Intratumoral CD103+ CD8+ T cells predict response to PD-L1 blockade

BACKGROUND

CD8+ tissue-resident memory T (T_RM) cells, marked by CD103 (ITGAE) expression, are thought to actively suppress cancer progression, leading to the hypothesis that their presence in tumors may predict response to immunotherapy.

METHODS

Here, we test this by combining high-dimensional single-cell modalities with bulk tumor transcriptomics from 1868 patients enrolled in lung and bladder cancer clinical trials of atezolizumab (anti-programmed cell death ligand 1 (PD-L1)).

RESULTS

ITGAE was identified as the most significantly upregulated gene in inflamed tumors. Tumor CD103+ CD8+ T_RM cells exhibited a complex phenotype defined by the expression of checkpoint regulators, cytotoxic proteins, and increased clonal expansion.

CONCLUSIONS

Our analyses indeed demonstrate that the presence of CD103+ CD8+ T_RM cells, quantified by tracking intratumoral CD103 expression, can predict treatment outcome, suggesting that patients who respond to PD-1/PD-L1 blockade are those who exhibit an ongoing antitumor T-cell response.

Biodistribution and dosimetry of [(18)F]fluorodeoxyglucose labelled leukocytes in normal human subjects

SUMMARY

This study was performed in order to assess [(18)F]fluorodeoxyglucose white blood cell ((18)F-FDG WBC) dosimetry in normal human subjects. Using previously reported methods, mixed cell suspensions of autologous leukocytes were prepared from four normal volunteers. Leukocytes were labelled in heparin-saline by incubation with (18)F-FDG at 37 degrees C for 20 min. After washing and resuspension, (18)F-FDG WBCs (225-315 MBq) were administered by intravenous injection. Whole-body imaging was performed at 0.5, 1, 2, 4 and 6 h using a GE Varicam with 511 keV collimation. Blood samples were obtained at corresponding times as well as fractionated urinary collection. Whole-body anterior and posterior images were used for calculation of organ dosimetry. Uptake of (18)F-FDG WBCs occurred predominantly within the reticulo-endothelial system. Plasma activity, urinary excretion (9.9+/-2.3% at 6 h), and brain uptake (1.7+/-0.4%) were consistent with partial elution of (18)F-FDG. Positron emission tomography imaging performed at 5-6 h after injection yielded good quality images of reticulo-endothelial uptake. Whole-body and organ dosimetry for (18)F-FDG WBCs in doses of 225-250 MBq are comparable with reported results for conventional doses of (111)In oxine labelled leukocytes. Further studies of (18)F-FDG WBC as an agent for positron emission tomography imaging of inflammatory disease appear warranted.

Inverse associations between plasma lycopene and other carotenoids and prostate cancer

Although dietary intake of tomatoes and tomato products containing lycopene has been reported to reduce the risk of prostate cancer, few studies have been done on the relationship between plasma lycopene and other carotenoids and prostate cancer. This case-control study was conducted to investigate the effects of plasma lycopene, other carotenoids, and retinol, as well as alpha- and gamma-tocopherols on the risk of prostate cancer. The study included 65 patients with prostate cancer and 132 cancer-free controls; all of them were interviewed using a standard epidemiological questionnaire at the Memorial Sloan-Kettering Cancer Center from 1993 to 1997. Plasma levels of carotenoids, retinol, and tocopherols were measured by high performance liquid chromatography. An unconditional logistic regression model was used in bivariate and multivariate analyses using Statistical Analysis System (SAS). After adjusting for age, race, years of education, daily caloric intake, pack-years of smoking, alcohol consumption, and family history of prostate cancer, significantly inverse associations with prostate cancer were observed with plasma concentrations of the following carotenoids: lycopene [odds ratio (OR), 0.17; 95% confidence interval (CI), 0.04-0.78; P for trend, 0.0052] and zeaxanthin (OR, 0.22; 95% CI, 0.06-0.83; P for trend, 0.0028) when comparing highest with lowest quartiles. Borderline associations were found for lutein (OR, 0.30; 95% CI, 0.09-1.03; P for trend, 0.0064) and beta-cryptoxanthin (OR, 0.31; 95% CI, 0.08-1.24; P for trend, 0.0666). No obvious associations were found for alpha- and beta-carotenes, retinol, and alpha- and gamma-tocopherols. Our study confirmed the inverse associations between lycopene, other carotenoids such as zeaxanthin, lutein, and beta-cryptoxanthin, and prostate cancer. This study provides justification for further research on the associations between lycopene and other antioxidants and the risk of prostate cancer.

Regulation of the compounding of positron emission tomography drugs

Controversial aspects of the regulatory framework for compounding drug products used in positron emission tomography (PET) are discussed. The Food and Drug Administration Modernization Act of 1997 (FDAMA), which amends the Federal Food, Drug, and Cosmetic Act (FFDCA), required that FDA establish approval (new drug application [NDA] and abbreviated new drug application [ANDA]) procedures and current good manufacturing practice (CGMP) requirements for PET drugs; this seems to conflict with differentiation between manufacturing and compounding in FFDCA. Compounding by pharmacists is implied in the FDAMA section on PET, but specific mention of "pharmacist" needs to be included. Congress apparently did not intend for compounded PET drugs to be regulated differently from other drugs. Although FDA has waived NDA and ANDA fees for three PET radiopharmaceuticals, revision of FDAMA to exempt PET drug products from regulations placed on manufacturing is needed. Without relief from the current regulations, many academic PET centers are likely to close; this would violate FDAMA's stated intent of making PET available to patients at reasonable cost. Also problematic is FDAMA's prohibition of compounding "regularly or in inordinate amounts" a product that is commercially available; the common PET radiopharmaceutical fludeoxyglucose F 18 injection, for example, is commercially available. A sensible alternative to NDA or ANDA and CGMP requirements would be the enforcement of USP standards for PET drugs by state boards of pharmacy.

Evaluation of an alternative radiochemical purity testing method for technetium-99m sestamibi

OBJECTIVE

Our study evaluated the accuracy and reliability of 3 radiochemical purity (RCP) measurement methods of 99mTc-sestamibi. A regular-sized (1.0 cm x 9.0 cm) Whatman 31 ET Chr paper strip (regular 31 ET) also was included in our evaluation because of its ease in handling.

METHODS

The miniaturized and regular 31 ET methods were compared with the standard RCP testing method (aluminum oxide-coated plastic thin-layer chromatography [TLC] plate, with > or = 95% ethanol as the developing solvent). A total of 30 experimental runs were performed in triplicate (n = 90) over an RCP range of 82%-98%. The 99mTc-sestamibi preparations were reconstituted purposely to ensure that 50% of the tested samples had RCP values below the 90% limit.

