Does the presence of high levels of free Sn2+ in PYP kit causes in vivo red blood cell radiolabeling and high blood pool radioactivity?

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, School of Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Nuclear Medicine, School of Medicine, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

3 Department of Molecular Imaging, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Technetium-99m-pyrophosphate scintigraphy (TPS) is a highly effective method for diagnosing transthyretin cardiac amyloidosis (ATTR-CA). It may eliminate the need for endomyocardial biopsy. However, the detection of radioactivity in the blood pool (BP) during these scans can make it difficult to interpret planar images. This often leads to the necessity for longer and repeated scanning sessions.
Methods: We conducted a prospective study involving unique patients who underwent TPS. The initial group of 58 patients used a pyrophosphate (PYP) kit labeled with 30 mCi (PYP-30) of radioactivity, while the subsequent group had a kit labeled with 90 mCi (PYP-90), although the administrated dose remained constant. This study aimed to assess how varying radioactivity levels in the kits affected BP activity visualization.
Results: Univariable analysis showed creatinine level of the patients and added radioactivity amount in the PYP kits affected BP activity (p<0.05), while gender, age, and BMI did not (p>0.05). Multivariable analysis confirmed creatinine (OR<0.001) and added radioactivity (OR=0.005) significantly influenced BP visualization. Patients with creatinine<1.5 showed a significant difference in BP activity between two groups (PYP-30 and PYP-90), but those with creatinine ≥1.5 did not.
Conclusion: These findings emphasize the significance of considering the levels of radioactivity in PYP kits, which may be linked to the concentration of free Sn²⁺ in the prepared kit, as well as the patient’s kidney function. These factors are essential for optimizing imaging quality and improving diagnostic accuracy in cases of cardiac amyloidosis.

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Main Subjects

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