Adsorption↗

Radiolabeled somatostatin analogs in prostate cancer.

Vapreotide (RC-160), a somatostatin analog, was labeled with 99mTC by a direct method and also by using CPTA [1,4,8,11-tetraazacyclotetradecane] as a bifunctional chelating agent. The labeled compounds were evaluated in nude mice bearing experimental human prostate cancers. In these studies, 111In-DTPA-D-Phe-Octreotide (111In-DTPA-octreotide) served as a standard and 99mTc-oxytocin as a receptor-non-specific control. 99mTc-octreotide was also used. The 24 htumor uptake of 99mTc-RC-160 was nearly 400% higher, (p < 0.05), than that of 111In-DTPA-octreotide and diminished upon receptor blocking. In all tissues except the kidneys, the uptake of 99mTc-RC-160 was also higher than that of 111In-DTPA-octreotide. The uptake of 99mTc-RC-160 was influenced by the amount of peptide injected and the best tumor/muscle and tumor/blood ratios were obtained when only one micrograms of the peptide (200 Ci/mmol) was administered.

Animals↗