title: 99Tcm-citrate: a new bone imaging radiopharmaceutical.
abstract: 99Tcm-citrate has been shown to incorporate irreversibly in the skeleton with a biodistribution different to that on a conventional bone scan. The aims of this study were to confirm the bone-imaging properties of 99Tcm-citrate, to identify the variabilities influencing its skeletal uptake, to compare its uptake in bone with that of 99Tcm-MDP and to assess its possible role in bone scintigraphy. Appropriate animal and human studies (n = 45) were conducted. The 3 h lesion-to-bone ratio of 99Tcm-citrate was compared with that of 99Tcm-MDP in more than 150 lesions, including osteoblastic sites (Group A), lesions undergoing treatment or healing (Group B), and degenerative or old healed lesions (Group C). The uptake ratio was classified as concordant (< 20% variation), mildly discordant (20-50% variation) or significantly discordant (> 50% variation). Animal experiments showed most bone uptake of 99Tcm-citrate when prepared at a pH of 6.0-6.5. The two radiopharmaceuticals appeared to compete for bone uptake, suggesting related but different sites of bone accumulation. The 99Tcm-citrate/99Tcm-MDP uptake ratio in Group A was concordant (mean +/- S.D. = 0.92 +/- 0.15), while Group C lesions had a significantly lower 99Tcm-citrate/99Tcm-MDP uptake ratio (0.34 +/- 0.24, P < 0.01). A comparison of Group B lesions showed wide variation in intensity and area of involvement in many lesions (uptake ratio < 0.5 or > 1.5 in 13 of 30 sites). We conclude that 99Tcm-citrate has a different site of bone localization than phosphonates, possibly in the organic matrix. Although its skeletal uptake is lower than that of 99Tcm-MDP, it may have better specificity in differentiating osteoblastic from degenerated or healed bony lesions, and therefore be useful in predicting healing of bone secondaries, fractures or osteomyelitic lesions.
authors.affiliation: Institute of Nuclear Medicine and Allied Sciences, Delhi, India. aseem@drinma.ren.nic.in
authors.forename: A
authors.initials: A
authors.lastname: Bhatnagar
authors.forename: P
authors.initials: P
authors.lastname: Mishra
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.forename: K
authors.initials: K
authors.lastname: Chuttani
authors.forename: K
authors.initials: K
authors.lastname: Chakravarty
authors.forename: C M
authors.initials: CM
authors.lastname: Jain
authors.forename: A
authors.initials: A
authors.lastname: Mondal
authors.forename: M K
authors.initials: MK
authors.lastname: Chopra
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000000981:diagnostic imaging; D001859:Bone Neoplasms / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000378:metabolism; D002951:Citrates / Q000009:adverse effects / Q000493:pharmacokinetics; D004355:Drug Stability; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D015609:Organotechnetium Compounds / Q000009:adverse effects / Q000493:pharmacokinetics; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000493:pharmacokinetics; D017556:Technetium Compounds; D013669:Technetium Tc 99m Medronate; D017971:Tin Compounds; D014018:Tissue Distribution
chemical_list: D002951:Citrates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; C030490:technetium Tc 99m citrate; D013669:Technetium Tc 99m Medronate