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This study presents the development of a kit formulation for the preparation of 99mTc-DMP-HSA, followed by a comparison of such kit-prepared 99mTc-DMP-HSA to 99mTc-RBCs in a volunteer. Reconstitution of the labeling kits with up to 5.55 GBq 99mTc afforded 99mTc-DMP-HSA preparations with a > 95% radiochemical purity for up to 8 h. Only minor differences were observed in the global distribution of both tracer agents, whereas the calculated ejection fractions were almost identical. The effective dose equivalent of 99mTc-DMP-HSA is 8.68 microSv/MBq.

Unlabelled: The purpose of this study was to assess the normal perfusion pattern of the pediatric brain with 99mTc-ethylcysteinate dimer (99mTc-ECD)., Methods: Tomographic imaging was performed with a dedicated system with high sensitivity and resolution. Sixteen children, referred for brain imaging in the workup of seizure disorder, were included since they turned out negative after a 1-yr follow-up. A standardized brain presentation was obtained after reslicing and reorienting of the three-dimensional volumetric dataset., Results: Quantitative analysis did not reveal significant left-right uptake differences per patient. Three age clusters were investigated that showed differences in regional uptake, mainly a relatively increased uptake in basal ganglia, visual and motor cortex. An uptake ratio or perfusion index was calculated after normalization. Normal limits were established for the children in the three groups., Conclusion: Technetium-99m-ECD is a safe agent for children and should be the radiopharmaceutical of choice for brain perfusion studies because of favorable radiation dosimetry and stability. The age dependence of perfusion necessitates a database comparison before concluding that the observed perfusion pattern is normal.

The blood retention of 99Tcm-dimercaptopropionyl human serum albumin (99Tcm-DMP-HSA), prepared from a kit, was compared with that of five other 99Tcm-labelled blood pool tracers in two healthy volunteers. 99Tcm-DMP-HSA showed an almost identical behaviour to in vitro labelled red blood cells (RBCs), which are generally considered the reference standard for blood pool agents. The mean apparent blood mass of 99Tcm-DMP-HSA was 2.1% higher 10 min post-injection (p.i.) than that of in vitro 99Tcm-RBCs, 2.0% higher 30 min p.i., 4.7% higher 60 min p.i. and 2.3% higher 120 min p.i. In vivo labelling of RBCs yielded a labelling efficiency of 75-98%, depending on the stannous agent used. About 20 min after pertechnetate administration, the intravascular activity as a percentage of injected dose stabilized at levels close to that of in vitro labelled RBCs. One commercially available 99Tcm-HSA kit was found to be unsuitable as a blood pool tracer. As 99Tcm-DMP-HSA offers the same practical advantages as 99Tcm-HSA, but better biological characteristics, it shows promise as a new tracer for radionuclide ventriculography and further large-scale investigations are warranted.

Recently, we have shown that tetrapeptides can be efficiently labelled with technetium-99m by direct labelling at alkaline pH. Tetrapeptides can be considered derivatives of mercaptoacetyltriglycine (MAG3) in which the mercaptoacetyl moiety is replaced by an amino acid residue. In view of the interesting biological properties of some C-methyl substituted derivatives of 99mTc-MAG3, we have now synthesised and evaluated the complexes of 99mTc with tetrapeptides containing three glycyl (G) moieties and one D- or L-alanyl (A) moiety. In mice, 99mTc-L-GAGG, 99mTc-D-GGAG and 99mTc-L-GGAG showed a rapid and high renal excretion, comparable to that of 99mTc-MAG3. Renal handling was somewhat reduced for isomers d and l of 99mTc-AGGG and 99mTc-D-GAGG and markedly inferior for 99mTc-L-GGGA and 99mTc-D-GGGA. In the baboon, 99mTc-L-AGGG, 99mTc-D-AGGG and 99mTc-L-GAGG showed a comparable or even higher 1-h plasma clearance than 99mTc-MAG3. 99mTc-D-GAGG, 99mTc-L-GGAG and 99mTc-D-GGAG were characterised by a lower plasma clearance and the clearance of 99mTc-L-GGGA and 99mTc-D-GGGA was remarkably low. The three 99mTc-labelled tetrapeptides with the highest plasma clearance in a baboon were compared with 99mTc-MAG3 in a human volunteer. 99mTc-L-AGGG and 99mTc-L-GAGG had a roughly similar plasma clearance as 99mTc-MAG3. The clearance of 99mTc-D-AGGG was significantly lower and liver uptake was clearly visible with this compound. Left kidney renograms of 99mTc-L-AGGG and 99mTc-D-AGGG indicated moderate kidney accumulation. On the other hand, the renogram obtained after injection of 99mTc-L-GAGG had an excellent shape and the maximum kidney concentration was slightly higher than for 99mTc-MAG3. These results show the importance of the position of the methyl substituent on the 99mTc-tetrapeptide with respect to its biological behaviour.

