Altered biodistribution of radiopharmaceuticals: role of radiochemical/pharmaceutical purity, physiological, and pharmacologic factors

One of the most common problems associated with radiopharmaceuticals is an unanticipated or altered biodistribution, which can have a significant clinical impact on safety, scan interpretation, and diagnostic imaging accuracy. In their most extreme manifestations, unanticipated imaging results may even compromise the utility and or accuracy of nuclear medicine studies. We present here an overall summary of altered biodistribution of radiopharmaceuticals with a special emphasis on the molecular mechanisms involved. Important factors affecting the biodistribution of radiopharmaceuticals can be described in 5 major categories and include (1) radiopharmaceutical preparation and formulation problems; (2) problems caused by radiopharmaceutical administration techniques and procedures; (3) by changes in biochemical and pathophysiology; (4) previous medical procedures, such as surgery, radiation therapy and dialysis; and finally (5) by drug interactions. The altered biodistribution of (99m)Tc radiopharmaceuticals are generally associated with increased amounts of (99m)Tc radiochemical impurities, such as free (99m)TcO(4)(-) and particulate impurities, such as (99m)Tc colloids or (99m)Tc-reduced hydrolyzed species. Faulty injection, such as dose infiltration or contamination with antiseptics and aluminum during dose administration, may cause significant artifacts. The patient's own medical problems, such as abnormalities in the regulation of hormone levels; failure in the function of excretory organs and systems, such as hepatobiliary and genitourinary systems; and even simple conditions, such as excessive talking may contribute to altered biodistribution of radiopharmaceuticals. Previous medical procedures (chemotherapy, radiation therapy, dialysis) and drug interaction are the some of the nontechnical factors responsible for unanticipated biodistribution of radiotracers. This review provides a comprehensive summary of various factors and specific examples to illustrate the significance of altered biodistribution of radiopharmaceuticals.