A critical evaluation of methods for preparing pentavalent 99Tcm-DMSA

Pentavalent 99Tcm-dimercaptosuccinic acid (99Tcm-(V)DMSA) has established uses in the detection and diagnosis of medullary thyroid carcinoma, osteosarcoma, amyloidosis and many soft tissue tumours, but is not readily available as a commercial kit. We have evaluated published methods for preparation of 99Tcm-(V)DMSA that are based on the modification of 99Tcm-(III)DMSA commercial kits. The criteria for assessment were achievement of satisfactory radiochemical purity and practical considerations regarding the ease of synthesis. Quantification of the desired product's activity was achieved via thin-layer chromatography (silica gel) with an n-butanol:acetic acid:water solvent system. The developed plates were imaged on a gamma camera and analysed using standard software. The methods investigated were designated as Birmingham, Cambridge and Canterbury: the latter two were very similar. With experience, the methods eventually produced similar radiochemical purities of > 90%. However, the Birmingham method was found to be more satisfactory in terms of its reliability and simplicity of synthesis.