El 99mTc-alendronato como nueva opción en la gammagrafía ósea / 99mTc-Alendronate as an option in bone scanning

Objetivo. Comparar la calidad de las imágenes de gammagrafía ósea obtenidas con un radiofármaco nuevo, el 99mTc-ABP, con aquéllas obtenidas con el 99mTc-MDP. Material y métodos. Fue un estudio comparativo en un mismo sujeto. Se estudiaron 9 voluntarios sanos (5 mujeres y 4 hombres) de 23 a 39 años de edad. A todos se les inyectaron 740 MBq de los radiofármacos Tc-ABP y Tc-MDP con un intervalo de 72 horas entre uno y otro. Dos horas después de cada inyección se les realizó un gammagrama óseo de cuerpo entero con una cámara de centello MultiSpect 2 y se determinaron los parámetros radiofarmacocinéticos. Tres médicos nucleares evaluaron por separado la calidad de las imágenes mediante el trazado de regiones de interés (RDI) sobre vértebras, costillas, esternón, fémur, articulaciones y cráneo. Se obtuvieron relaciones hueso/músculo con RDI sobre diferentes huesos. Los resultados se compararon etadísticamente con las pruebas de kappa y de Wilcoxon. Resultados. La concordancia sobre la calidad de las imágenes de los dos radiofármacos por los tres observadores fue moderada (kappa 0.4). La relación fémur/músculo mostró una distribución normal y no manifestó diferencias significativas entre radiofármacos. Conclusiones. La calidad de las imágenes con ambas preparaciones fue similar. Recomendamos utilizar al 99mTc-ABP en la gammagrafía ósea debido a la menor exposición a radiación del paciente

In vitro effect of cyclophosphamide on the binding of radiopharmaceuticals (99mTcO4 and 99mTc-MDP) to blood elements

Sodium pertechnetate (99mTcO4) and many99m Tc-products are the radiopharmaceuticals most frequently used in nuclear medicine. Using an in vitro model, we evaluated the effect of cyclophosphamide on per cent radioactivity of 99mTcO4 and methylenedi-phosphonic acid (99mTc-MDP) bound toi isolated blood elements. Blood samples were incubated with the two radiopharmaceuticals, plasma and blood cells were separated and precipitated, and soluble and insoluble fractions were separated. To evaluate the effect of cyclophosphamide, blood was incubated with this drug 1h prior to the addition of the radiopharmaceuticals. The fraction of 99mTcO4 radioactivity was slightly higher in plasma (61.2 to 53.8 per cent) than in blood cells (38.8 to 46.2 per cent) up to 6 h and cyclophosphamide did not interfere with this distribution. The amount of 99mTc-mdp radioactivity was higher in plasma (91.1 to 87.2 per cent) than in blood cells 8.9 to 12.9 per cent) up to 24 h and cyclophosphamide did not modify it. The binding of 99mTcO4 to the insoluble fraction of plasma (4.9 to 6.1 per cent) was low and cyclophosphamide did not interfere with it up to 6h, but a small blockade (9.8 to 4.8 per cent) was observed at 24 h. From 3 h on, cyclophosphamide slightly inhibited 99mTcO4 binding to blood cells (23.1 to 16.6 per cent) and increased it at 24h (31.2 to 14.3 per cent). Cyclophosphamide did not alter 99mTc-MDP binding to the insoluble fraction of blood cells and slightly decreased 99mTc-MDP binding to the insoluble fraction of plasma (29.8 to 23.6 per cent) up to 6 h. The effect of cyclophosphamide was strongest at 24 h, with decreased radioactivity binding to the insoluble fraction of plasma (47.6 to 27.0 per cent) and blood cells (51.2 to 23.2 per cent). The fact that cyclophosphamide can bind to plasma proteins and/or cross the cell membrne explains in part the results obtained. Studies using other chemotherapeutic drugs may lead to the development of an in vitro model for the evaluation of drug interaction with radiopharmaceutical substances

Poor renal uptake of technetium-99m-DMSA and technetium-99m-MDP in a patient with Fanconi syndrome and near normal glomerular filtration rate

We present a patient with Fanconi syndrome who demonstrated poor renal uptake of 99mTc-DMSA and high urinary concentration of the tracer. A 99mTc-DTPA scan was normal and the creatinine clearance only minimally decreased. These findings suggest that 99mTc-DMSA may be accumulated in the kidney by glomerular filtration and subsequent tubular reabsorption, with the nonabsorbed fraction appearing in the urine. In Fanconi Syndrome the tubular reabsorption of DMSA may also be reduced, thus explaining the poor renal uptake in this patient. A 99mTc-MDP bone scan showed faint renal uptake and diffuse high uptake mainly in the spine, demonstrating that the metabolic bone disease associated with Fanconi Syndrome can be another mechanism for poor renal visualization on bone scan.