Explorations cardiologiques nucléaires dans la cardiomyopathie de Takotsubo

Transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy (TTC) was described for the first time in Japan in the earliest nineties. It represents 1 to 2 % of acute cardiac events and mimics closely acute myocardial infarction. The aim of this study was to investigate ^99mTc-tetrofosmine or ²⁰¹Thallium myocardial Single Photon Emission Computed Tomography (SPECT), ¹²³I-metaIodoBenzylGuanidine (¹²³I-mIBG) myocardial SPECT and myocardial Positron Emission Tomography using ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) in patients with TTC, assessing respectively left ventricular perfusion, innervation and metabolism. We studied four patients (three females) with TTC. We performed two weeks after acute phase (subacute phase) myocardial perfusion SPECT and ¹²³I-mIBG myocardial SPECT for each patient. Two of them underwent myocardial PET with FDG. Then, we assessed left ventricular innervation and metabolism three months (chronic phase I) and more than six months (chronic phase II) after the acute phase. We compared the discrepancies between radionuclides uptake in the left ventricular apical region during a follow-up period of more than six months. In subacute phase, perfusion SPECT was normal for each patient. Conversely, ¹²³I-mIBG SPECT and FDG-PET showed concordant apical uptake defect. This perfusion-metabolism pattern called “inverse flow-metabolism mismatch” is the metabolic state of stunned myocardium. After three months, we found improvement of apical tracer uptake in both FDG-PET and ¹²³I-mIBG SPECT. These findings suggest that TTC is characterized by myocardial apical stunning which is related to a disturbance of cardiac sympathetic innervation. ¹²³I-mIBG SPECT might be useful to diagnose earlier this pathology and to rule out acute myocardial infarction.     

Recent developments in 99mTc and 123I-radiopharmaceuticals for SPECT imaging

Availability of ¹²³I of high radionuclidic purity has encouraged the development of ¹²³I-based radiopharmaceuticals for the assessment of myocardial fatty acid metabolism, myocardial neuronal activity, and for receptor and antibody imaging. Advances in the chemistry of technetium have resulted in the development of novel agents for myocardial and cerebral perfusion and renal function studies. Monoclonal antibodies labeled with ^99mTc show promise for imaging neoplastic lesions, myocardial infarcts, and thrombus localization. Recent developments in ¹²³I and ^99mTc agents for myocardial and brain imaging studies are discussed.     

Impact d’une réduction d’activité sur la mesure de la fraction d’éjection du ventricule gauche sur caméra D-SPECT

IntroductionRadionuclide ventriculography provides a reproducible measurement of the left ventricular fraction ejection (LVEF) but with a significant body radiation (effective dose of 5,9 mSv for the injection of 850 Mbq of ^99mTc). The highly sensitive semi-conductor (CZT) cameras could allow decreasing the injected activity by a factor 3, similarly to that of myocardial perfusion imaging. Our study was aimed to determine whether the LVEF measurement provided by radionuclide ventriculography on the CZT D-SPECT camera is impacted by a 70% reduction in recorded counts.Materials and methodsAfter the in vivo labeling of red blood cells with 850 MBq of ^99mTc, 49 patients completed a conventional 2D recording (Conv-2D) on Anger camera followed by a 3D recording on the D-SPECT camera (3D-100%). The CZT recordings of all projections were subsequently shortened to 30% of their initial durations (3D-30%) in order to assess the LVEF measured with a 70% reduction in recorded counts.ResultsMean LVEF values were 62.7 ± 11.1% on Conv-2D and higher on both 3D-100% (66.8 ± 14.8%, P < 0.001) and 3D-30% (66.3 ± 15.7%, P < 0.001). The correlation coefficients with the LVEF determined with the reference Conv-2D method were equivalents for 3D-100% (r² = 0.73) and 3D-30% (r² = 0.70) and with a similar level of overestimation for the highest LEVF values.ConclusionA 70% reduction in recorded counts does not significantly impact the LVEF measured with radionuclide ventriculography on the CZT D-SPECT camera. These values are coherent with those obtained with the reference 2D method but with a clear overestimation for the highest LVEF values.     

