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Comparison of Modified Technetium-99m Albumin and Technetium-99m Red Blood Cells for Equilibrium Ventriculography

Nuclear Medicine and Radiotherapy Departments, Middelheim General Hospital, Antwerp
Radiopharmacy and Nuclear Medicine Departments, University of Leuven, Leuvin, Belgium

Correspondence: For correspondence or reprints contact: A.-S. Hambÿe, Department of Nuclear Medicine, Middelheim General Hospital, Lindendreef 1, 2020 Antwerp, Belgium.

ABSTRACT

A newly developed modified form of ^99mTc-labeled human serum albumin reconstituted from a kit (^99mTc-dimercaptopropionyl-human serum albumin; ^99mTc-DMP-HSA) was prospectively compared to ^99mTc-labeled red blood cells (RBC) in patients referred for equilibrium radionuclide ventriculography at rest to evaluate its potential use as a blood-pool imaging agent. Methods: A Paired comparison between ^99mTc-DMP-HSA and either in vitro or in vivo ^99mTc-labeled RBC was performed within 2 days in 20 patients. For each study, two sets of images were acquired, starting at 15 min and 180 min postinjection, respectively. Each set consisted of a gated blood-pool cardiac study and a planar static image centered on the patient's thorax. All data were processed by two independent observers. Early and late postinjection parameters were calculated: ejection fraction (EF) value, activity within the main organs surrounding the left ventricle (LV), ratio of activity between the LV and these surrounding organs for each study separately, and temporal (late/early) evolution of the intraorgan activities and of the LV/organ ratios after decay correction. Results: The images and the visual wall-motion analysis were of good quality with both agents in most patients, without significant image degradation at 180 min postinjection. Calculated EF values were highly comparable with the two tracers. Interobserver variability was 0.17% (RBC) and 1.08% (DMP-HSA) for the early EF value (EF1), and 0.62% (RBC) and 0.27% (DMP-HSA) for the late EF (EF2). Mean difference between EF2 and EF1 was 0.74% (Observer 1) and 0.28% (Observer 2) for ^99mTc-RBC, and –2.88% (Observer 1) and –2.07% (Observer 2) for ^99mTc-DMP-HSA. When comparing ^99mTc-DMP-HSA to ^99mTc-RBC the mean difference was 1.27% (Observer 1) and 0.36% (Observer 2) for EF1, and –2.35% (Observer 1) and –1.99% (Observer 2) for EF2. Also, the biodistribution and temporal evolution of the organ repartition of both compounds were stable and similar, with values of late/early activity ratios very close to one for all the studied organs [mean intraorgan ratio: 0.946 for ^99mTc-RBC (range: 0.881-1.086) and 0.979 for ^99mTc-DMP-HSA (range:0.914-1.141); mean late/early LV/organ ratio: 0.964 for ^99mTc-RBC (range:0.919-1.016) and 0.967 for ^99mTc-DMP-HSA (range:0.912-1.035)].

Key Words: technetium-99m-DMP-HSA • technetium-99m-labeled red blood cells • gated blood-pool imaging

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