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Comparative Evaluation of Renal Transplant Rejection with Radioiodinated Fibrinogen ^99mTc-Sulfur Colloid, and ⁶⁷Ga-Citrate

St. Louis Veterans Administration Hospital and St. Louis and Washington University Schools of Medicine, St. Louis, Missouri

Correspondence: For reprints contact: E. A. George, Nuclear Medicine Service (172-JC), Veterans Administration Hospital, St. Louis, Mo. 63125.

ABSTRACT

The diagnostic accuracy, ease, and technical feasibility of imaging with or ¹³¹I-fibrinogen, ^99mTc-sulfur colloid, and ⁶⁷Ga-citrate in renal transplant rejection are compared. Radio fibrinogen data resulted from literature review, radiocolloid data from 125 studies in 52 transplant patients, and gallium citrate data from 24 examinations in seven renal transplant patients performed simultaneously with the radiocolloid studies. Specificity of graft labeling during rejection appears to be similar with radiofibrinogen, ^99mTc-sulfur colloid, and ⁶⁷Ga-citrate. For routine clinical use ^99mTc-sulfur colloid surpasses radiofibrinogen and radiogallium because of its better imaging qualities with a permissible radiation dose, leading to better separation of positive and negative results. The ^99mTc-sulfur colloid accumulates in areas of intravascular fibrin thrombosis in acute and chronic rejecting renal transplants. Hence, the mechanisms for accumulation of ^99mTc-sulfur colloid and labeled fibrinogen in rejecting transplants would seem to be similar. Such physiologic properties as rapid blood clearance and such physical properties as short physical half-life combine to produce reliable graft visualization with adequate definition, thus favoring ^99mTc-sulfur colloid as the single agent of choice for clinical evaluation of renal transplant rejection at this time.