Évaluation de la cinétique globale et segmentaire du ventricule gauche chez les patients connus ou suspects de cardiopathie ischémique : comparaison des données apportées en scintigraphie de perfusion myocardique et en tomoventriculographie isotopique

Background and aimsThe analysis of the left ventricular contractile function plays a major role in the diagnosis and management of patients with cardiopathies. The aim of our study was to compare gated blood pool SPECT and myocardial perfusion scintigraphy for the assessment of the left ventricular wall contractility at the global and the segmental scales.Material and methodsThe data of 23 ^99mTc-Tetrofosmin perfusion scintigraphies, and 50 ²⁰¹Thallium perfusion scintigraphies were compared to those of gated blood pool SPECT performed at close interval.ResultsThe correlations were good (r = 0.81 to 0.94) concerning the global parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes) in the two groups. Quite good correlations were also found at the segmental scale (r = 0.49 to 0.62), between the segmental ejection fraction calculated in gated blood pool SPECT and the wall thickening or the wall motion estimated in perfusion scintigraphy. These correlations were significantly lower in the “²⁰¹Thallium perfusion scintigraphy” group than in the “^99mTc-Tetrofosmin perfusion scintigraphy” group, especially for hypokinetic segments.ConclusionAlthough they use very different approaches, GBPS and MPS give data about global and segmental left ventricular wall contraction that are well correlated, but not strictly interchangeable.     

Sensitivity and Specificity of Dual-Isotope 99mTc-Tetrofosmin and 123I Sodium Iodide Single Photon Emission Computed Tomography (SPECT) in Hyperparathyroidism

Purpose

Despite recommendations for ^99mTc-tetrofosmin dual tracer imaging for hyperparathyroidism in current guidelines, no report was published on dual-isotope ^99mTc-tetrofosmin and ¹²³I sodium iodide single-photon-emission-computed-tomography (SPECT). We evaluated diagnostic accuracy and the impact of preoperative SPECT on the surgical procedures and disease outcomes.

Methods

Analysis of 70 consecutive patients with primary hyperparathyroidism and 20 consecutive patients with tertiary hyperparathyroidism. Imaging findings were correlated with surgical results. Concomitant thyroid disease, pre- and postoperative laboratory measurements, histopathological results, type and duration of surgery were assessed.

Results

In primary hyperparathyroidism, SPECT had a sensitivity of 80% and a positive predictive value of 93% in patient-based analysis. Specificity was 99% in lesion-based analysis. Patients with positive SPECT elicit higher levels of parathyroid hormone and higher weight of resected parathyroids than SPECT-negative patients. Duration of parathyroid surgery was on average, approximately 40 minutes shorter in SPECT-positive than in SPECT-negative patients (89±46 vs. 129±41 minutes, p=0.006); 86% of SPECT-positive and 50% of SPECT-negative patients had minimal invasive surgery (p = 0.021). SPECT had lower sensitivity (60%) in patients with tertiary hyperparathyroidism; however, 90% of these patients had multiple lesions and all of these patients had bilateral lesions.

Conclusion

Dual-isotope SPECT with ^99mTc-tetrofosmin and ¹²³I sodium iodide has a high diagnostic value in patients with primary hyperparathyroidism and allows for saving of operation time. Higher levels of parathyroid hormone and higher glandular weight facilitated detection of parathyroid lesion. Diagnostic accuracy of preoperative imaging was lower in patients with tertiary hyperparathyroidism.     

Technetium-99m monoclonal antibody fragment (FAb) scintigraphy in the evaluation of small cell lung cancer: a preliminary report

Small cell lung cancer (SCC) has the most rapid growth rate of the four cell types and metastasizes early. Present imaging modalities for staging include chest x-ray, CT, MRI and bone scans. In this preliminary study, we assessed the clinical role of ^99mTc-monoclonal antibody (MOAB) scintigraphy in five patients with histologically proven SCC. Each patient was infused with 20–30 mCi of ^99mTc labeled Fab fragment of MOAB (NR-LU-10, NeoRx, Seattle, Wash.). Total body simultaneous anterior and posterior images were obtained 14–16 h post injection. SPECT images of the chest were obtained through a 360 ° rotation of the gamma camera and recorded on a 62 × 64 × 16 matrix. Images (1.2cm thick) were generated in transaxial, sagittal and coronal views.Fourteen of fifteen chest lesions detected by CT were confirmed by ^99mTc MOAB scintigraphy. Scintigraphy detected one additional chest lesion not seen by CT. Scintigraphy failed to detect a brain lesion (2 cm), a chest lesion, and two adrenal lesions, all of which were seen by CT. In one patient with multiple (more than 10) lesions in the liver, both scintigraphy and CT detected all lesions. Three spine lesions seen on ^99mTc MDP scan and positive for metastasis on MRI concentrated ^99mTc MOAB, but two rib lesions seen on ^99mTc MDP bone scan did not concentrate ^99mTc MOAB. It is concluded from these preliminary results that the potential usefulness of ^99mTc MOAB scintigraphy as a complementary imaging modality in the staging of small cell lung cancer should be investigated further.     

