sodium-pertechnetate-tc-99m and Emphysema

In tomographic Technegas ventilation studies, the deposited aerosol should be stable. The aim of this study was to investigate the stability of deposited Technegas in severely obstructed patients and in healthy volunteers. Six emphysematous patients and five healthy volunteers were studied. Anterioposterior (AP) and posterioanterior (PA) dynamic images of ventilation (120 frames, 1 frame.min-1) were acquired after inhalation of 99mTc-Technegas' in the supine position. The time-activity curve of the whole lung showed two phases in the emphysematous patients as well as in the healthy volunteers. The activity decreased rapidly in the first phase, then reached almost a constant level (the second phase) after approximately 50 min. The logarithms of both the first phase and the second phase were close to straight lines. The half-time of the first phase was approximately 9 min. No systematic differences in 'Technegas' clearance rate were found between central regions and peripheral regions and between high count rate regions and normal count rate regions. Pertechnegas contamination was subsequently detected, and we conclude that the rapid first phase is probably due to clearance of Pertechnegas. When stable Technegas is required, we suggest that data acquisition should start about 50 min after inhalation.

Topics: Adult; Aged; Data Interpretation, Statistical; Emphysema; Female; Forced Expiratory Volume; Humans; Lung; Male; Middle Aged; Radionuclide Imaging; Reference Values; Sodium Pertechnetate Tc 99m; Supine Position; Time Factors; Tissue Distribution; Vital Capacity

We analyzed the relationship between regional severity of emphysema, which was evaluated by three-dimensional fractal analysis (3D-FA) of Technegas SPECT images, and coronary heart disease (CHD). For 22 patients with emphysema who underwent Technegas SPECT, we followed up CHD events. The follow-up period was 5.4+/-0.5 (mean +/- SD) years. We defined the upper-lung fractal dimension (U-FD) and lower-lung fractal dimension (L-FD) obtained with 3D-FA of Technegas SPECT images as the regional severity of emphysema. FD became greater with the progression of emphysematous change. During the follow-up period, CHD events occurred in 6 (27%) of the 22 patients. The ratio of U-FD to L-FD for patients with CHD events (0.87+/-0.22) was significantly smaller than for patients without CHD events (1.52+/-0.38) (p = 0.0015). These findings suggest that severer emphysema in the lower lung indicates a higher risk of CHD than that in the upper lung.

Topics: Aged; Coronary Disease; Data Interpretation, Statistical; Emphysema; Female; Fractals; Humans; Hypertension; Lung; Male; Predictive Value of Tests; Respiratory Function Tests; Risk Factors; Smoking; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

1. We have developed a method for non-invasive measurement of lung tissue mass, thoracic blood and interstitial volumes by a combination of transmission and emission scanning with technetium isotope (99mTc). 2. In a lung model we demonstrated that emission counts could be successfully corrected for attenuation with data obtained by transmission scanning, despite an uneven distribution of radioactivity and attenuation in the model. 3. In dogs we compared regional transthoracic tissue thickness, measured by transmission scanning, and regional 'thickness' of blood measured by transmission/emission scanning with direct gravimetric measurements made post mortem. Scanning and direct measurements correlated significantly. 4. In man we used a [99mTc]pertechnetate (99mTcO4) flood source to obtain antero-posterior transmission scans with a gamma-camera. The thickness of attenuating tissue was estimated in each pixel. Scans were obtained of thoracic blood (by labelling erythrocytes with 99mTcO4) and of interstitium (with 99mTc-labelled diethylenetriaminepenta-acetic acid and subtraction of the blood image). We used a computer program to correct the emission scans for attenuation using the transmission scan derived tissue thickness, pixel by pixel. Finally we took a lateral chest radiograph to estimate chest wall thickness. 5. In normal man lung tissue thickness at hilar level was 3.1 +/- 0.5 cm (n = 8). Thoracic blood thickness increased from the apex downwards in the upright lung, being 1.2 +/- 0.1 cm at the hilar level and 2.0 +/- 0.3 cm at the lung base. Interstitial thickness was 0.8 +/- 0.3 cm at the hilum and 0.85 +/- 0.2 at the base. These values compare well with data in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Dogs; Emphysema; Humans; Lung; Models, Anatomic; Pulmonary Fibrosis; Sarcoidosis; Sodium Pertechnetate Tc 99m; Thorax; Tomography, Emission-Computed; Tomography, X-Ray Computed