RESULTS

The evaluated RCP ranges were 89.9% +/- 6.3%, 91.0% +/- 3.8%, and 91.4% +/- 4.3% for the TLC, miniature 31 ET, and regular 31 ET methods, respectively (n = 30 each). A strong correlation was found between the TLC and miniature 31 ET methods (r = 0.92), as well as between the TLC and regular 31 ET methods (r = 0.94). Both alternative methods tended to overestimate RCP value as determined by the TLC method, especially in an RCP range below 95%. This resulted in a false-positive rate of 27% for the miniature 31 ET method and 33% for the regular 31 ET method. The test/retest reliability was 99% for both the TLC and regular 31 ET methods, and 91% for the TLC and miniature 31 ET methods.

CONCLUSION

The miniature and regular 31 ET methods produced a high false-positive rate, which makes them unacceptable for the determination of RCP value of 99mTc-sestamibi.

The relationship between elution time and eluate volume using the Ultra-TechneKow DTE technetium-99m generator

OBJECTIVE

The new Ultra-TechneKow Dry Ship Top Elute 99mTc generator (UTK-DTE generator; Mallinckrodt Medical, Inc., St. Louis, MO) was devised to facilitate fractionated elution with an ergonomically designed elution shield. Fractionation is accomplished traditionally by visually observing the eluted volume through 2 layers of leaded glass windows located in a lighted elution shield and generator auxiliary shield. The goal of our study was to use elution time to determine the endpoint for obtaining the required volume of 99mTc-eluate from a UTK-DTE generator.

METHODS

After triplicate elution at several predetermined elution times, the initial weight of the evacuated collecting vial was subtracted from the total weight after elution to determine the elution volume.

RESULTS

A quadratic relationship was established between the eluate volume (v, mL) and elution time (t, s) (v = 0.3594 + 0.1889 t - 0.0009 t2). This equation is suitable for use with the 10-mL elution vial. This formula may not be accurate for the first elution since the UTK-DTE generator is a dry-column generator when shipped. The following elution times were calculated for some commonly eluted volumes: 2 mL (9 s), 4 mL (22 s), 5 mL (28 s), 7 mL (45 s), and 10 mL (88 s).

CONCLUSION

Our calculated elution time method can be used to predict the eluate volume from a UTK-DTE generator.

18F-FDG labelling of human leukocytes

Radiolabelled leukocytes are useful for the imaging of inflammation and infection, and 18F-fluorodeoxyglucose (18F-FDG) is known to concentrate in metabolically active cells. We evaluated the feasibility of leukocyte labelling with 18F-FDG using ACD and heparin anticoagulants at 20 degrees C and 37 degrees C, with and without gentle mixing during incubation. With leukocytes (WBC) harvested from 20 ml blood, studies were performed using 18F-FDG in concentrations of 3.7-74 MBq (0.1-2.0 mCi). 18F-FDG WBC stability in platelet-poor plasma was assessed at 1-4 h. Satisfactory labelling efficiency was achieved with incubation in heparin-saline at 37 degrees C for 30 min (62.7+/-1.6%), and was further enhanced by mixing during incubation (78.1+/-3.9%). Cell labelling was predominantly of granulocytes (78.5+/-1.4%). 18F-FDG WBC was relatively stable in platelet-poor plasma for up to 4 h, and no cell staining was observed in viability studies using trypan blue. These results indicate the feasibility of leukocyte labelling with 18F-FDG, providing an approach that may be useful in PET imaging of inflammation and infection.

Nuclear pharmacy, Part II: Nuclear pharmacy practice today

OBJECTIVE

Nuclear pharmacy is a specialty within the profession of pharmacy that focuses on the proper use of radiopharmaceuticals. This article reviews various features of contemporary nuclear pharmacy practice. After reading this article the nuclear medicine technologist should be able to: (a) describe nuclear pharmacy training and certification; (b) discuss nuclear pharmacy practice settings; (c) discuss nuclear pharmacy practice activities; (d) list professional organizations; and (e) describe activities associated with job satisfaction. In addition, the reader should be able to discuss regulatory issues of current concern.

Biodistribution and radiation dosimetry of stabilized 99mTc-exametazine-labeled leukocytes in normal subjects

Labeling leukocytes with 99mTc-exametazime is a validated technique for imaging infection and inflammation. A new radiolabeling technique has recently been described that enables leukocyte labeling with a more stable form of 99mTc-exametazime. A normal value study of stabilized 99mTc-exametazime-labeled leukocytes has been performed, including biodistribution and dosimetry estimates in normal subjects.

METHODS

Ten volunteers were injected with stabilized 99mTc-exametazime-labeled autologous leukocytes to study labeled leukocyte kinetics and dosimetry in normal subjects. Serial whole-body imaging and blood sampling were performed up to 24 h after injection. Cell-labeling efficiency and in vivo viability, organ dosimetry, and clearance calculations were obtained from the blood samples and imaging data as well as urine and stool collection up to 36 h after injection.

RESULTS

Cell-labeling efficiency of 87.5% +/- 5.1% was achieved, which is similar to or better than that reported with the standard preparation of 99mTc-exametazime. In vivo stability of the radiolabeled leukocytes was also similar to in vitro results with stabilized 99mTc-exametazime and better than previously reported in vivo stability for nonstabilized 99mTc-exametazime-labeled leukocytes. Organ dosimetry and radiation absorbed doses were similar with a whole-body absorbed dose of 1.3 x 10(-3) mGy/ MBq. Urinary and fecal excretion of activity was minimal, and visual assessment of the images showed little renal parenchymal activity and no bowel activity up to 2 h after injection.

CONCLUSION

Cell labeling and in vivo stability appear improved compared with the leukocytes labeled with the nonstabilized preparation of 99mTc-exametazime. There are advantages in more cost-effective preparation of the stabilized 99mTc-exametazime and an extended window for clinical usage, with good visualization of abdominal structures on early images. No significant increase in specific organ and whole-body dosimetry estimates was noted compared with previous estimates using nonstabilized 99mTc-exametazime-labeled leukocytes.

Evaluation of macroaggregated albumin particle sizes for use in pulmonary shunt patient studies

OBJECTIVE

To assess commercial macroaggregated albumin (MAA) reagent kits for compliance with particle-size parameters needed for proper clinical evaluation of pulmonary shunts (right-to-left).

DESIGN

Comparative trial.

SETTING

Nuclear pharmacy (laboratory setting).

PATIENTS AND OTHER PARTICIPANTS

Not applicable.