Comparison of 90Y SIRT predicted and delivered absorbed doses using a PSF conversion method

PurposeThe aims of this study were to develop and apply a method to correct for the differences in partial volume effects of pre-therapy Technetium-99 m (^99mTc)-MAA SPECT and post-therapy Yttrium-90 (⁹⁰Y) bremsstrahlung SPECT imaging in selective internal radiation therapy, and to use this method to improve quantitative comparison of predicted and delivered ⁹⁰Y absorbed doses.MethodsThe spatial resolution of ^99mTc SPECT data was converted to that of ⁹⁰Y SPECT data using a function calculated from ^99mTc and ⁹⁰Y point spread functions. This resolution conversion method (RCM) was first applied to ^99mTc and ⁹⁰Y SPECT phantom data to validate the method, and then to clinical data to assess the power of ^99mTc SPECT imaging to predict the therapeutic absorbed dose.ResultsThe maximum difference between absorbed doses to phantom spheres was 178%. This was reduced to 27% after the RCM was applied.The clinical data demonstrated differences within 38% for mean absorbed doses delivered to the normal liver, which were reduced to 20% after application of the RCM. Analysis of clinical data showed that therapeutic absorbed doses delivered to tumours greater than 100 cm³ were predicted to within 52%, although there were differences of up to 210% for smaller tumours, even after the RCM was applied.ConclusionsThe RCM was successfully verified using phantom data. Analysis of the clinical data established that the ^99mTc pre-therapy imaging was predictive of the ⁹⁰Y absorbed dose to the normal liver to within 20%, but had poor predictability for tumours smaller than 100 cm³.     

Synthesis and biodistribution of a new class of 99mTc-labeled fatty acid analogs for myocardial imaging

A series of ^99mTc-bis(aminoethanethiol)-fatty acid (^99mTc-BAT-fatty acid) analogs were synthesized and evaluated as potential tracers of myocardial metabolism. The BAT-fatty acid precursors were prepared using a new synthetic route that avoids the use of strong reducing agents such as lithium aluminum hydride. Biodistribution studies of the no-carrier-added ^99mTc-complexes were conducted in rats using [¹²⁵I]IPPA as an internal standard. The myocardial uptake of the ^99mTc-BAT-fatty acid analogs was significantly less than that of [¹²⁵I]IPPA and indicates the ^99mTc analogs are not suitable candidates for SPECT-based myocardial imaging studies.     

3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates

BackgroundTo improve therapy outcome of Yttrium-90 selective internal radiation therapy (⁹⁰Y SIRT), patient-specific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using Technetium-99m (^99mTc) MAA SPECT/CT, Yttrium-90 (⁹⁰Y) bremsstrahlung (BRS) SPECT/CT, and ⁹⁰Y PET/CT.MethodsTen SIRTs of nine patients with unresectable hepatocellular carcinoma (HCC) were investigated. The ^99mTc SPECT/CT data, obtained from ^99mTc-MAA-based treatment simulation prior to ⁹⁰Y SIRT, were scaled with the administered ⁹⁰Y therapy activity. 3D absorbed dose images were generated by dose kernel convolution with scaled ^99mTc/⁹⁰Y SPECT/CT, ⁹⁰Y BRS SPECT/CT, and ⁹⁰Y PET/CT data of each patient. Absorbed dose estimates in tumor and healthy liver tissue obtained using the two SPECT/CT methods were compared against ⁹⁰Y PET/CT.ResultsThe percentage deviation of tumor absorbed dose estimates from ⁹⁰Y PET/CT values was on average −2 ± 18% for scaled ^99mTc/⁹⁰Y SPECT/CT, whereas estimates from ⁹⁰Y BRS SPECT/CT differed on average by −50 ± 13%. For healthy liver absorbed dose estimates, all three imaging methods revealed comparable values.ConclusionThe quantification capabilities of the imaging data influence ⁹⁰Y SIRT tumor dosimetry, while healthy liver absorbed dose values were comparable for all investigated imaging data. When no ⁹⁰Y PET/CT image data are available, the proposed scaled ^99mTc/⁹⁰Y SPECT/CT dosimetry method was found to be more appropriate for HCC tumor dosimetry than ⁹⁰Y BRS SPECT/CT based dosimetry.     

