Abstract
Radionuclide assessment of pulmonary capillary protein leak using [99mTc] human serum albumin (99mTc-HSA) was first reported from our laboratory. In this study we investigated the impact of 1) sampling time post tracer injection, and 2) lung region assignment, on diagnostic accuracy between 2 groups (controln=20 and ARDSn=20). Each patient received 370 MBq99mTc-HSA i.v. and was imaged for 45 min. The slope index (SI) [change in lung: heart activity ratio/min] was calculated from 11 computer assigned lung regions for intervals of 5–15 (early [E]) and 15–45 (late [L]) min. The diagnostic accuracy of E vs L SI calculations for the 11 regions was evaluated by stepwise logistic regression. E SI data and L SI data from the lower 1/3 of the lung did not achieve significance for inclusion in the discriminant model (P<0.05). In the nine remaining regions L SI was significant. Optimal discrimination was achieved from L SI data obtained from a region confined to the lateral half of the mid 3rd of the lung field (sensitivity 81%, specificity 85%, accuracy 83%). The results confirm that: 1) a late (15–45 min) sampling period and 2) proper region assignment are necessary to maximize accuracy of this technique.
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References
Anderson RR, Holliday RL, Driedger AA, Lefcoe M, Reid B, Sibbald WJ (1979) Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome accompanying human sepsis. Am Rev Resp Dis 119:869–877
Avido DM, Schmidt CF (1957) Pathogenesis of pulmonary edema by alloxan. Circ Res 5:180–186
Brigham KL, Snell JD (1973) In vivo assessment of pulmonary vascular integrity in experimental pulmonary edema. J Clin Invest 52:2041–2052
Brigham KL, Snell JD, Harris TR, Marshall S, Haynes J, Bowers RE, Perry J (1979) Indicator dilution lung water and vascular permeability in humans: effects of pulmonary vascular pressure. Circ Res 44:523–530
Buchman SR, Sugerman HJ, Tatum JL, Wright TP, Blocher CR, Hirsch JI (1984) Failure of methylprednisone, ibuprofen, or prostacyclin to reduce HCl-induced pulmonary albumin leak in dogs. Surgery 96:163–169
Coates G, Dolovich M, Newhouse MT (1983) Evaluation of pulmonary epithelial permeability with submicroscopic99mTc DTPA aerosols. Radiology 149:243
Creutzig H, Sturm JA, Schober O, Nerlich ML, Kant CJ (1984) Nuklearmedizinische diagnostik des “Pulmonary capillary protein leak”. Nuklearmedizin 23:253–256
Dauber IM, Pluss WT, VanGrondelle A, Trow RS, Weil JV (1985) Specificity and sensitivity of noninvasive measurement of pulmonary vascular protein leak. J Appl Physiol 59(2):564–574
Gorin AB, Weidner WJ, Demling RH, Staub NC (1978) Noninvasive measurement of pulmonary transvascular flux in sheep. J Appl Physiol Respirat Environ Exercise Physiol 45(2):225–233
Gorin AB, Stewart PA (1979) Differential permeability of endothelial and epithelial barriers to albumin flux. J Appl Physiol 48:1315–1324
Gorin AB, Kohler J, DeNardo G (1980) Noninvasive measurement of pulmonary trasvascular protein flux in normal man. J Clin Invest 66:869–877
Gump FE, Mashima Y, Jorgensen S, Kiney JM (1971) Simultaneous use of three indicators to evaluate primary capillary damage in man. Surgery 70:262–270
Lull RJ, Tatum JL, Sugerman HJ, Hartshore MF, Boll DA, Kaplan KA (1983) Radionuclide evaluation of lung trauma. Semin Nucl Med 13:223–237
Marshall BE, Teichner RL, Kallos T, Sugerman HJ, Wyche Jr MQ, Tantum KR (1971) Effects of posture and exercise on the pulmonary extravascular water volume in man. J Appl Physiol 31(3):375–379
Mason GR, Effros RM, Uszler JM, Mena I (1985) Small solute clearance from the lungs of patients with cardiogenic and noncardiogenic pulmonary edema. Chest 88:327–334
Quinn DA, Carvalho AC, Geller E, Khaw B, Barlai Kovach M, Zielonka J, Greene R, Strauss HW, Zapol WM (1987)99mTc-fibrinogen scanning in adult respiratory distress syndrome. Am Rev Respir Dis 135:100–106
Robin ED, Carey LC, Grenvik A, Glauser F, Gaudio R (1972) Capillary leak syndrome with pulmonary edema. Arch Intern Med 130:66–71
Sibbald WJ, Driedger AA, Moffat JD, Myers ML, Reid BA, Holliday RL (1981) Pulmonary microvascular clearance of radiotracers in human cardiac and noncardiac pulmonary edema. J Appl Physiol Respirat Environ Exercise Physiol 50(6):1337–1374
Spicer KM, Reines DH, Frey GD (1986) Diagnosis of adult respiratory distress syndrome with Tc-99m human serum albumin and portable probe. Crit Care Med 14(8):669–676
Staub NC (1978) Pulmonary edema due to increased microvascular permeability to fluid and protein. Circ Res 43:143–151
Sturm JA, Wisner DH, Oestern HJ, Kant CJ, Tscherne H, Creutzig H (1986) Increased lung capillary permeability after trauma: A prospective study. J Trauma 26(5):409–418
Sugerman HJ, Hirsch JI, Strash AM et al. (1980) Preliminary report: Gamma camera detection of oleic acid alveolar-capillary albumin leak. J Surg Res 29:93–99
Sugerman HJ, Tatum JL, Strash AM, Hirsch JI, Greenfield LJ (1981) Effects of pulmonary vascular recruitment on gamma scintigraphy and pulmonary capillary protein leak. Surgery 90:388–395
Sugerman HJ, Hirsch JI, Tatum JL, Strash AM, Greenfield LJ (1982a) Comparative scintigraphy in oleic acid pulmonary microvascular injury. Crit Care Med 10:31–33
Sugerman HJ, Strash AM, Hirsch JI, Shirazi K, Tatum JL, Mathers JAL, Greenfield LJ (1982b) Scintigraphy and radiography in oleic acid pulmonary microvascular injury: effects of positive end-expiratory pressure (PEEP). J Trauma 22(3):179–185
Sugerman HJ, Blocher CS, Hirsch JI, Strash AM, Tatum JL (1983) Failure of various agents to decrease oleic acid pulmonary albumin leak. J Surg Res 34:456–462
Sugerman HJ, Tatum JL, Burke TS, Strash AM, Glauser FL (1984) Gamma scintigraphic analysis of albumin flux in patients with acute respiratory distress syndrome. Surgery 95:674–681
Tatum JL, Strash AM, Sugerman HJ, Hirsch JI, Beachley MC, Greenfield LJ (1981) Single isotope evaluation of pulmonary capillary protein leak (ARDS Model) using computerized gamma scintigraphy. Invest Radiol 16(6):473–476
Tatum JL, Burke TS, Sugerman HJ, Strash JI, Fratkin MJ (1982) Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: Initial clinical trials. Radiology 143:237–241
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Supported by NIH Grant # 1R23GM27245-01
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Tatum, J., Sugerman, H., Perdikaris, N. et al. Determinants of diagnostic accuracy in pulmonary scintigraphy for pulmonary capillary protein leak associated with adult respiratory distress syndrome (ARDS): A technical note. Eur J Nucl Med 15, 67–70 (1989). https://doi.org/10.1007/BF00702621
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DOI: https://doi.org/10.1007/BF00702621