INTERVENTIONS

Minimally, 90% of the particles contained within an MAA reagent kit should be within the 10 to 90 microns range with minimal variation in particle size distribution and as few small particles (i.e., < 10 microns) as possible. Five separate vials from five commercial brands of MAA reagent kits were obtained, and 500 to 517 particles were analyzed for each sample. An additional study was performed on one of the MAA reagent kit brands, using five vials from each of five different lot numbers to determine the variability between lots.

MAIN OUTCOME MEASURES

Long axis (maximum, micron), short axis (minimum, micron), and the area (micron 2) of each MAA particle.

RESULTS

One MAA brand had the lowest percentage of unacceptable MAA particle sizes and maintained consistent particle sizes between vials. However, the same MAA reagent kit brand showed that only two of five lots had a low percentage of MAA particle sizes below the 10-micron limit.

CONCLUSION

Particle sizes varied among the five different brands of MAA reagent kits, as did different lots of the best-performing kit. This variability in particle sizes may affect the accuracy and reproducibility of pulmonary shunt patient studies.

Practical methods for reducing radioactive contamination incidents in the nuclear cardiology laboratory

OBJECTIVE

The purpose of this study was to determine the extent and cause of radioactive contamination in our nuclear cardiology laboratory, and to develop possible solutions to minimize future occurrence.

METHODS

We conducted a retrospective review to determine the underlying causes of the 15 minor radioactive contamination events that have occurred in the exercise areas of our laboratory since 1986. Of the 15 documented events, 8 were caused by failure of intravenous apparatus and 7 were due to syringe mishandling. Based on a staff questionnaire, we determined the most prevalent causes of radioactive contamination. Other than problems associated with intravenous setup, the causes were lack of experience by the individual performing the injection, followed closely by radioactive syringe disposal problems, injection technique, and unclear designation of duties during the exercise procedure.

RESULTS

Based on these findings, we formulated a 4-part plan: a training program; a closely inspected intravenous apparatus; a mobile radioactive waste container; and a clear designation of duties for personnel to be included in the exercise procedure protocol.

CONCLUSION

We have implemented a sensible and practical plan for reducing radioactive contamination, which is currently being evaluated.

Sensible approaches to avoid needle stick accidents in nuclear medicine

OBJECTIVE

Needle sticks are a continuous concern in the health care environment because of the prevalence of bloodborne pathogens in today's society. Radioactive contamination is another concern with needle sticks during nuclear medicine and nuclear pharmacy procedures. In our institution, substantial efforts have been made to prevent needle sticks, but they still occur occasionally. The purpose of this project was to analyze different practices and products to determine the best protocol in an effort to avoid further needle sticks.

METHODS

The nuclear medicine technologists were surveyed to determine how many needle sticks have occurred and the situation behind each occurrence. Using our initial survey, the circumstances involved in each incident were reviewed, suggestions considered, and various means of protection analyzed. Five options were presented in a second survey.

RESULTS

The results of the second survey showed that technologists favored the newly designed needle-capping blocks for preventing needle sticks in their daily routine procedures.

CONCLUSION

The newly designed needle-capping block is best suited for both nuclear medicine and nuclear pharmacy laboratories. We will continue to monitor the effectiveness of this new approach in preventing needle sticks.

Comparison of four 1-mL syringes for administering first-pass radionuclide angiography doses

OBJECTIVE

For optimal imaging in first-pass radionuclide angiography (FPRNA) studies, 1.11 GBq (30 mCi) 99mTc-sestamibi doses are drawn up in volumes of 0.1-0.3 mL. A single bolus injection of this small volume is important to obtain accurate time-activity curves. Because of the small volume and concentrated radioactivity, it is undesirable for study effectiveness and image quality to have a significant amount of residual activity remaining in the syringe after injection. The purpose of this study was to compare the amount of residual activity in 4 different 1-mL syringes.

METHODS

Each test syringe (n = 20) was filled with a volume (0.2 mL) of approximately 1.11 GBq (approximately 30 mCi) 99mTc-sestamibi. Initial activity was measured, and the dose was injected back into a vial only once, simulating bolus injection into a patient. The remaining activity was measured, followed by the calculation of percent residual activity.

RESULTS

The two 25-G x 5/8-in. permanent needles had a low percent of residual activity, as well as a much sturdier needle for injection. However, one of these syringes is more expensive.

CONCLUSION

The results of our comparison studies showed that the syringe with a 25-G x 5/8-in. permanent needle is ideal for FPRNA doses because of its sturdiness, low residual activity, and the quality of the bolus and resulting images.

Comparison of three cold kit reconstitution techniques for the reduction of hand radiation dose

In the performance of conventional nuclear pharmacy work, personnel usually receive the highest hand radiation dose during reconstitution of 99Tcm-labelled radiopharmaceuticals. This study was conducted to compare the hand radiation doses incurred during the preparation of 99Tcm-labelled radiopharmaceuticals using three different reconstitution procedures: (1) the standard reconstitution method (i.e. withdrawing 99Tcm activity and normal saline [NS] into the same syringe before adding to the cold kit) (standard); (2) an alternative reconstitution procedure using two syringes to add normal saline separately before 99Tcm activity to the cold kit (NS/Tc); and (3) a standard reconstitution procedure using a robotic system (Amercare Syringe Fill Station, model NuMed SFS 3a, Amercare Ltd, Oxon, UK) (robot). Radiation doses were monitored by thermoluminescent dosimeters (Landauer Inc., Glenwood, IL, USA) on the base of the fourth finger (i.e. ring finger) of the non-dominant hand and on the mid-portion of the second finger (i.e. index finger) of the dominant hand. Three sets of ring badges were measured for each procedure, with 10 stimulated or real reconstitutions per set. Two different radiopharmaceutical kits were evaluated: 99Tcm-MDP, as it is the most frequently used radiopharmaceutical in the majority of nuclear medicine departments (all three reconstitution methods; i.e. standard, NS/Tc and robot), and 99Tcm-sestamibi, as it is not only reconstituted with the highest amount of radioactivity but is also the most frequently dispensed radiopharmaceutical in our laboratory (standard and robot). All kits were prepared from an elution vial containing a standardized amount of 99Tcm activity (i.e. 104.4 +/- 3.6 GBq). To each of the cold MDP and sestamibi kits, 20.7 +/- 1.2 GBq and 44.2 +/- 0.7 GBq of 99Tcm activity were added, respectively. Average accumulated radiation doses for 10 reconstitutions to the fingers (non-dominant/dominant) for the preparations of 99Tcm-MDP were as follows: 14.2 +/- 0.9 mSv/2.8 +/- 0.8 mSv (standard), 10.0 +/- 0.6 mSv/2.7 +/- 0.2 mSv (NS/Tc), and 0.6 +/- 0.1 mSv/1.3 +/- 0.1 mSv (robot). For 99Tcm-sestamibi, the average accumulated radiation doses for 10 reconstitutions to the fingers (non-dominant/dominant) were 6.7 +/- 0.7 mSv/4.6 +/- 0.5 mSv (standard) and 1.1 +/- 0.1 mSv/3.1 +/- 0.4 mSv (robot). When compared to the standard reconstitution method, our results show that the NS/Tc method slightly reduced radiation dose to the non-dominant hand, without any significant reduction for the dominant hand. However, the robot has proved to be the most effective method to considerably reduce radiation dose to both hands. A robotic system should be a useful ALARA (as low as reasonably achievable) tool to prepare other high-activity 99Tcm-labelled radiopharmaceuticals, as well as therapeutic and PET radiopharmaceuticals.