Imagerie scintigraphique de la démence : technique d’acquisition

Scintigraphic imaging of dementia relies today essentially on the study of brain Single Photo Emission Computed Tomography (SPECT) perfusion, after intravenous injection of ^99mTc radiopharmaceutic. This paper is based on the guidelines published in October 2001 by the European Association of Nuclear Medicine (http://eanm.org/).     

Évaluation de la perfusion et de la fonction contractile du myocarde à l’aide de l’analyse de Karhunen-Loeve en tomographie d’émission monophotonique myocardique synchronisée à l’ECG

GoalWe evaluated the diagnostic performance of the Karhunen–Loeve transform applied to myocardial gated SPECT. The previous studies showed that KLT images characterize myocardial perfusion (KL0) and contractile function (KL1).Method and material99mTc-gSPECT studies were performed in 101 patients (121 acquisitions) with suspected or known coronary artery disease. The images were evaluated using a five-point scoring system dividing the left ventricle into 11 segments. We compared the scores obtained by this semi-quantitative visual analysis of gSPECT and KLT images.Results and discussionThe agreement for perfusion and thickening scores was 94 and 95% respectively. Quantitative evaluation of KL0 and KL1 images by univariate and multivariate analysis was performed in the left ventricular ROI. Discriminant analysis characterized the acquisitions as normal or pathologic with a sensitivity of 95% and a specificity of 96% and positive and negative predictive values of 96 and 95%. These selection criteria were tested prospectively in 52 patients with similar results. KLT generates a synthesis of left ventricular perfusion and kinetics. It facilitates discrimination between normal and pathological acquisitions with high predictive values.     

Synthesis and characterization of 123I-CMICE-013: A potential SPECT myocardial perfusion imaging agent

Coronary artery disease (CAD) is a major cause of death in Canada and the United States. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a useful diagnostic test in the management of patients with CAD. The widely used SPECT MPI agents, ^99mTc sestamibi and ^99mTc tetrofosmin, exhibit less than ideal pharmacokinetic properties with decreasing uptake with higher flows. ¹²³I has a similar energy as ^99mTc, an ideal half life, and is readily available from cyclotrons. The objective of this study was to develop an ¹²³I labeled MPI agent based on rotenone, a mitochondrial complex I inhibitor, as an alternative to currently available SPECT MPI agents. Methods: ¹²³I-CMICE-013 was synthesized by radiolabeling rotenone with ¹²³I in trifluoroacetic acid (TFA) with iodogen as the oxidizing agent at 60 °C for 45 min, followed by RP-HPLC purification. The product was formulated in 5% EtOH in 10 mM NaOAc pH 6.5. The inactive analog ¹²⁷I-CMICE-013 was isolated and characterized by NMR and mass spectrometry, and the structure determined. Micro-SPECT imaging studies were carried out in normal and infarcted rats. Biodistribution studies were performed in normal rats at 2 h (n = 6) and 24 h (n = 8) post injection (p.i.). Results: ¹²³I-CMICE-013 was isolated with >95% radiochemical purity and high specific activity (14.8–111 GBq/μmol; 400–3000 mCi/μmol). Structural analysis showed that rotenone was iodinated at 7′-position, with removal of the 6′,7′-double bond, and addition of a hydroxy group at 6′-position. MicroSPECT images in normal rats demonstrated homogeneous and sustained myocardial uptake with minimal interference from lung and liver. Absent myocardial perfusion was clearly identified in rats with permanent left coronary artery ligation and ischemia-reperfusion injury. In vivo biodistribution studies in normal rats at 2 h p.i. showed significant myocardial uptake (2.01 ± 0.48%ID/g) and high heart to liver (2.98 ± 0.93), heart to lung (4.11 ± 1.04) and heart to blood (8.37 ± 3.97) ratios. At 24 h p.i., the majority of ¹²³I-CMICE-013 was cleared from tissues, and a significant amount of tracer was found in the thyroid, indicating in vivo deiodination of the tracer. Conclusion: ¹²³I-CMICE-013 is a promising new radiotracer for SPECT MPI with high myocardial uptake, very good target to background ratios and favorable biodistribution characteristics.     

