Comparison of ultrashort-lived iridium-191m with technetium-99m for first pass radionuclide angiocardiographic evaluation of right and left ventricular function in adults

First-pass radionuclide angiocardiography with single-crystal gamma cameras

Both multicrystal and single-crystal detectors have been in use for more than 25 years for measurement of ejection fraction by analysis of images collected during the first-pass transit of radionuclides through the heart. Originally, multicrystal cameras were preferred, because they provided higher count rates than Anger cameras; however, over the years improvements in count rate capability and collimator design have enabled Anger cameras to perform equally well. This has become an important issue now that readily available 99mTc agents, such as sestamibi, enable evaluation of both myocardial function and perfusion from a single injection. The technical abilities of a particular camera determine which acquisition protocols are most likely to provide clinically useable images for the widest spectrum of patients. Electrocardiographic-gated list mode collection is highly desirable for first-pass imaging, providing the greatest flexibility of data review, rebinning, and analysis. Attention to quality control issues of data characterization and processing is important to ensure accuracy and precision of all measurements. Accurate determinations of ejection fraction of the left ventricle are possible routinely and, under favorable circumstances, of the right ventricle as well.

The continuing important role of radionuclide generator systems for nuclear medicine

In this review, the continuing importance and status of development of radionuclide generator systems for nuclear medicine are discussed. Radioisotope costs and availability are two important factors, and both nuclear reactors and accelerator facilities are required for production of the parent radioisotopes. Radionuclide generator research is currently focused on the development of generators which provide radioisotopes for positron emission tomography (PET) applications and daughter radioisotopes for various therapeutic applications which decay primarily by particle emission. Generator research continues to be influenced by developments and requirements of complementary technologies, such as the increasing availability of PET. In addition, the availability of a wide spectrum of tumor-specific antibodies, fragments, and peptides for radioimmunodiagnosis and radioimmunotherapy has stimulated the need for generator-derived radioisotopes. The advantages of treatment of arthritis of the synovial joints with radioactive particles (radiation synovectomy) may be expected to be of increasing importance as the elderly population increases, and many of these agents are prepared using generator-derived radioisotopes such as yttrium-90 and rhenium-188. Therapeutic use of the "in vivo generator" is a new approach, where the less radiotoxic parent radioisotope is used to prepare tissue-specific therapeutic agents. Following in vivo site localization, decay of the parent provides the daughter for therapy at the target site. The principal foundation of most diagnostic agents will continue to require technetium-99m from the molybdenum-99/technetium-99m ("Moly") generator. With the limited availability of nuclear reactors and facilities necessary for production and processing of fission 99mTc and the significant issues and problems associated with radioactive waste processing, however, the possibility of utilizing lower specific activity 99Mo produced from neutron activation of enriched 98Mo may become practical in the future.

The use of iridium-191m for pulmonary blood flow imaging

A preliminary evaluation of the potential utilization of osmium-191/iridium-191m for pulmonary blood flow imaging was performed. This evaluation was part of a more general study concerning the use of 191mIr for first-pass radionuclide angiocardiography (FPRNA). In eight selected patients with suspected pulmonary disease, we generated, from the data collected during FPRNA, an image representing blood flow distribution to the lungs. A software program was developed in order to differentiate the lungs from the heart, to define the wash-in lung phase and finally to construct an image representing pulmonary blood flow distribution. We compared that image with a standard lung perfusion image using technetium-99m macroaggregated albumin (MAA) and plain chest X-ray and computerized tomography (CT). The obtained 191mIr perfusion images showed a spatial activity distribution similar to that seen on 99mTc-MAA lung perfusion scans, and in most cases the same perfusion defects. Disease revealed by plain chest X-ray and CT was nicely correlated with perfusion defects seen on the 191mIr images. The combined information of lung perfusion and dynamic cardiac parameters obtained by FPRNA (right and left ventricular ejection fractions) added another relevant dimension to the clinical picture of patients with pulmonary embolism, chronic obstructive lung disease, lung tumour or suspected congestive heart failure. We conclude that 191mIr may become a practical tool for achieving the conceptually promising approach of combined lung-heart real-time imaging.

Effects of piroximone on the right ventricular function in severe heart failure patients

OBJECTIVES

To assess the effects of piroximone, a phosphodiesterase inhibitor, on right ventricular function in patients with heart failure.

DESIGN

Randomized study: patients were randomly assigned to the piroximone infusion rate of 5 or 10 micrograms/kg/min.

SETTING

Cardiologic intensive care unit.

PATIENTS

12 consecutive patients with severe heart failure.

INTERVENTIONS

Right heart catheterization was performed using a Swan-Ganz ejection fraction thermodilution catheter.

MEASUREMENTS AND RESULTS

Measurements of right ventricular ejection fraction (RVEF), end-diastolic and end-systolic right ventricular volumes were obtained using the thermodilution principle. To determine contractility indexes, the relationships between end-systolic pulmonary arterial pressure (ESPAP) over right ventricular end-systolic volume (RVESV) and ESPAP over RVEF were calculated during the infusion of prostacyclin at incremental infusion rates of 2, 4, 6 and 8 ng/kg/min. The slope of the relation between ESPAP over RVESV shifted during piroximone therapy from 7.635 +/- 1.632 to 1.975 +/- 0.432 (p < 0.01) and from 6.092 +/- 1.99 to 1.028 +/- 0.853 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively. The slope of the relation between ESPAP over RVEF decreased from -0.414 +/- 0.296 to -0.821 +/- 0.257 (p < 0.01) and from -0.127 +/- 0.048 to - 0.533 +/- 0.135 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively.

CONCLUSIONS

This study suggests a positive action of piroximone on right ventricular contractility at these 2 dosages. This approach using this type of catheter allowed us to determine right ventricular inotropic indexes.

Evaluation of osmium(II)-nitrosyl complexes as a method to increase the yield of the 191Os-191mIr generator

The nitrosyl complexes pentachloronitrosylosmate(II), [OsCl5(NO)]2-, and hydroxytetranitronitrosylosmate(II), [Os(OH)(NO2)4(NO)]2-, were evaluated as parent species for use on the 191Os-191mIr generator in an attempt to increase the 191mIr yield of the generator by providing a direct route to a chemically stable 191mIr daughter. The uptake of the 191Os-labeled complexes by the inorganic ion-exchangers ZrO2, SnO2, PbS, MnO2 and Al2O3 and the organic resin AG MP-1 was measured and prototype generators were prepared using those exchangers that demonstrated greater than 90% uptake of the 191Os-labeled complexes. The 191mIr(III)-nitrosyl complexes produced subsequent to beta- decay of the 191Os-nitrosyl parent complexes were found to undergo secondary chemical reactions to form nitro (NO2-) complexes that were tightly retained on the ion exchanger limiting 191mIr yield to less than 5%.