Gallium-67 activated charcoal: a new method for preparation of radioactive capsules for colonic transit study

Indium-111 is currently the radionuclide of choice for colonic transit study. However, it is expensive and not available in many hospitals. Technetium-99m has been proposed for colonic transit study but the short half-life has limited its use. Gallium-67 citrate is inexpensive and available in most countries. Most importantly, it has a suitable half-life for colonic transit study. Attempts have been made in some studies to use (67)Ga citrate to label activated charcoal, but the results have not been good because of poor stability. In this study, we successfully labelled activated charcoal()with (67)Ga citrate by adding alcohol and 5% glucose solution. To evaluate the in vitro stability, the (67)Ga-activated charcoal was incubated in a milieu mimicking the intestinal content, containing lipase, trypsin and glycochenodeoxycholate at different pH values (6.0, 7.0, 7.4 and 8.0) and for different durations (0 h, 24 h, 48 h, 72 h and 96 h). For the in vivo study, the (67)Ga-activated charcoal was loaded into a commercial empty enteric capsule. Colonic transit scintigraphy was performed in five volunteers, including three healthy people and two constipated patients, after intake of the radioactive capsule. Images were obtained at 2 h, 4 h, 6 h, 8 h, 24h, 48 h, 72 h etc. until no radioactivity was detected in the bowel. Our data show that the in vitro stability of (67)Ga-activated charcoal was good. The labelling efficiency still exceeded 91% at 96 h at pH values of 6.0, 7.0 and 7.4. In the group with a pH value of 8.0, the labelling efficiency gradually fell during the 4-day incubation but was still higher than 88% at the end of the fourth day. In the in vivo study, most capsules disintegrated in the caecum/colon region, and the (67)Ga-activated charcoal mixed very well with bowel content. In addition, the radioactive charcoal could be detected clearly on the 72-h image, which is very important for the evaluation of colonic transit time in patients with constipation. In conclusion, activated charcoal labelled with (67)Ga citrate is a potential radioactive marker for colonic transit study.