Tetrapeptides are a class of N4-tetraligands that can efficiently bind 99mTc. In fact, tetrapeptides can be considered as derivatives of mercaptoacetyltriglycine (MAG3) in which the mercaptoacetyl moiety is replaced by a more stable and easier to handle aminoacyl group. Direct labelling of tetrapeptides with 99mTc in alkaline medium (pH > or = 11) in the presence of stannous ions gave a high yield (> 95%) of one or two (probably isomeric) radiochemical species. Exchange labelling at different pH values in the presence of stannous tartrate resulted in lower yields of the same 99mTc-labelled products as those formed during direct labelling. In addition, other radiochemical species were formed of which one was characterized as an oxotechnetium-complex with the cyclisized tetrapeptide. Tetrapeptides with a chiral centre in the first amino acid yield upon labelling with 99mTc two radiochemical species, probably the two diastereomers with an oxotechnetium core respectively syn and anti with respect to the substituent on the amino acid. Only one diastereomer was observed when the chiral carbon atom is located in the second or third amino acid. Electrophoresis indicated that these new 99mTc-labelled complexes are neutral in acidic medium and negatively charged in neutral and alkaline conditions. This correlates with a complex in which an oxotechnetium(V) group is bound to the ligand through three deprotonated nitrogen atoms of the amide functions and the free electron pair of the amine nitrogen atom. Biodistribution in mice showed for all studied 99mTc-labelled tetrapeptides a rapid clearance from the blood mainly by the renal system. The presence of a methyl substituent in the tetrapeptide increased the urinary excretion. 99mTc-labelled L-glycylalanylglycylglycine showed in mice a urinary excretion comparable to that of 99mTc-MAG3. Further rise of lipophilicity by introduction of a dimethyl, isopropyl or isobutyryl group leads to increased hepatobiliary handling. It is concluded that tetrapeptides are an interesting group of technetium complexing agents which can easily be labelled with 99mTc at room temperature in alkaline medium. This class offers the possibility of a wide variety of derivatives, just by substituting one or more amino acids. This group of ligands thus opens a new research field of 99mTc-complexes with potential usefulness in several areas.

A stable 99mTc-labelled compound that is easy to prepare and that is retained for a long period of time in the blood would constitute an ideal replacement for 99mTc-HSA (limited by its rapid diffusion) and 99mTc-erythrocytes (lengthy and risky in vitro labelling) as tracer agent for ventriculography. We investigated whether 99mTc-labelled polymers would be suitable for this purpose. Four types of poly-L-lysine (PL) (Mw 41,000 to 377,000) were used either in underivatized form labelled at pH 12, or derivatized with a varying number of mercaptoacetyl (MA) substituents by reaction with N-hydroxysuccinimidyl-S-acetylmercaptoacetate followed by deprotection with hydroxylamine and labelling at pH 7.5. A high labelling yield was obtained in all cases. HPLC-purified 99mTc-PLs and 99mTc-MA-PLs were evaluated in mice, with 125I-HSA as an internal biological standard. The retention in the blood at 10 minutes and 60 minutes p.i. was not higher than about 30% for any of the tested compounds versus 84% for 125I-HSA, and was only 10% for the smallest 99mTc-labelled PL and MA-PL. Liver uptake was high for the 99mTc-PLs, whereas the 99mTc-MA-PL's were excreted in significant amounts to the urine. It is concluded that 99mTc-labelled poly-L-lysines or polymercaptoacetyl-poly-L-lysines are not suitable as blood pool tracer agents.

Prosthetic vascular graft infection is a relatively uncommon complication of peripheral vascular surgery. We retrospectively analysed technetium-99m-d,l-hexamethylpropylene amine oxime (99Tcm-d,l-HMPAO) labelled leukocyte scans of 21 patients with a suspected vascular graft infection. Operative findings, bacteriological cultures, radiological findings or clinical follow-up were used to confirm the diagnosis. We found eight true-positive and six true-negative cases. There were no false-positive scintigraphic diagnoses. The false-negative rate was 33% (n = 7). Our results show a sensitivity of 53%, a specificity of 100% and an accuracy of 66%. The conclusion is that a negative 99Tcm-d,l-HMPAO-labelled leukocyte scan is of limited value in ruling out a vascular graft infection. A combination of computed tomography (CT-scan) and a 99Tcm-d,l-HMPAO-labelled leukocyte scan is probably the most efficient way of diagnosing a vascular graft infection.