Pulmonary function monitoring during adenosine myocardial perfusion scintigraphy in patients with chronic obstructive pulmonary disease

OBJECTIVE

To determine whether adenosine could be safely administered to patients with chronic obstructive pulmonary disease (COPD) for coronary vasodilatation during perfusion scintigraphy without causing bronchospasm.

MATERIAL AND METHODS

The study was divided into two phases. In the monitoring phase, patients with COPD were pretreated with an inhaled bronchodilator (albuterol) and had pulmonary function monitored during the infusion of a graduated dose of adenosine. Eligibility for entry into this phase of the study was determined on the basis of results of pulmonary function testing (PFT) during resting. Once we had shown that adenosine could be safely administered to patients with COPD, an implementation phase was begun. Entry did not require resting PFT, and patients were administered adenosine without monitoring of pulmonary function. Differences between patients with normal pulmonary function or mild COPD and those with more severe COPD were analyzed statistically.

RESULTS

Of 94 patients entered into the monitoring phase, none had obvious bronchospasm. The dosage of adenosine was reduced in four patients because of a decrease in forced expiratory volume in 1 second (FEV1) of 20% in comparison with baseline (FEV1 before administration of albuterol). The mean FEV1 decreased slightly from 1.83 L after administration of albuterol to 1.78 L during the maximal adenosine dose. Patients with a remote history of asthma, positive result of a methacholine challenge test, or mild COPD (FEV1 60 to 80% of the maximal predicted value for age) did not differ significantly in their response to infusion of adenosine from those with moderate or severe COPD (FEV1 30 to 59% of the maximum predicted for age). Of 117 patients in the implementation phase, 2 had bronchospasm during infusion of adenosine that was quickly terminated by stopping the administration in one patient and reducing the dose of adenosine in the other.

CONCLUSION

This study shows that adenosine can be safely administered intravenously to selected patients with known or suspected COPD to produce coronary vasodilatation for myocardial perfusion imaging. Patients who are within the guidelines established for this study should be considered for adenosine coronary vasodilatation with use of bronchodilator pretreatment, a graduated dose of adenosine, and regular chest auscultation during the infusion.

Effects of alternative reconstitution procedures on the labelling efficiency and in vitro stability of 99Tcm-labelled radiopharmaceuticals

Adding normal saline (NS) separately before 99Tcm-sodium pertechnetate to MDP cold kits has been shown to reduce substantially the radiation dose to the hand. A similar dose reduction will probably prove to be valid with the preparation of most other 99Tcm-labelled radiopharmaceuticals. However, it is unknown how this altered reconstitution procedure may affect the labelling efficiency and in vitro stability of the 99Tcm-labelled radiopharmaceuticals. We have evaluated the effects on the labelling efficiency and in vitro stability of 99Tcm-labelled MDP, mertiatide and sestamibi reconstituted with three different methods: adding normal saline before 99Tcm activity (NS/Tc); adding 99Tcm activity before normal saline (Tc/NS); and the standard reconstitution method of adding both 99Tcm activity and normal saline together. The labelling efficiency and in vitro stability were evaluated by measuring the radiochemical purity of each radiopharmaceutical tested at 0, 1, 3, 6, 12 (except 99Tcm-MDP) and 24 h after reconstitution. For 99Tc-mertiatide, there was a very slight difference in the labelling efficiency, mostly due to the Tc/NS method being approximately 0.29% lower across time post-reconstitution than the standard method. For 99Tcm-labelled MDP and sestamibi, there were no differences between the three methods in terms of labelling efficiency and in vitro stability. In conclusion, both alternative methods (i.e. NS/Tc and Tc/NS) appear not to have any detrimental effect on the labelling efficiency and in vitro stability of the 99Tcm-labelled radiopharmaceuticals that we tested. However, of the two alternative kit reconstitution methods, we recommend the NS/Tc method, since it may reduce the hand radiation dose.

Radiolabelled mixed leukocytes and pure granulocytes with stabilized 99Tcm-exametazime

Although the methylene blue stabilizer extends the shelf life of 99Tcm-exametazime to 4-6 h after reconstitution, the dark blue appearance of the mixture of stabilized 99Tcm-exametazime and blood components makes it impossible to separate out the leukocyte button. The aim of this study was to assess the feasibility of using stabilized 99Tcm-exametazime to radiolabel mixed leukocytes separated by Volex sedimentation with hypotonic lysis (VL) and pure granulocytes isolated by a single-density Ficoll-Hypaque gradient with hypotonic lysis (FL). Isolated cells from 40-ml and 80-ml donor blood samples were mixed with 0.5 ml stabilized 99Tcm-exametazime (approximately 925 MBq 99Tcm and 62.5 micrograms exametazime) and incubated at room temperature for 15 min. After incubation, two dilution steps with 3 ml and 9 ml of 12.6% ACD/NS (anticoagulant citrate dextrose, solution A, USP, mixed with 0.9% NaCl, v/v) were conducted to dilute the dark blue mixture and to remove any unbound 99Tcm activity. With the addition of 9 ml of 12.6% ACD/NS solution to the 1-ml bottom portion from the first dilution, the supernatant of the centrifuged preparation was clear enough to be withdrawn. The overall labelling efficiency (LE) of labelled leukocytes and granulocytes was 87.1 +/- 4.9% and 87.7 +/- 6.2%, respectively (n = 12 each). Overall, radiolabelled cells (n = 12) from the 80-ml blood samples (LE = 90.3 +/- 2.8%) had an approximately 6% higher labelling efficiency than from the 40-ml blood samples (LE = 84.5 +/- 6.0%) and also had a slightly better in vitro stability compared to the 40-ml samples. The in vitro stability studies showed that only approximately 2% (n = 48) 99Tcm activity was eluted each hour from the radiolabelled leukocytes or granulocytes for the 40-ml or 80-ml blood samples during the 6-h evaluation period. Cell viability of all labelled leukocyte samples was confirmed by the trypan blue staining technique. In conclusion, mixed leukocytes separated by the VL method and pure granulocytes isolated by the FL method can be effectively labelled with stabilized 99Tcm-exametazime with the use of the 'double dilution' technique.

