Abnormal Biological Distribution Related to Normal Saline Among Technetium-99m dimercaptosuccinic acid (99mTc-DMSA) Scans

Abstract

Aim: The primary aim is to describe the incidence and causes of abnormal distribution of ^99mTc-DMSA among patients who underwent renal scans in Royal Hospital (Oman), in 2020. The secondary aim is to assess the effect of a specific batch of normal saline A (batch NO 132129) compared to another normal saline B (batches NO 132589 and NO 133325) used in the preparation of ^99mTc-DMSA on the abnormal biodistribution of ^99mTc-DMSA. Methods: An ambidirectional cohort study that included all patients who underwent DMSA renal scan between January and December 2020. Both prospective and retrospective data collection were utilized. Collected data included possible causes of abnormal biodistribution, quality of ^99mTc-DMSA and normal saline, and time of ^99mTc-DMSA injection. Data analysis was conducted by SPSS-25. Results: The total incidence of abnormal biodistribution was 26.5% with the most common cause being high creatinine (29%). Normal saline batch A, used in the preparation, was found to be significantly associated with abnormal biodistribution (49.7%) compared to batch B (6.6%) (p-< 0.001). This association was more prominent among patients injected after two hours with ^99mTc-DMSA preparation (83.0%) compared to within two hours (13.3%). Conclusion: High incidence of abnormal biodistribution of ^99mTc-DMSA was detected and for the first time in the literature, a specific preservative-free, normal saline that is up to standard, has been identified as a significant cause of abnormal biodistribution. Therefore, it should be listed by nuclear medicine professionals and pharmaceutical companies as a possible cause for abnormal ^99mTc-DMSA biodistribution.