Lung scintigraphy with [123I]IMP in patients with pulmonary tuberculosis

Lung scintigraphy using N-isopropyl-p-[¹²³I]iodoamphetamine (IMP) was performed on 26 patients with pulmonary tuberculosis. Early (5 min after injection) and late images (4 h after injection) were obtained with a large-field γ-camera equipped with a digital computer. Lung scintigraphy using [^99mTc]MAA (MAA) was also done. Although early IMP images showed the same findings as [^99mTc]MAA images, a discrepancy between delayed IMP images and [^99mTc]MAA images was seen in some patients. Increment of activities seen in late images was demonstrated in most patients whose chest x-ray findings included exudative inflammatory changes. Uptake and clearance of IMP was considered to be affected by the active phase of pulmonary tuberculosis.     

Development of 99mTc-labeled asymmetric urea derivatives that target prostate-specific membrane antigen for single-photon emission computed tomography imaging

Prostate-specific membrane antigen (PSMA) is expressed strongly in prostate cancers and is, therefore, an attractive diagnostic and radioimmunotherapeutic target. In contrast to previous reports of PMSA-targeting ^99mTc-tricarbonyl complexes that are cationic or lack a charge, no anionic ^99mTc-tricarbonyl complexes have been reported. Notably, the hydrophilicity conferred by both cationic and anionic charges leads to rapid hepatobiliary clearance, whereas an anionic charge might better enhance renal clearance relative to a cationic charge. Therefore, an improvement in rapid clearance would be expected with either cationic or anionic charges, particularly anionic charges. In this study, we designed and synthesized a novel anionic ^99mTc-tricarbonyl complex ([^99mTc]TMCE) and evaluated its use as a single-photon emission computed tomography (SPECT) imaging probe for PSMA detection. Direct synthesis of [^99mTc]TMCE from dimethyl iminodiacetate, which contains both the asymmetric urea and succinimidyl moiety important for PSMA binding, was performed using our microwave-assisted one-pot procedure. The chelate formation was successfully achieved even though the precursor included a complicated bioactive moiety. The radiochemical yield of [^99mTc]TMCE was 12–17%, with a radiochemical purity greater than 98% after HPLC purification. [^99mTc]TMCE showed high affinity in vitro, with high accumulation in LNCaP tumors and low hepatic retention in biodistribution and SPECT/CT studies. These findings warrant further evaluation of [^99mTc]TMCE as an imaging agent and support the benefit of this strategy for the design of other PSMA imaging probes.     

The chemistry of rhenium and technetium as related to the use of isotopes of these elements in therapeutic and diagnostic nuclear medicine

The β emitting isotopes ¹⁸⁶Re and ¹⁸⁸Re are logical choices on which to base therapeutic radiopharmaceuticals that might be expected to be analogous to diagnostic radiopharmaceuticals based on ^99mTc. However, the chemistry of rhenium is sufficiently different from that of technetium so that the development of Re radiopharmaceuticals often cannot be predicated on the known chemistry and biological behavior of ^99mTc radiopharmaceuticals. The relevant chemical differences involve the greater stability of the higher oxidation states of Re (and thus the greater tendency of reduced Re radiopharmaceuticals to undergo re-oxidation to perrhenate), and the greater substitution inertness of reduced Re complexes. These differences are illustrated (1) in the preparation and use of ¹⁸⁶Re (Sn)-HEDP and ^99mTc(Sn)-HEDP diphosphonate radiopharmaceuticals designed, respectively, for palliative therapy and diagnosis of metastatic cancer to bone, and (2) in the preparation and biodistribution of tr-[¹⁸⁶Re(DMPE)₂Cl₂]⁺ and [¹⁸⁶Re(DMPE)₃]⁺, analogs to the potential myocardial perfusion imaging agents tr-[^99mTc(DMPE)₂Cl₂]⁺ and [^99mTc(DMPE)₃]⁺. [HEDP = (1-hydroxyethylidene)diphosphonate; DMPE = 1,2-bis(dimethylphosphino)ethane].     