The use of human glutathione S-transferase A1 in the detection of cystic fibrosis liver disease

OBJECTIVE

To determine the value of serum human glutathione S-transferase A1 (hGST A1) in the detection of cystic fibrosis liver disease (CFLD).

METHODS

Sixty-three children (aged 0.5-16 years) with cystic fibrosis (CF) were screened prospectively for evidence of hepatobiliary abnormalities between February 1993 and February 1996. Comparison was made between clinical examination, abdominal ultrasonic scan, measurement of conventional liver enzymes (LFTs) and serum hGST A1 concentration in the detection of hepatobiliary abnormalities in children with CF.

RESULTS

The 5-95% concentration of serum hGST A1 was 1.7-4.27 micrograms L-1 for the control group. The hGST A1 levels in the CF patients were significantly higher than in the non-CF group. Thirty-eight (60%) children had detectable hepatobiliary abnormalities. Ultrasound scanning detected the highest number of abnormalities (41%), followed by hGST A1 (30%). The presence of clinical liver disease was found in 19% of the children. The estimated sensitivities of detecting CFLD by clinical method, ultrasound scan, serum hGST A1, and LFTs would be 32%, 68%, 50% and 16%, respectively.

CONCLUSIONS

Serum hGST A1 measurement increases the sensitivity of detecting hepatic abnormalities when included with clinical and ultrasound evaluation although, in some cases with advanced liver disease, serum hGST A1 may be normal. Conventional liver enzyme tests add little information in the detection of CF liver disease.

Use of stabilized technetium-99m-exametazime for radiolabeling leukocytes

With a stabilizing agent (i.e., methylene blue and sodium phosphate buffer mixture), the in vitro stability of 99mTc-exametazime has been increased to 4-6 hr postreconstitution. However, it is not feasible to use the stabilized 99mTc-exametazime for leukocyte radiolabeling. This is due to the deep blue appearance of the mixture of stabilized 99mTc-exametazime and blood components, which makes it impossible to separate properly the supernatant from the leukocyte button. In our study, we have developed a practical methodology for overcoming this difficulty in order to use stabilized 99mTc-exametazime in leukocyte labeling.

METHODS

The stabilized 99mTc-exametazime preparation used in our method consisted of 2 ml 7.4-8.0 GBq (200-215 mCi) 99mTc and 2 ml methylene blue/phosphate buffer solution. The separated leukocytes from 80-ml fresh venous blood were incubated with three different ages (i.e., 0-, 4-, or 6-hr postreconstitution) of stabilized 99mTc-exametazime (approximately 925 MBq, approximately 25 mCi; 0.5-1 ml) at room temperature for 15 min. After incubation, 3 ml of 12.6% ACD/NS solution (anticoagulant citrate dextrose, solution A, USP mixed with 0.9% NaCl, v/v) was added to the tube and centrifuged at 160 g for 5 min. Three milliliters of the dark blue supernatant were carefully removed, and the bottom 1 ml portion was resuspended with 9 ml of 12.6% ACD/NS solution. After centrifugation (160 g for 5 min), the supernatant was clear enough to be drawn off without disturbing the radiolabeled leukocyte button. The white cell button was then resuspended in 4 ml of platelet-poor plasma.

RESULTS

The overall labeling efficiency (LE) of our new technique was 67.8%-91.9%, with the higher LE associated with fresher stabilized 99mTc-exametazime. During a 6-hr in vitro stability evaluation, radiolabeled leukocytes lost 1.2% +/- 0.3% (n = 24), 1.3% +/- 0.1% (n = 16) and 1.8% +/- 0.1% (n = 16) each hour of the cell-bound 0-, 4-, and 6-hr-old 99mTc-exametazime, respectively. The 99mTc-exametazime-labeled leukocytes examined by the trypan blue staining technique at 6-hr postradiolabeling yielded nonstained cells indicating viable leukocytes.

CONCLUSION

We concluded that with a small volume of 99mTc-exametazime and double dilution steps with 12.6% ACD/NS solution, stabilized 99mTc-exametazime can be used effectively for leukocyte radiolabeling with a high LE and long in vitro stability.

An optimal dual-size vial system for the cost-effective usage of Adenoscan

BACKGROUND

Adenoscan (Fujisawa USA, Inc., Deerfield, Ill.) has been initially packaged in a 30 ml glass vial for single use only because it contains no preservative. This restricted usage has generated considerable waste and high cost for the patient. Although the new 20 ml vial of Adenoscan provides some reduction in waste, the savings offered by the 20 ml and 30 ml vial system is still not optimal. The purpose of this study was to investigate an optimal dual-size vial system that would provide limited amounts of waste while maintaining its practicality to satisfy different patient populations.

MATERIALS AND RESULTS

The least waste for each potential combination (n = 344) of two vials was calculated by assuming that patient weights (30 to 200 kg) follow a normal distribution. The 6 ml and 15 ml vial combination had the least expected waste for lighter patient populations, and the 9 ml and 15 ml vial system had the least expected waste for heavier populations. The calculated wastes for 4207 patients (83 +/- 19 kg) undergoing adenosine stress myocardial perfusion studies at the Mayo Clinic were 10.5 +/- 9.3 ml (30 ml vial), 5.1 +/- 2.9 ml (20 ml and 30 ml vial system), 1.6 +/- 1.0 ml (6 ml and 15 ml vial system), and 1.8 +/- 1.2 ml (9 ml and 15 ml vial system).

CONCLUSIONS

In general, both the 6 ml and 15 ml and 9 ml and 15 ml vial systems perform better than either the single 30 ml vial or the 20 ml and 30 ml vial system. Furthermore, the 6 ml and 15 ml vial combination offers the lowest expected waste for the actual patient population that underwent the adenosine stress myocardial perfusion imaging studies at our institution.

Activated charcoal as a potential radioactive marker for gastrointestinal studies

The scintigraphic measurement of colonic transit is currently performed using 111In ion exchange resin pellets delivered to the colon in a capsule coated with a pH sensitive polymer, methacrylate, which dissolves in the distal ileum. However, in the USA, this requires an investigational drug permit. Our aim was to evaluate the in vitro binding characteristics of activated charcoal in milieus that mimicked gastric and small intestinal content. The in vitro incubation of activated charcoal was performed with Na99Tc(m)O4, 99Tc(m)-DTPA, 111InCl3, 111In-DTPA, 201TlCl and 67Ga-citrate in the pH range 2-4 and pH 7.2 at 37 degrees C. We estimated the association of radiopharmaceuticals with the activated charcoal over a 3 h in vitro incubation. With the exception of 67Ga-citrate, the association of activated charcoal with the other radiopharmaceuticals was approximately 100% throughout the 3 h incubation. In conclusion, activated charcoal appears to adsorb avidly with common radioisotopes, and appears promising as an alternative to resin ion exchange pellets used for the measurement of gastrointestinal transit by scintigraphy.

