Increasing the accuracy of lung perfusion scintigraphy in children with bidirectional Glenn circulation

• Published in: Pediatric radiology 2010-12, Vol.40 (12), p.1890-1894
• Main Authors: Fukuda, Yutaka, Momoi, Nobuo, Mitomo, Masaki, Aoyagi, Yoshimichi, Endo, Kisei, Matsumoto, Ayumi, Hosoya, Mitsuaki
• Format: Article
• Language: English
• Subjects: Accuracy; Algorithms; Child, Preschool; Children & youth; Female; Humans; Hypertension; Image Enhancement - methods; Imaging; Infant; Injections, Intravenous; Lung - diagnostic imaging; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Perfusion Imaging - methods; Pulmonary arteries; Pulmonary Valve Stenosis - complications; Pulmonary Valve Stenosis - diagnostic imaging; Pulmonary Valve Stenosis - surgery; Radiology; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sheep; Technetium Tc 99m Aggregated Albumin; Tricuspid Atresia - complications; Tricuspid Atresia - diagnostic imaging; Tricuspid Atresia - surgery; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-010-1710-y

Background In children who have undergone a bidirectional Glenn procedure without antegrade or additional pulmonary blood flow, we have often noted a discrepancy between apparent lung perfusion on scintigraphy and superior vena cava angiography when evaluating right and left pulmonary blood flow. We found a tendency for radionuclide, tracer 99mTc-MAA, when administered through a single upper extremity vein, to preferentially accumulate in the ipsilateral lung. Objective In the present study, we examined whether the ratio of right-to-left pulmonary flow varied when 99mTc-MAA was administered via either the right upper or the left upper extremity vein. Materials and methods We studied six children (median age 1.3 ± 0.23 years) who underwent a bidirectional Glenn before total cavopulmonary connection. Five children who underwent biventricular repair served as a control. Perfusion scintigraphy using 99mTc-labeled macroaggregated albumin (99mTc-MAA) was performed in all children. First, we injected radionuclide via the right upper extremity and calculated the pulmonary accumulation in both lungs (R-image). Second, we injected the same dose of radionuclide via the left upper extremity and calculated the pulmonary accumulation (B-image), which represented the resulting administration via both upper extremities. The lung accumulation that resulted from radionuclide administration via the left upper extremity (L-image) was determined by subtracting the R-image from the B-image. We evaluated the right-to-total pulmonary blood flow ratio (radionuclide accumulation in right lung / radionuclide accumulation in both lungs) in the R-, L- and B-images. Results The right-to-total pulmonary blood flow ratios in the R-, L- and B-images were 815 ± 15.3%, 39.8 ± 11.7% and 61.3 ± 11.8%, respectively, and there were significant differences among the three images ( P