Dual-isotope measurement of lung water

Iodine-131-labeled iodo-antipyrine and ^99mTc-labeled erythrocytes were used to measure water content in lungs. These radioactive tracers were injected into 11 dogs with injured lungs. Blood samples were drawn and the animals sacrificed. The lungs were removed, weighed and homogenized. Samples of blood and lung homogenate were assayed for ¹³¹I and ^99mTc. Samples were also weighed before and after drying to a constant weight at 70–76 °C. Extravascular lung water was determined by the dual-isotope technique and again by gravimetric analysis. The average ratio of the results from the two different methods was 1.14 ± 0.20. The two methods were also compared by regression analysis and the correlation coefficient was 0.97 ± 0.09.     

Distributions of perfusion and lung water

We investigated the feasibility of using ¹²³I-iodoantipyrine (¹²³I-IAP) and ^99mTc-labeled macroaggregated albumin (^99mTc-MAA) to describe and compare the distributions of perfusion and water content in lung injuries. These radiopharmaceuticals were administered to 9 rabbits, 5 control and 4 with lung injuries. Isolated lungs were imaged by a scintillation γ camera. The distribution of ¹²³I-IAP outlined the entire lung mass whereas perfusion defect in the distribution of ^99mTc-MAA was seen clearly in the case of severe lung injury.     

A developmental analysis of differences in the uptake of [123I]isopropyliodoamphetamine versus99mTc-pertechnetate by the choroid plexus and brain

The uptake of intravascular [¹²³I]isopropyliodoamphetamine (IMP) and^99mTc-pertechnetate into choroid plexus (CP) and brain (frontal cortex) was studied by an indicator fractionation method applied to immature, ketamine-anesthetized Sprague-Dawley rats (1.5, 2, and 3 wk). Assessment of the rate and extent of uptake of these indicators provides functional information (eg blood flow; transport) about various regions of the developing CNS. IMP uptake by lateral ventricle CP was 1.15 ml/g/min in 1.5-wk-old infant rats and gradually increased to 3.9 ml/g/min by adulthod (7–8 wk) (P<0.05); over the same postnatal period,^99mTc uptake went from 2.82 to 3.18 ml/g/min. IMP uptake by cortex was 0.39 and 0.99 ml/g/min in infants and adults, respectively (P<0.05); however,^99mTc uptake by cortex was only 0.07±0.01 ml/g/min at all ages, reflecting early development of blood-brain barrier (BBB) to pertechnetate. Overall, our findings indicated a progressive increase with age in the rate of uptake of IMP by CP and brain; and that^99mTc penetration into CP was relatively constant and substantially greater than into cortex at all developmental stages. Thus the nature of uptake of IMP, relative to^99mTc, was markedy different at the blood-cerebrospinal fluid barrier (i.e., CP) vs. the blood-brain barrier.     

Synthesis of Tc-99m labeled glucosamino-Asp-cyclic(Arg-Gly-Asp-d-Phe-Lys) as a potential angiogenesis imaging agent

Angiogenesis imaging agents for single photon emission computed tomography (SPECT) play a role in diagnosing tumor-induced angiogenesis as well as tumor metastasis. We synthesized and evaluated radiolabeled RGD glycopeptides by incorporation of the [^99mTc(CO)₃(H₂O)₃]⁺. ^99mTc labeled glucosamino-D-c(RGDfK) ([^99mTc]2) was prepared in 90–93% radiochemical yields (decay corrected). In vitro cell binding assays demonstrated selective binding [^99mTc]2 to human umbilical vein endothelial (HUVE) cells, with inhibition of binding to 37.3% of control levels by 10 μM of cold authentic compounds. In addition, [^99mTc]2 was shown to have high binding affinity to purified α_vβ₃ integrin (IC₅₀ = 1.5 nM). These results suggest that these radiolabeled RGD glycopeptides may have value for non-invasive assessment of angiogenesis.     

A Generator-Produced Gallium-68 Radiopharmaceutical for PET Imaging of Myocardial Perfusion

Lipophilic cationic technetium-99m-complexes are widely used for myocardial perfusion imaging (MPI). However, inherent uncertainties in the supply chain of molybdenum-99, the parent isotope required for manufacturing ⁹⁹Mo/^99mTc generators, intensifies the need for discovery of novel MPI agents incorporating alternative radionuclides. Recently, germanium/gallium (Ge/Ga) generators capable of producing high quality ⁶⁸Ga, an isotope with excellent emission characteristics for clinical PET imaging, have emerged. Herein, we report a novel ⁶⁸Ga-complex identified through mechanism-based cell screening that holds promise as a generator-produced radiopharmaceutical for PET MPI.