Abnormal Biologic Distribution Related to Normal Saline Among 99mTc-Dimercaptosuccinic Acid Scans

J Nucl Med Technol. 2023 Mar;51(1):38-43. doi: 10.2967/jnmt.122.264241. Epub 2022 Oct 4.

Abstract

The primary aim was to describe the incidence and causes of abnormal distribution of 99mTc-dimercaptosuccinic acid (99mTc-DMSA) among patients who underwent renal scans in Royal Hospital (Oman) in 2020. The secondary aim was to assess the effect of a specific batch of normal saline A (batch 132129) compared with another normal saline, B (batches 132589 and 133325), used in the preparation of 99mTc-DMSA on the abnormal biodistribution of 99mTc-DMSA. Methods: This was an ambidirectional cohort study that included all patients who underwent 99mTc-DMSA renal scanning between January and December 2020. Both prospective and retrospective data collection was used. The collected data included possible causes of abnormal biodistribution, quality of 99mTc-DMSA and normal saline, and time of 99mTc-DMSA injection. Results: The total incidence of abnormal biodistribution was 26.5%, with the most common cause being a high creatinine level (29%). Normal saline batch A was significantly associated with abnormal biodistribution (49.7%), compared with batch B (6.6%) (P < 0.001). This association was more prominent among patients injected with the 99mTc-DMSA preparation after 2 h (83.0%) compared with before 2 h (13.3%). Conclusion: A high incidence of abnormal biodistribution of 99mTc-DMSA was detected and-for what is the first time, to our knowledge, in the literature-a specific preservative-free, normal saline that is up to standard has been identified as a significant cause of abnormal biodistribution. Nuclear medicine professionals and pharmaceutical companies should take note of this possible cause of abnormal 99mTc-DMSA biodistribution.

Keywords: 99mTc-DMSA; biodistribution; liver uptake; normal saline; renal scintigraphy.

MeSH terms

  • Biological Products*
  • Cohort Studies
  • Humans
  • Kidney
  • Prospective Studies
  • Radiopharmaceuticals
  • Retrospective Studies
  • Saline Solution
  • Technetium Tc 99m Dimercaptosuccinic Acid*
  • Tissue Distribution

Substances

  • Technetium Tc 99m Dimercaptosuccinic Acid
  • Saline Solution
  • Biological Products
  • Radiopharmaceuticals