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Dextrose solutions yield radiochemical impurities: the "sweet" scans
Eman Al-Enizi1, Nafisah Kazem, Azu Owunwanne
1Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait.
Journal of Nuclear Medicine Technology
|March 8, 2003
Summary
Using 5% dextrose instead of saline to prepare radiochemical kits can create impurities like technetium-99m dextrose. This leads to altered biodistribution in scintigraphy for some radiochemicals, confusing nuclear medicine physicians.
Area of Science:
- Nuclear Medicine
- Radiopharmacy
- Diagnostic Imaging
Background:
- Radiopharmaceutical kits are crucial for diagnostic imaging.
- Accidental introduction of chemicals during preparation can lead to radiochemical impurities.
- The use of incorrect diluents can significantly impact imaging results.
Purpose of the Study:
- To report the experience of preparing radiochemicals with 5% dextrose instead of normal saline.
- To investigate the formation of radiochemical impurities and their impact on biodistribution.
- To analyze the consequences of using dextrose as a diluent in specific radiopharmaceutical kits.
Main Methods:
- Investigated the erroneous dilution of technetium-99m (99mTc) pertechnetate eluate with 5% dextrose.
- Prepared four types of radiochemical kits: 99mTc-tetrofosmin, 99mTc-methylene diphosphonate (MDP), 99mTc-stannous colloid, and 99mTc-mebrofenin.
- Reviewed radiopharmacy procedures and performed instant thin-layer chromatography (ITLC) on affected kits.
Main Results:
- Scintigrams revealed altered biodistribution in three of the four radiochemicals prepared with 5% dextrose.
- Observed cardiac blood-pool, soft-tissue background, renal, bladder, and gallbladder activity, potentially due to 99mTc-dextrose.
- No impurities or altered biodistribution were found in 99mTc-tetrofosmin prepared with 5% dextrose.
- ITLC confirmed the absence of impurities in 99mTc-tetrofosmin but did not rule out 99mTc-dextrose in other agents.
Conclusions:
- Unintended dilution with 5% dextrose frequently produces impurities, possibly 99mTc-dextrose.
- The impact of 5% dextrose varies among radiochemical kits, leading to mixed imaging findings.
- Nuclear medicine physicians must be aware of these potential artifacts when interpreting scans prepared with dextrose.