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Clinical Comparison of Technetium-99m-EC, Technetium-99m-MAG3 and Iodine-131-OIH in Renal Disorders

Levent Kabasakal, H. Turgut Turolu, Çetin Önsel, Kutlan Özker, Ilhami Uslu, Saadet Atay, Tülay Cansiz, Kerim Sönmezolu, Enis Altiok, Ali Tan Isitman, Tarik Kapiciolu and Irfan Urganciolu

Department of Nuclear Medicine, Cerrahpaa Medical Faculty of Istanbul University, Istanbul, Turkey

Correspondence: For correspondence or reprints contact: Levent Kabasakal, MD, Medical College of Wisconsin, Department of Nuclear Medicine, Box 104, Milwaukee County Medical Complex, 8700 West Wisconsin Avenue, Milwaukee, Wisconsin 53226.

ABSTRACT

Technetium-99m-ethylenedicysteine has recently been developed for renal function studies. The pharmacokinetics of ^99mTc-EC were studied by constant infusion technique and compared with ^99mTc-MAG3 and ¹³¹I-OIH in 11 patients with various renal disorders. Methods: After giving a 7.4 MBq ¹³¹I-OIH and 90–110 MBq ^99mTc-EC or ^99mTc-MAG3 bolus, a constant infusion (1MBq/ml ^99mTc-agent and 0.07 MBq/m ¹³¹I-OIH was started. Sixteen blood and five urine samples were obtained over three hr. Results: The renal clearance of ^99mTc-EC was higher than that of ^99mTc-MAG3. The ^99mTc-EC/OIH and ^99mTc-MAG3/OIH ratios were 0.75 ± 0.05 and 0.55 ± 0.10 (p = 0.00087), respectively. The distribution volume of ^99mTc-EC was also higher than that of ^99mTc-MAG3 (15722 ± 4644 and 9509 ± 2788 ml/1.73m², respectively; p = 0.072). The ^99mTc-EC/OIH and ^99mTc-MAG3/OIH distribution volume ratios were 1.03 ± 0.14 and 0.55 ± 0.10, respectively (p = 0.0003). The 60-min excretion values of ^99mTc-EC and ^99mTc-MAG3 were compared to that of OIH. The ^99mTc-EC/OIH and ^99mTc-MAG3/OIH excretion ratios were 0.96 ± 0.06 and 1.07 ± 0.10, respectively (p = 0.162). The protein binding of ^99mTc-EC and OIH were found to be 34% ± 4 and 66% ± 5, respectively (p < 0.0001). The red cell binding of ^99mTc-EC was negligible (3% ± 1.2) in comparison to OIH (27% ± 3; p < 0.0001). Conclusion: This limited study demonstrates the pharmacokinetic and renal clearance properties of ^99mTc-EC. This agent has good potential for renal function evaluation.

Key Words: iodine-131-OIH • technetium-99m-MAG3 • technetium-99m-EC • renal function • renal imaging