Definition of myocardial perfusion by continuous infusion of krypton-81m

Krypton-81m, a radionuclide emitting a 190 kev gamma ray, has a half-life of 13 seconds. It is a radioisotope of an inert water-soluble noble gas and is produced at a constant rate by spontaneous decay of rubidium-81 in an 81Rb-81mKr generator-delivery system. Delivery is through a minibore Teflon catheter that can be threaded through a standard no. 7 or 8F angiographic catheter. The generator is eluted by 5 percent dextrose-in-water, delivered by infusion pump at 1.5 ml/min, and the eluate is infused intraarterially directly into any organ. Delivery and decay reach equilibrium within 2 minutes, producing a heterogeneous distribution that is proportional to the perfusibility of the tissue concerned and the time required to reach it. The ultrashort halflife of the radionuclide rapidly eliminates activity when delivery ceases; thus, experiments can be sequentially repeated at brief intervals. The radiation hazard for easily imaged doses is negligible. Preliminary studies in open chest dogs were visualized by scintillation camera, stored on digital data disk, processed, and displayed in dual channel, dual color mode on a video system. Images of myocardial perfusion defined relative levels of perfusion, collateral circulation between coronary arterial branches, equilibrium time of diffusible perfusion of the myocardium, focal defects in induced occlusion, collateral circulation to occlusion, and reactive hyperemia after release of induced coronary occlusion. The system and technique appear applicable to human subjects.