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Regional Pulmonary Perfusion Assessed with Continuous Intravenous Infusion of Kr-81m: A Comparison with Tc-99m Macroaggregates

Royal Postgraduate Medical School, Hammersmith Hospital, London, England

Correspondence: For reprints contact: J. M. B. Hughes, Royal Postgraduate Medical School, Hammersmith Hospital, London, England W12 OHS.

ABSTRACT

The radioactive gas krypton-81m (T_1/2 = 13 sec) can be produced in the gaseous form or in solution by passing air or water over a resin column to which the parent nuclide rubidium-81 (T_1/2 = 4.6 hr) is bound. Due to the rapid radioactive decay, a continuous administration of Kr-81m into the inflow of an organ yields a functional image of tracer arrival, that is, regional distribution of flow in that organ. Continuous inhalation of Kr-81m gas therefore produces functional images of pulmonary ventilation. We investigated the feasibility of assessing regional pulmonary blood flow by a continuous i.v. infusion of Kr-81m solution. Krypton-81m ventilation and perfusion images, together with a routine Tc-99m macroaggregate (Tc-HAM) perfusion lung scan, were obtained in 20 patients with various chest disorders. There was excellent agreement between Kr-81m and Tc-HAM perfusion images when the ventilation was not disturbed, as in patients with pulmonary embolism. In the presence of macroscopic ventilation abnormalities, however, the correlation between the Kr-81m perfusion and the Tc-HAM scans is less good. This is understandable because Kr-81m that diffuses into the alveoli will be exhaled unevenly. The main advantages of Kr-81m over Tc-HAM for assessment of pulmonary blood flow are: a) absolute safety in children, especially in the presence of right-to-left shunts; b) continuous monitoring during changing clinical and experimental conditions; and c) low radiation dose.

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