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Clinical Usefulness of Ultrashort-Lived Iridium-191m from a Carbon-Based Generator System for the Evaluation of the Left Ventricular Function

Division of Nuclear Medicine, Middelheim Hospital, Belgium
Division of Nuclear Medicine, St. Peter Hospital, Belgium
Cyclotron Research Center, University of Liege, Belgium
Nuclear Medicine Group, Health and Safety Research Division, Oak Ridge National Laboratory (ORNL), Oak Ridge, Tennessee

Correspondence: For reprints contact: P. R. Franken, MD, Div. Nuclear Medicine, A. Z. Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium; or F. F. Knapp, Jr., PhD, Nuclear Medicine Group, Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831-0622.

ABSTRACT

Ultrashort-lived ^191mIr (4.96 sec; 63–74 and 129 keV photons) is potentially advantageous for first-pass radionuclide angiocardiography, offering the opportunity to perform repeat studies with very low absorbed radiation dose to the patient. Left ventricular (LV) first-pass studies were performed in 72 patients with ^191mIr from a new bedside 1.3 Ci (48.1 GBq) ¹⁹¹Os/^191mIr generator system using an activated carbon support that offers high ^191mIr yields (15–18%) and consistent low ¹⁹¹Os breakthrough (2–4 x 10^–4%/bolus). Using a single crystal digital gamma camera, uncorrected end-diastolic counts in the left ventricular representative cycle ranged from 10 up to 30 k counts.The reproducibility of repeated LV ejection fraction (LVEF) determination at 2-min intervals in 50 patients was r = 0.97, mean diff. = 2.08 ± 1.55 EF units. Comparison between ^191mIr (80–120 mCi; 2,960–4,400 MBq) and ^99mTc (20–25 mCi; 750–925 MBq) LV count rates indicates a 3 wk useful shelf life of this new generator system for cardiac studies. Iridium-191m determined LVEF correlated closely with ^99mTc determined LVEF in 32 patients (r = 0.96, mean diff. = 1.87 ± 1.23 EF units). Parametric images for LV wall motion analysis were comparable with both isotopes. We condude that rapid, repeat, and reproducible high countrate first-pass left ventricular studies can be obtained with ^191mIr from this new ¹⁹¹Os/^191mIr generator system using a single crystal digital gamma camera.