Feasibility of scintigraphy in exercise-induced pulmonary haemorrhage detection and quantification: preliminary...

We hypothesised that scintigraphic imaging of the lungs following injection of 99mTc labelled red blood cells (99mTc-RBC) in the exercising horse might enable exercise-induced pulmonary haemorrhage (EIPH) quantification. Ideally, to favour detection of bleeding, circulating 99mTc-RBC not involved in the haemorrhage should be removed from the circulation quickly. Altering RBC during labelling to stimulate splenic uptake of 99mTc-RBC may encourage this. In order to investigate this hypothesis, 99mTc-RBC distribution was followed for 1 h in 2 groups of horses. Group 1 was injected i.v., at rest, with radioactive nondenatured RBC (99mTc-NDRBC); Group 2 received labelled RBC partly denatured by heating (99mTc-HDRBC). In Group 2, splenic uptake was higher at all times and radioactivity in the lung was proportionally higher and decreased less quickly than in Group 1. Hence, the time-consuming 99mTc-HDRBC labelling technique did not demonstrate any advantage over the easier 99mTc-NDRBC labelling procedure. Additionally, the feasibility of scintigraphic visualisation of a small amount of pulmonary bleeding was confirmed with the following trial: using an endoscope, a radioactive solution mimicking 50 ml of bleeding was deposited at the usual site of EIPH in a live horse. The radioactivity recorded in that area was compared to the one obtained in the same region in Group 1 and 2. The activity measured 20 min post endoscopy corresponded to 33% of the activity obtained in Group 1 vs. 8% in Group 2 at that timing. Once again, there was no advantage of using 99mTc-HDRBC vs. 99mTc-NDRBC. These results demonstrated that small amounts of bleeding might potentially be detected with scintigraphy; they also suggest that the limiting factor for detecting small amounts of bleeding may be the level of lung background radioactivity.