Myositis ossificans complicating severe Guillain-Barré syndrome

We report myositis ossificans occurring in a 13-year-old boy with severe and rapidly progressive Guillain-Barré syndrome. This complication should be considered when severe musculoskeletal pain is experienced by such patients. Disodium etidronate may be of benefit in this condition.

Colonic transit scintigraphy labeled activated charcoal compared with ion exchange pellets

Scintigraphic measurement of colonic transit is currently performed by delivering 111In ion exchange resin pellets to the colon in a methacrylate-coated capsule. However, use of this method is constrained by the need for an investigational drug permit. We have demonstrated previously optimal adsorption in vitro of commonly used radioisotopes (e.g., 99mTc or 111In) to activated charcoal in milieus that mimicked gastric and small intestinal content. The aim of this study was to compare the transit profiles of radioactive activated charcoal and resin pellets delivered to the colon in the same methacrylate-coated capsule.

METHODS

In 10 healthy volunteers, we compared the colonic transit profiles over 32 hr of simultaneously administered resin pellets labeled with 111In and activated charcoal mixed with 99mTc-diethylenetriaminepentaacetic acid. Transit was summarized as the geometric center (weighted average of counts) in the colon at each scanning period.

RESULTS

Colonic transit profiles were virtually identical with the two markers, with less than 0.1 geometric center unit differences in the transit profiles over the 32-hr periods.

CONCLUSION

Activated charcoal is a suitable alternative to resin pellets when delivered in a methacrylate-coated, delayed-release capsule to the colon for measurement of transit by scintigraphy.

Faster and easier radiochemical purity testing for [125I]sodium iothalamate

A previous method for determination of the radiochemical purity (RCP) value of [125I]sodium iothalamate uses two paper strips and solvents (total developing time is approximately 2.5 h). To simplify and shorten the RCP testing procedure, our laboratory has developed a single-strip chromatography method that not only distributes free 125I and [125I]sodium iothalamate to different relative front (Rf) locations, but is also faster and easier to perform. RCP of [125I]sodium iothalamate was determined with the use of a 10-cm instant thin-layer chromatography strip impregnated with polysilicic acid gel (ITLC-SA) as the solid phase, and a mobile phase of 2-butanol:acetic acid:water (140:2.5:70, v/v). By using autoradiography and counting the strip segments in a gamma counter, our results indicated that free 125I migrated to Rf = 0.89-1.00 while the [125I]sodium iothalamate moved to Rf = 0.44-0.67. The total developing time for the single-strip ITLC-SA system was approximately 1 h.

Rapid preparation method for technetium-99m bicisate

The method currently recommended for the preparation of technetium-99m bicisate (99mTc-bicisate) requires a lengthy 30-min incubation at room temperature. The purpose of this study was to evaluate an alternative method to shorten the preparation time. 99mTc-bicisate was prepared with 3.7 GBq (100 mCi) 99mTc according to the manufacturer's instructions, except for the final incubation step, which was replaced with the microwave heating procedure. A standard thin-layer chromatography (TLC) method (i.e., Baker-Flex silica gel IB-F TLC plate with ethyl acetate as mobile phase) was used for the determination of the radiochemical purity (RCP) of 99mTc-bicisate. Our evaluation with different microwave heating processes (300 W with different heating times) demonstrated that as the microwave heating temperature was increased (i.e., 44 masculine-71 masculine C), an increased percentage of samples reached 95% within 5 min post preparation (n=58). The highest RCP value (i.e., 97.4%+/-0.5%, n=10) could be obtained immediately after an 8-s microwave heating time at 300 W (microwave temperature at 69 masculine C), and an average RCP value of 96.4%+/-1.3% (n=90) was maintained throughout the 24-h evaluation period. However, the trend seemed to reverse at higher microwave temperatures (i.e., 76 masculine-90 masculine C), which reconfirmed our initial findings that overheating had no benefit for the preparation of 99mTc-bicisate. To ensure that temperature was the only determining factor, a hot water incubator set at 69 masculine C was used (n=6). Similar RCP results were achieved. In conclusion, the use of a microwave oven at a low heat cycle provides a rapid and efficient way to prepare 99mTc-bicisate.

Radioiodine dispensing and usage in a centralized hospital nuclear pharmacy

131I sodium iodide is the radiopharmaceutical of choice for both diagnosis and therapy in patients with various thyroid abnormalities. The radioiodide capsule has been the preferred dosage form, primarily because it provides a more convenient and safer vehicle for radioiodine administration. However, encapsulated 131I costs approximately twice as much a liquid 131I and does not provide as much flexibility as 131I solution in dosage selection. Also, the bioavailability of the capsular radioiodide preparation is inferior to that of the aqueous dosage form. The patient must swallow multiple capsules when a large amount of 131I activity is used. Capsule form is not suitable for any patient who has difficulty swallowing a capsule, has a feeding tube, or requires intravenous injection of 131I solution. In addition, radioiodide capsules must be analyzed statistically to ensure that the dosage units meet the United States Pharmacopeia uniformity requirements. If liquid radioiodine is used, distilled water rather than tap water should be used for dose preparation. It also is recommended that an antioxidant (e.g., sodium thiosulfate, sodium bisulfite), disodium edetate, and a pH adjustment of 7.5-9.0 be used to reduce radioiodide volatility. Due to the acceleration of the oxidative reaction caused by heat and light, 131I should be stored in a dark, cool environment. To comply with the quality management program implemented by the US Nuclear Regulatory Commission on January 27, 1992, all of the required information (e.g., prescribed dosage, procedure date, and signature of the authorized user) for a valid written directive is preprinted to ensure that the written directive is completed entirely and appropriately. Before each administration of therapeutic 131I solution, the calculated dose is verified by the prescribing physician, and the measured dose of 131I is reconfirmed by a second nuclear medicine technologist. Each patient's identity is verified by two methods (i.e., patient's full name and birth date).

