The Distribution of Radioactive Microspheres After Intra-Arterial Injection in the Legs of Patients With Peripheral Vascular Disease

Ba, Rhodes; Nd, Greyson; Me, Siegel; Fa, Giargiana; Ri, White; Williams, Gail M.; Hn, Wagner

doi:10.2214/ajr.118.4.820

Cited by 23 publications

(7 citation statements)

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“…Two sequential emission scans were performed from 30 to 120 & from 120 to 210 seconds after the initial time of inhalation. The time course of radioactive concentration in the arterial blood was measured by sequential blood sampling (5,10,15,20,25,30,40,60,120,180,240, and 300 seconds after injection) from one brachial artery of the subject; each sampling procedure lasts five seconds, thus averaging the radioactive concentration during this interval. The tracer concentration in the blood samples at the time of withdrawal was evaluated by weighting and counting in a well-counter, with proper correction for radioactive decay.…”

Section: Methodsmentioning

confidence: 99%

The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers

Depairon

Zicot

1996

Angiology

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Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent claudication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected leg. In 5 patients, F and E were correlated with the results of occlusive venous strain gauge plethysmography and with the measurements of blood gases in one brachial artery and in the femoral vein of the affected limb. Blood flow values measured at rest and after exercise by PET were poorly correlated with the plethysmographic findings. This may be because PET does not interfere with flow as venous occlusion plethysmography does in low peripheral pressure conditions. The results show that F, R, and E were not significantly different in normal and pathologic legs at rest. The values of F and R were significantly higher in pathologic than in normal lower limbs, ten minutes after exercise, whereas E was not significantly altered by exercise at any side. This suggests that, during the recovery from a walk test, the delayed increase in oxygen uptake is proportional to the delayed hyperemia in the ischemic muscles ("oxygen debt") and probably not linked to a luxury perfusion.

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Section: Methodsmentioning

confidence: 99%

The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers

Depairon

Zicot

1996

Angiology

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“…Distribution of perfusion in the normal extremity, as pre viously noted from microsphere perfusion studies, is pri manly in proportion to muscle mass with a relative hypoper fusion of the nonmuscular structures of the knees and ankles [10] ( figs. 1 and 2).…”

Section: Resultsmentioning

confidence: 83%

Thallium-201 peripheral perfusion scans: feasibility of single-dose, single-day, rest and stress study

Me¹,

Ca²

1981

American Journal of Roentgenology

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“…The variation of image pattern is related to the involved artery and its perfusion, as well as the extraction ability of the corresponding tissues for a specific radiotracer. In fact, in radionuclide assessment of peripheral arterial diseases, intraarterial injection of 99m Tclabeled human serum albumin microspheres was used as a noninvasive method before exercise plus intravenous injection of 99m Tc-sestamibi had been established (15,16). …”

Section: Discussionmentioning

confidence: 99%

Inadvertent Intraarterial Injection of 18F-FDG: A Case Report and Literature Review of Hot Forearm and Hot Hand Signs

Zhu

Doss²,

Tan³

et al. 2011

Journal of Nuclear Medicine Technology

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Unintentional intraarterial injection of radiotracers may cause artifacts leading to difficulties in accurately interpreting PET/CT images. We report a case of a 73-y-old man with a history of metastatic colon cancer who underwent a PET/CT scan for restaging. In the PET scan, there was intense and diffuse distribution of 18 F-FDG in his left forearm and hand. This is a classic sign of an accidental intraarterial injection of 18 F-FDG in the antecubital region. Similar phenomena after inadvertent intraarterial injection of other radiotracers are reviewed. The associated risk factors, preventive measures, and radiation dose to the arm are discussed. Uni ntentional intraarterial injection of radiotracers, including 99m Tc-methylene diphosphonate, 99m Tc-sestamibi, and 201 Tl-chloride, may cause artifacts leading to difficulties in accurately interpreting these functional images (1-7). Under these conditions, the images usually show intense uptake in the extremity distal to the injection site, in a pattern previously described as a hot forearm, a hot hand, or a glove phenomenon. Here, we present a patient with a similar phenomenon in his left forearm and hand on a PET/CT scan after an inadvertent intraarterial injection of 18 F-FDG. CASE REPORTA 73-y-old man was diagnosed with stage IV adenocarcinoma of the cecum, with liver metastasis, one and a half years previously. He underwent a right hemicolectomy and partial hepatectomy. He then received multiple rounds of chemotherapy, including folinic acid, fluorouracil, and oxaliplatin, plus bevacizumab, capecitabine, irinotecan, and cetuximab. After his most recent round of therapy, he was referred for a restaging PET/CT scan.When performing the intravenous injection of 18 F-FDG, the technologist encountered difficulty obtaining intravenous access, possibly because of the multiple courses of chemotherapy and antiangiogenesis therapy. Once access was obtained, 535 MBq (14.46 mCi) of 18 F-FDG were injected into the patient's left antecubital access. Approximately 120 min later, a PET/CT scan was obtained from mid thigh to skull base with a Discovery LS PET/CT system (GE Healthcare).On the PET/CT images, multiple focal lesions were found in the mesentery, liver, and both lungs, with standardized uptake values (SUVs) ranging from 2.2 to 6.9, indicating possible metastasis of colon cancer. There were also 2 tumors with SUVs of 3.0 and 7.5 at his left tonsil and left upper neck, respectively, which were later diagnosed to be a second primary squamous cell carcinoma of the tonsil with spread to the regional lymph nodes. Moreover, his whole left forearm, left hand, and fingers showed intense and diffuse 18 F-FDG uptake consistent with the blood distribution of a brachial artery (Fig. 1), with a maximum SUV of 8.8. The maximum SUV of the contralateral forearm and hand was approximately 1.1. There was no special finding in this region in either the previous PET/CT scan 3 mo earlier or a followup PET/CT study 3 mo later. Our inference is that the radiotracer was inadvertently injec...

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The Distribution of Radioactive Microspheres After Intra-Arterial Injection in the Legs of Patients With Peripheral Vascular Disease

Cited by 23 publications

References 0 publications

The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers

The Quantitation of Blood Flow/Metabolism Coupling at Rest and After Exercise in Peripheral Arterial Insufficiency, Using PET and 15-0 Labeled Tracers

Thallium-201 peripheral perfusion scans: feasibility of single-dose, single-day, rest and stress study

Inadvertent Intraarterial Injection of 18F-FDG: A Case Report and Literature Review of Hot Forearm and Hot Hand Signs

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