Skip to main content
SpringerLink
Log in

Technetium-99m Hexamethylpropylene Amine Oxime Lung Scintigraphy Findings in Low-Dose Amiodarone Therapy

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Amiodarone (AD)-induced pulmonary toxicity is one of the major complications of long-term AD therapy. Technetium-99m-labeled D,L-hexamethylpropylene amine oxime (Tc-99m HMPAO) scintigraphy has been used to assess lung injury. We designed this study to clarify lung uptake changes of Tc-99m HMPAO using low doses of AD (5 mg/kg/day) during long-term therapy in a rabbit model. Group 1 consisted of 7 rabbits fed with AD by gavage for 6 months. To investigate the effect of ketamine on Tc-99m HMPAO uptake, 5 rabbits were included in Group 2 as a control group. Tc-99m HMPAO scintigraphy was performed in both Group 1 and Group 2 at baseline and after 2, 4, 6, 8, and 12 weeks of AD intake. After 16, 20, and 24 weeks of drug intake, Tc-99m HMPAO scintigraphy was repeated only in group 1. One-min anterior images were acquired 30 min after the injection of 37 MBq of Tc-99m HMPAO. For semiquantitative evaluation, the mean count values were obtained and lung/background and liver/background ratios were calculated. Histopathologic evaluation was performed. No increase in lung and liver uptake of Tc-99m HMPAO was found 2, 4, 6, 8, and 12 weeks after drug intake. There was no significant increase in L/B and H/B ratios of Tc-99m HMPAO in Group 1 compared with Group 2. Both scintigraphic studies and histopathologic examinations showed nonspecific changes. Longitudinal studies investigating Tc-99m HMPAO lung uptake may be planned in patients carrying risk factors for AD-induced lung toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Braunwald E (1997) Heart Disease. A Textbook of Cardiovascular Medicine, 5th ed. W.B. Saunders, Philadelphia, pp 613–615

    Google Scholar 

  2. Camus P, Martin WJ, Rosenow EC (2004) Amiodarone pulmonary toxicity. Clin Chest Med 25:65–75

    PubMed  Google Scholar 

  3. Capa Kaya G, Bekis R, Kirimca F, et al. (2001) Use of technetium-99m HMPAO scintigraphy for the detection of amiodarone lung toxicity in a rabbit model. Eur J Nucl Med 28:346–350

    CAS  PubMed  Google Scholar 

  4. Chang C-H, Wu H-C, Tsai J-JP, et al. (2003) Usefulness of technetium-99m hexamethylpropylene amime oxime lung scan to detect subclinical lung injury in patients with chronic renal failure. Lung 181:97–101

    Article  CAS  PubMed  Google Scholar 

  5. Cooper JAD, White DA, Matthay RA (1986) Drug-induced pulmonary disease. Part 2: noncytotoxic drugs. Am Rev Respir Dis 133:488–505

    CAS  PubMed  Google Scholar 

  6. Dirlik A, Erinc R, Ozcan Z, et al. (2002) Technetium-99m-DTPA aerosol scintigraphy in amiodarone-induced pulmonary toxicity in comparison with Ga-67 scintigraphy. Ann Nucl Med 16:477–481

    PubMed  Google Scholar 

  7. Durak H, Kilinc O, Ertay T, et al. (2003) Tc-99m-HMPAO uptake by bronchoalveolar cells. AnnNucl Med 17:107–113

    Google Scholar 

  8. Durmus-Altun G, Altun A, Sami Salihoglu Y, et al. (2004) Value of technetium-99m diethyltriamine pentaaceticacid radioaerosol inhalation lung scintigraphy for the stage of amiodarone-induced pulmonary toxicity. Int J Cardiol 95:193–197

    PubMed  Google Scholar 

  9. Evans SJ, Myers M, Zaher J, et al. (1992) High dose oral amiodarone loading: Electrophysiologic effects and clinical tolerance. J Am Coll Cardiol 19:169–173

    CAS  PubMed  Google Scholar 

  10. Gunaydin B, Karadenizli Y, Babacan A, et al. (1997) Pulmonary microvascular injury following general anesthesia with volatile anesthetics–halothane and isoflurane: a comparative clinical and experimental study. Respir Med 91:351–360

    CAS  PubMed  Google Scholar 

  11. Hardman JG, Limbird LE (2001) Goodman & Gilman’s The Pharmacological Basis of Therapeutics. McGraw-Hill, New York, pp 953–957

    Google Scholar 

  12. Hilbert H, Mohsenin V (1996) Adaptation of lung antioxidants to cigarette smoking in humans. Chest 110:916–920

    CAS  PubMed  Google Scholar 

  13. Hilleman D, Miller MA, Parker R, et al. (1998) Optimal management of amiodarone therapy: efficacy and side effects. Pharmacotherapy 18:1388–1458