Radiopharmaceutical-related pitfalls and artifacts

The primary goal of this review article is to increase the reader's knowledge and understanding of problems associated with the radiopharmaceuticals commonly used in daily practice. To achieve this objective, problems related to the commonly used radiopharmaceuticals are divided into pitfalls and artifacts related to radiopharmaceutical preparation (technetium-99m [99mTc]-labeled and non-99mTc-labeled radiopharmaceutical) and those related to radiopharmaceutical administration. For the radiopharmaceutical formulation-associated pitfalls and artifacts, problems are discussed in terms of factor categories, such as factors associated with radionuclides, factors associated with components, factors associated with preparation procedures, and miscellaneous factors. As for the pitfalls and artifacts caused by radiopharmaceutical administration, these problems are categorized into errors associated with administration technique and nontechnical errors. Clinical manifestations (ie, appearance upon imaging) from the numerous literature-based examples are presented. The effect of the causative factors and the reason each factor can result in radiopharmaceutical preparation and administration problems are discussed. In addition, the possible preventive actions are presented for each group. However, the cause of some pharmaceutical related problems may not be easily recognized, and thus it is difficult to develop preventive and/or corrective plans for these cases.

Single photon emission computed tomography brain imaging

SPECT brain perfusion imaging has definite value in the evaluation of cerebrovascular disease (particularly acute stroke), dementia, epilepsy, and may have a role in the diagnosis of brain death and head trauma. SPECT with tumor tracers T1-201 and Tc-99m sestamibi shows promise for detecting tumor recurrence.

A comparison of current regulations and regulatory guide governing quality control of dose calibrators

The U.S. Nuclear Regulatory Commission recently amended its regulation governing the calibration of dose calibrators. The changes include (1) the radioactivity of radiopharmaceutical dosages that contain photon-emitting radionuclides has to be measured by a dose calibrator prior to administration to patients and human research subjects; (2) the lower end of the radioactivity limits for linearity testing has been raised to 1.1 MBq (30 microCi) to be consistent with the Nuclear Regulatory Commission Quality Management Program Requirements; and (3) the requirement for signature of the Radiation Safety Officer on the records for accuracy, linearity, and geometry dependence tests has been removed. Although these are practical amendments, further clarification of the new Nuclear Regulatory Commission regulation is required for the following issues: (1) inconsistency in individual's identification requirement for the record keeping (i.e., initials of the individual who performed the constancy check and identity of the operator for the accuracy, linearity, and geometry dependence tests); (2) whether the use of 99mTc is adequate for linearity testing when other radionuclides are being measured in the dose calibrator; and (3) lack of provision for dose calibrator adjustment when conducting the accuracy test. In addition, Nuclear Regulatory Commission Regulatory Guide 10.8 should be revised to become consistent with the Nuclear Regulatory Commission's regulation in order to assist licensees with full compliance of the requirements or recommendations.

Optimal conditions of 99mTc eluate for the radiolabeling of 99mTc-sestamibi

Our nuclear pharmacy has reported that a failed radiochemical purity (RCP) (i.e., RCP < 90%) of 99mTc-sestamibi may be associated with the use of a first elution at later stages from a long-ingrowth time (i.e., > or = 72 h) wet-column generator. The primary purpose of this study was to evaluate the effects of 99mTc eluates from wet- and dry-column generators on the RCP of 99mTc-sestamibi under the above conditions. RCP values were found to be measurably higher and kit failure rates lower with the use of dry-column generator eluate. Using a dry-column generator eluate, Cardiolite kits were prepared with 11.10 GBq of 99mTc at 3, 4, and 5 h postelution and 5.55 GBq at 6, 10, 11, and 12 h postelution. Our data suggest that when 11.10 GBq of 99mTc from a dry-column generator with > or = 72-h ingrowth was used to prepare 99mTc-sestamibi, kit failure started to occur using 99mTc eluate at approximately 4 h postelution. When 5.55 GBq was used to reconstitute the kit, RCP failure began to occur using 99mTc eluate approximately 10 h postelution and wet-column generators; the failure rate can be reduced even further by avoiding the addition of high activities of 99mTc and long elution times.

Single photon emission computed tomography

Single-photon emission computed tomography is a well established functional imaging technique in epilepsy that aids precise noninvasive localization of the seizure focus required for surgical intervention in refractory seizures. Electroencephalography with video monitoring of seizures precedes more invasive evaluation, such as cortical or depth electrodes. Positron emission tomography studies in temporal lobe epilepsy are moderately sensitive, demonstrating ipsilateral hypometabolism. Ictal single photon emission computed tomography studies in temporal lobe epilepsy demonstrate transient intense hyperemia in the anterior temporal lobe structures. Peri-ictal images show persisting mesial temporal hyperperfusion with lateral hypoperfusion developing over the next 2 to 5 minutes to be replaced by significant hypoperfusion in the postictal phase. Interictal single photon emission computed tomography with ipsilateral hypoperfusion, suffers from reduced sensitivity and accuracy, whereas ictal and, to a lesser extent, peri-ictal and postictal single photon emission computed tomography are highly sensitive and accurate in localizing temporal lobe epilepsy. New iodinated neuroreceptor single photon emission computed tomography imaging agents hold promise in localizing the seizure focus (focally reduced uptake) without ictal injection, and also may elucidate underlying mechanisms inherent to epilepsy.

Generator eluate effects on the labeling efficiency of 99mTc-sestamibi

Our nuclear pharmacy noted that 99mTc-sestamibi kits sometimes failed radiochemical purity (RCP) testing (i.e., RCP < 90%). All failed kits had been prepared with eluate from a newly arrived generator (ingrowth time > or = 72 h) which had been eluted > or = 6 h before the kit failure. The effects of 99mTc activity and eluate volume were then investigated to help explain the reason for the low RCP values. Our results demonstrated that higher failure rates of the 99mTc-sestamibi kits were noted when higher activities of 99mTc eluates were added, and the higher failure rates of the kits were associated with lower RCP values. In addition, higher kit failure rate and lower RCP values of the 5.55-GBq kits at 12 h postelution in comparison with the 11.1-GBq kits at 6 h (same eluate volume) indicated that the 99mTc activity and volume had a less detrimental effect on the 99mTc-sestamibi kit preparation than the 99mTc eluate age. The kit failures might be explained by the higher amount of 99mTc and the production of the free radicals during the long ingrowth time prior to generator elution. In conclusion, the use of a first elution from a long-ingrowth time generator at a later stage (i.e., 11.1 GBq at 6 h and 5.55 GBq at 12 h postelution) in preparation of a 99mTc-sestamibi kit is associated with a high rate of kit failure and should therefore be avoided.

Filtered technetium-99m-sulfur colloid evaluated for lymphoscintigraphy

Several 99mTc-labeled radiopharmaceuticals have been developed for lymphoscintigraphy of the extremities. In the United States, however, these agents are not widely used clinically. This study evaluates the use of smaller particle sizes ( < 0.1 micron) of 99mTc-sulfur colloid (99mTc-SC) for lymphoscintigraphy.