Animal studies have indicated that technetium-99m L,L-ethylenedicysteine (99mTc-L,L-EC) may be a promising tracer agent for renal function studies. We have performed a paired study with 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) and 99mTc-L,L-EC in six male volunteers. In both cases, iodine-131-labelled o-iodohippurate was co-injected as an internal biological standard. The analog images between 0 and 30 min p.i. were of identical diagnostic value for both tracer agents. The two renograms were similar in all volunteers. The mean 1-h plasma clearance for 99mTc-MAG3 and 99mTc-L,L-EC was significantly different, respectively 382.9 +/- 17.1 ml/min per 1.73 m2 versus 460.2 +/- 47.7 ml/min per 1.73 m2 (P < 0.003). The urinary excretion after 30 min p.i. was 69.4% +/- 5.6% of the injected dose for 99mTc-MAG3 versus 66.5% +/- 2.5% for 99mTc-L,L-EC (P > 0.05) and after 60 min p.i. respectively 83.1% +/- 3.9% versus 79.8% +/- 4.3% (P > 0.05). 99mTc-L,L-EC has a very low plasma protein binding (31% +/- 6.8%) as compared to 99mTc-MAG3 (88% +/- 5.2%) and a larger volume of distribution. Although the exact mechanism responsible for the high plasma clearance of 99mTc-L,L-EC is not yet fully known, we conclude that this new agent merits further clinical evaluation in patients to establish its value as a renal radiopharmaceutical.

Different derivatives of MAG, carrying amino acids such as D- or L-alanine, D-serine, D-2-aminobutyric acid, D-valine or D-phenylglycine were synthesized and their 99mTc-complexes were evaluated in mice and a baboon. The efficiency of renal handling of the examined 99mTc-complexes is influenced not only by their lipophilicity but also to a great extent by their configuration and the site of substitution. The renal excretion characteristics of 99mTc-MAGAG-DA are superior to those of 99mTc-MAG3 and the studied 99mTc-complexes in both animal species. In an attempt to improve the renal handling of 99mTc-MAG3 and to evaluate the effect of derivatization we have synthesized different derivatives of MAG3 in which one or more glycyl groups are replaced by other amino acids such as D- or L-alanine, D-serine, D-2-aminobutyric acid, D-valine or D-phenylglycine. Due to the presence of a chiral centre in the ligand core, exchange labelling of each of the MAG3 derivatives results in the formation of two diastereomeric technetium complexes. These isomers were separated by HPLC and evaluated in mice. Biodistribution in mice indicates that the efficiency of renal handling of the examined 99mTc-complexes is not only influenced by their lipophilicity but also to a great extent by their configuration. The renal excretion characteristics of isomer DA of 99mTc-MAGAG in mice are superior to those of all other studied 99mTc-complexes and also of the reference compound [131I]Hippuran. The isomers LB of several alanyl derivatives of 99mTc-MAG3 exhibit a pronounced renal retention in both mice and baboon. The results of the evaluation in a baboon confirm the superiority of 99mTc-MAGAG-DA over 99mTc-MAG3 and the other studied 99mTc-complexes.

L,L-ethylenedicysteine (L,L-EC) can be labeled efficiently with 99mTc at pH 12 to obtain a highly pure and very stable tracer agent (99mTc-L,L-EC). The biological behavior of 99mTc-L,L-EC was studied in mice and a baboon. In mice, 99mTc-L,L-EC demonstrated a more rapid urinary excretion and less retention in the kidneys, the liver, the intestines, and the blood than did 99mTc-MAG3 at 10 and 60 min p.i. Urinary excretion decreased in probenecid pretreated mice, which indicates active tubular transport. In the baboon, the renograms for 99mTc-MAG3 and 99mTc-L,L-EC were comparable. Plasma-protein binding of 99mTc-L,L-EC was lower than that of 99mTc-MAG3 while its distribution volume and 1-hr plasma clearance were clearly higher. The promising results of the animal experiments suggest that 99mTc-L,L-ethylenedicysteine may be a useful alternative to 99mTc-MAG3 for renal function studies in humans.