    Google Scholar 

  14. Hung C-J, Liu F-Y, Shaiu Y-C, et al. (2003) Assessing transient pulmonary injury induced by volatile anesthetics by increased lung uptake of technetium-99m hexamethylpropylene amimie oxime. Lung 181:1–7

    Article  CAS  PubMed  Google Scholar 

  15. Kalbfieisch SJ, Williamson B, Man KC, et al. (1993) Prospective, randomized comparison of conventional and high dose loading regimens of amiodarone in the treatment of ventricular tachycardia. J Am Coll Cardiol 22:1723–1729

    Google Scholar 

  16. Kim SG, Mannino MM, Chou R, et al. (1992) Rapid suppression of spontaneous ventricular arrhythmias during oral amiodarone loading. Ann Intern Med 117:197–201

    CAS  PubMed  Google Scholar 

  17. Latorre G, Lucas I, Herrero JI, et al. (1999) Severe hepatotoxicity caused by amiodarone: description of a case. Rev Med Univ Navarra 43:86–91

    CAS  PubMed  Google Scholar 

  18. Meyers JL (1997) Pathology of drug-induced lung disease. In: Katzenstein AA, Askin FB (eds) Katzenstein and Askin’s surgical pathology of non-neoplastic lung disease Vol 4. W.B. Saunders, Philadelphia, pp 81–111

    Google Scholar 

  19. Roca J, Heras M, Rodriguez-Roisin R, et al. (1992) Pulmonary complications after long term amiodarone treatment. Thorax 47:372–376

    CAS  PubMed  Google Scholar 

  20. Rossi SE, Erasmus JJ, McAdams HP, et al. (2000) Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 20:1245–1259

    CAS  PubMed  Google Scholar 

  21. Rotmensch HH, Liron M, Tupilsky M, et al. (1980) Possible association of pneumonitis with amiodarone therapy. Am Heart J 100:412–413

    Article  CAS  PubMed  Google Scholar 

  22. Shih WJ, Gruenwald F, Biersack HJ, et al. (1991) Tc-99m HMPAO diffuse pulmonary uptake demonstrated in cigarette smokers. Clin Nucl Med 16:668–672

    CAS  PubMed  Google Scholar 

  23. Shih WJ, Rehm SR, Gruenwald F, et al. (1993) Lung uptake of Tc-99m HMPAO in cigarette smokers expressed by lung/liver activity ratio. Clin Nucl Med 18:227–230

    CAS  PubMed  Google Scholar 

  24. Spaniol M, Bracher R, Ha HR, et al. (2001) Toxicity of amiodarone and amiodarone analogues on isolated rat liver mitochondria. Hepatology 35:628–636

    CAS  Google Scholar 

  25. Suga K, Uchisako, Nishigauchi K, et al. (1994) Technetium-99m-HMPAO as a marker of chemical and irradiation lung injury: experimental and clinical investigations. J Nucl Med 35:1520–1527

    CAS  PubMed  Google Scholar 

  26. Summitt J, Morady F, Kadish A (1992) A comparison of standard and high-dose regimens for the initiation of amiodarone therapy. Am Heart J 124:366–373

    Article  CAS  PubMed  Google Scholar 

  27. Uchisako H (1993) Evaluation of 99m Tc-HMPAO scintigraphy for irradiated lung in rabbits: detection of pulmonary microvascular injury. Nippon Igaku Hoshasen Gakkai Zasshi 53:835–846

    CAS  PubMed  Google Scholar 

  28. Ulrik CS, Backer V, Aldlershvile J, et al. (1992) Serial pulmonary function tests in patients treated with low-dose amiodarone. Am Heart J 123:1550–1554

    Article  CAS  PubMed  Google Scholar 

  29. Weinberg BA, Miles WM, Klein LS, et al. (1993) Five-year follow-up of 589 patients treated with amiodarone. Am Heart J 125:109–120

    Article  CAS  PubMed  Google Scholar 

  30. Zhu YY, Botninick E, Dae M, et al. (1988) Gallium lung scintigraphy in amiodarone lung toxicity. Chest 93:1126–1131

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Dokuz Eylül University, School of Medicine, Izmir, Turkey

    G. Capa Kaya, T. Ertay, R. Bekis, C. Tasci, E. Sayit & H. Durak

  2. Department of Pathology, Dokuz Eylül University, School of Medicine, Izmir, Turkey

    B. Tuna & A. Kargı

  3. Animal Research Center, Dokuz Eylül University, School of Medicine, Izmir, Turkey

    O. Yılmaz

Authors
  1. G. Capa Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Ertay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Tuna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Bekis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Tasci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Sayit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. O. Yılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Kargı
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. Durak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Capa Kaya.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaya, G.C., Ertay, T., Tuna, B. et al. Technetium-99m Hexamethylpropylene Amine Oxime Lung Scintigraphy Findings in Low-Dose Amiodarone Therapy. Lung 184, 57–61 (2006). https://doi.org/10.1007/s00408-005-2562-3

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-005-2562-3

Keywords

Search

Navigation