METHODS

The 99mTc-SC was prepared by kit, and the final preparation was filtered through a sterile 0.1-micron filter. The radiochemical purity (RCP) of the filtered 99mTc-SC was determined before administration. Nineteen patients with suspected lymphedema were injected with 18.5 MBq (500 muCi) filtered 99mTc-SC intradermally in each foot, and whole-body images were obtained immediately and 1, 3, 6 and 24 hr later. Local views over the inguinal or axillary lymph nodes were also obtained every 5 min for the first hour.

RESULTS

The average RCP value was 93.4% +/- 4.2% (n = 19), and the RCP difference pre- and postfiltration of the 99mTc-SC preparation was -1.7% +/- 1.4% (n = 40). Evaluation of the particle size with the polycarbonate filter showed that 89.9% +/- 4.5% (n = 28) of particles were less than 50 nm, and the particle size was further determined by electron microscopy to be 38.0 +/- 3.3 nm (n = 202). The mean particle sizes of two peaks measured by laser light scattering techniques were 7.5 and 53.9 nm (major peak). Clinical studies with filtered 99mTc-SC demonstrated similar lymphoscintigrams compared with those obtained with 99mTc antimony sulfide colloid (99mTc-ATC). Filtered 99mTc-SC showed a faster transport rate to the inguinal lymph nodes and lower radiation dosimetry for liver, spleen and whole body compared with 99mTc-ATC.

CONCLUSION

Filtered 99mTc-SC can be easily prepared and is readily available for routine clinical use in lymphoscintigraphic studies.

Coeliac disease in children of West Indian origin

Coeliac disease is uncommon in populations of non-European origin. Two English born West Indian children with coeliac disease are presented. The diagnosis should be considered in children of West Indian origin with chronic diarrhoea.

In vitro evaluation of neutrophil viability after exposure to a hypotonic medium

Separation techniques for radiolabelled leukocytes have inherent problems with contaminants (e.g. platelets and erythrocytes). Hypotonic lysis methods can eliminate the erythrocytes, but the question of neutrophil viability after an exposure to a hypotonic solution (i.e. sterile water) remains. Ficoll/ hypaque two-density gradient separation was performed on donor whole blood to obtain a pure neutrophil suspension. A timed sequence of water exposure was done for 5-100 s on the neutrophil preparations. The viability of these preparations was evaluated using flow cytometry and chemotaxis. The trypan blue staining method was used to document cell death. With water exposures ranging up to 100 s, 2.04 +/- 1.80% neutrophils exhibited cellular degradation by flow cytometry, and all samples demonstrated viable neutrophils by chemotaxis and trypan blue staining. The hypotonic medium exposure times for leukocyte separations should be less than 30 s for neutrophils to retain their viability by these in vitro techniques.

Effects of generator eluate age on the radiochemical purity of fractionated 99Tcm-MAG3

The fractionation of US mercaptoacetyltriglycene (MAG3) cold kits provides an economical way of preparing 99Tcm-MAG3. However, our nuclear pharmacy noted that fractionated 99Tcm-MAG3 kits sometimes failed radiochemical purity (RCP) testing (i.e. RCP < 90%) when a 99Tcm eluate of older age was used. The purpose of this study was to evaluate the effects of eluate age on the radiochemical purity of fractionated 99Tcm-MAG3 kits. Each of four US MAG3 cold kits was initially diluted with 10 ml N2-purged 0.9% NaCl solution and subdivided into 10 aliquots of 1 ml MAG3 solution and overlayered with N2. The 40 fractionated MAG3 vials were immediately frozen at -20 degrees C for storage. Fractionated MAG3 kits were reconstituted with 1 ml of approximately 111 GBq 99Tcm eluate from a long-ingrowth generator (i.e. > or = 72 h) every hour during the 6 h post-elution period. The RCP of each 99Tcm-MAG3 preparation was determined using the recommended Sep-Pak C18 column chromatography 1, 2, 3, 4, 5 and 6 h post-reconstitution. All fractionated MAG3 kits prepared with 99Tcm eluates 4 h post-elution or less maintained an average RCP value of 96.3 +/- 2.5% (n = 144) throughout the 6 h evaluation period following preparation. However, 99Tcm eluates 5 and 6 h post-elution resulted in kit failure rates of 16.7% (1/6) with RCP = 89.3%, and 50% (3/6) with RCP = 88.2, 83.9 and 87.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid radiochemical purity testing for [131I]m-iodobenzylguanidine

The standard high pressure liquid chromatography (HPLC) method for determining radiochemical purity (RCP) of [131I]m-iodobenzylguanidine ([131I]mIBG) is cumbersome and time-consuming. A simplified and rapid separation method with the use of a reverse-phase extraction chromatography technique (i.e. Sep-Pak C18 [SPC] cartridge) is described. The new SPC system closely correlates (r = 0.99) to the standard HPLC method, and the time to complete the SPC analysis is less than 5 min.

Comparison of four alternative radiochemical purity testing methods for 99Tcm-sestamibi

Four different methods for determining the radiochemical purity (RCP) of 99Tcm-sestamibi have been proposed to replace the recommended thin-layer chromatography (TLC) method, as the recommended method is inconvenient and time-consuming. The purpose of this study was to compare the recommended TLC method with the four proposed rapid QC methods for 99Tcm-sestamibi: (1) chloroform extraction (CE), (2) mini-paper chromatography with chloroform/tetrahydrofuran (1:1, v/v) (MPC), (3) Waters Sep-Pak alumina N cartridge with 100% ethanol (SPE), and (4) Waters Sep-Pak C18 cartridge with normal saline (SPNS). For RCP values ranging from 21.8 to 98.7% (n = 20), both the CE and SPNS methods produced falsely high RCP values (RCP difference: 14.1 +/- 23.5% for CE and 15.0 +/- 24.9% for SPNS). The MPC and SPE methods were in good agreement (r = 0.98 for MPC and 0.88 for SPE) with the recommended TLC method over the critical RCP range (i.e. 77.0-98.7%, n = 52) (RCP difference: -0.9 +/- 1.2% for MPC and -4.3 +/- 3.2% for SPE). None of the 99Tcm-sestamibi preparations that had been rejected (i.e. RCP < 90%) by the TLC method were accepted by either the MPC or SPE method. However, 4 of the 52 99Tcm-sestamibi preparations with acceptable RCP by the TLC method had unacceptable RCP by the MPC method, whereas 8 of the same 52 preparations were unacceptable by the SPE method.(ABSTRACT TRUNCATED AT 250 WORDS)