The reported frequency of prosthetic vascular graft infections after reconstructive vascular surgery is low. However, it is a serious and potentially catastrophic complication of this treatment, with high morbidity and mortality rates. Effective therapy involves graft excision and replacement. Tc-99m HMPAO labeled leukocyte scintigraphy appears to be an accurate method of detecting prosthetic vascular graft infections. The value of leukocyte scanning is illustrated by two case reports.

During a study of C-methyl derivatives of technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) it was found that the isomer of 99mTc-mercaptoacetylglycyl-D-alanylglycine (99m-TC-MAGAG-DA) is superior to 99mTc-MAG3 with regard to its renal excretion characteristics in both mice and the baboon. We have now compared the renal handling of 99mTc-MAGAG-DA and 99mTc-MAG3 in 6 healthy volunteers in a paired study. Renograms of 99mTc-MAGAG-DA show a shorter time to renal maximum and a lower residual renal activity at 30 min post-injection (p.i.). The urinary excretion of 99mTc-MAGAG-DA is higher at both 30 and 60 min p.i. The plasma concentration of 99mTc-MAGAG-DA is lower than that of 99mTc-MAG3 at each moment up to 60 min p.i., and the plasma clearance is accordingly higher. It is concluded that 99mTc-MAGAG-DA is excreted more efficiently than 99mTc-MAG3, but the preparation of 99mTc-MAGAG-DA requires a HPLC purification step, and this limits its practical clinical usefulness.

To study the differences in biological behaviour between the four stereoisomers of 99mTc-CO2-DADS we synthesized both the L- and D-isomer of N,N'-bis-(benzoylmercaptoacetyl)-2,3-diaminopropanoic acid ethyl ester. The N2S2 ligands were labelled with 99mTc by the dithionite reduction method in alkaline medium to hydrolyze the ester function. Each isomer yielded two diastereomeric 99mTc-complexes, that were separated by RP-HPLC to finally obtain the four isomers of 99mTc-CO2-DADS. The biodistribution of the isomers was determined in mice and a baboon. The study in mice indicates that only the LB-isomer is responsible for the high liver uptake reported for (DL)-99mTc-CO2-DADS-B (Fritzberg et al. J. Nucl. Med. 23, 592-598, 1982). The rate of renal extraction and hepatobiliary excretion of the three other isomers is comparable to that of [131I]o-I-hippurate. Baboon renograms for the LA- and DA-isomers are similar to that of [123I]o-I-hippurate. The renogram of the DB-isomer resembles more the 99mTc-DTPA renogram, whereas the LB-isomer exhibits a 99mTc-DMSA-like renal build-up. It appears that minor configurational changes can drastically alter the renal handling of these bisamide bisthiol 99mTc-tracer agents.

The use of labelled granulocyte scintigraphy is recognized as a reliable method for detecting osteomyelitis and other skeletal sepsis. Tc-99m hexamethyl propyleneamine oxime (Tc-99m HM-PAO), a lipophilic chelate offers the advantages of availability, lower radiation dose and higher image resolution, compared to other labelling agents. We have scanned 36 orthopedic patients with suspected infection, using autologous granulocytes labelled with Tc-99m HM-PAO. In all cases, scans were compared with clinical, microbiological and/or surgical findings. Sensitivity was 94% and specificity was 80%. We therefore believe that Tc-99m HM-PAO leucocyte scanning provides a useful method for detecting osteomyelitis and other skeletal infections.

The safety, biodistribution and kinetics of a new perfusion imaging agent [99mTc-L,L]-ethyl cysteinate dimer (ECD) was evaluated in normal volunteers. Technetium-99m-L,L-ECD is a neutral, lipophilic complex, which is radiochemically pure and stable. Twelve healthy adults were injected with 25-30 mCi of 99mTc-L,L-ECD and imaged periodically for up to 24 hr. Planar imaging showed rapid brain uptake with a peak concentration of 4.9% injected dose and very slow brain washout (approximately 6% per hour during the first 6 hr). Repeat or dynamic tomographic imaging of the brain using either a rotating gamma camera or a multidetector system was performed up to 6 hr postinjection. The distribution of 99mTc-L,L-ECD in the brain did not change and was similar to the pattern seen with other perfusion agents. Background facial areas and lungs cleared rapidly. Peak blood activity was below 10% injected dose at all times and 99mTc-L,L-ECD cleared rapidly through the kidneys. Vital signs, blood and urine chemistries were normal in all volunteers and no adverse reactions were noted. These results suggest that 99mTc-L,L-ECD should be useful for routine assessment of cerebral perfusion in humans.