(4)Saha Chapter 16

Adverse Reactions to and Altered

Biodistribution of
Radiopharmaceuticals
An adverse reaction due to a
radiopharmaceutical is an unusual experience
associated with administration of the
radiopharmaceutical.

The most common adverse reactions are nausea,
dyspnea,
bronchospasm,
decreased blood pressure,
itching,
flushing,
hives,
chills,
coughing,
bradycardia,
muscle cramps,
dizziness

The Society of Nuclear Medicine in the United
States collects from its members voluntary
reports of adverse reactions due to
radiopharmaceutical administration to
humans.

The overall incidence of adverse reactions in
the United States is about 2.3 reactions per
100,000 radiopharmaceutical administrations.
However, no death has been reported
Incidence of severe reactions has declined in
recent years due to better formulation and
manufacturing of radiopharmaceuticals

Of the different radiopharmaceuticals in use in
the United States,

99m
Tc-labeled albumin microsphere (although
currently not commercially available)

99m
Tc-sulfur colloid next.

There are also several reports of adverse
reactions with
99mTc-MAA,
99mTc-MDP,
99mTc-DISIDA.
These are not accurate due to inconsistency in
reporting.
Most adverse reactions are mild in nature and
require no or minimal treatment.
Antihistamines are the mainstay for the
treatment of severe anaphylaxis
Epinephrine is the agent of choice and is given
subcutaneously or intramuscularly, whereas in
severe conditions it is given intravenously.
In the case of poor response to antihistamine,
aminophylline may be given.

Iatrogenic Alterations in the Biodistribution
of Radiopharmaceuticals
Altered biodistribution due to extraneous
drugs may be undesirable or intentional.

Knowledge of altered biodistribution due to
other drugs helps the physician avoid
misinterpretation of the scintigraphic images
and thus an incorrect diagnosis

Bone imaging with
99mTc
phosphonate compounds
Chemotherapeutic agents
Increased renal activity
Melphalan
Increased bone uptake
Corticosteroids
Decreased bone uptake
Cytotoxic therapy
Increased uptake in calvarium
Meperidine
Soft tissue uptake
Iron dextran
Increased uptake at injection site
Aluminum ion
Increased liver activity
Dextrose
Increased renal activity
Iron
Increased renal activity
Phospho soda
Decreased bone uptake
RES imaging with
99mTc SC
Al3+,Mg2+
Increased lung activity
Anesthetics
Increased splenic uptake

Estrogens
Focal areas of
decreased uptake in
liver
BCNU
Decreased splenic
uptake


Myocardial perfusion imaging
with
201Tl chloride

Dipryridamole
Increased Myocardial uptake
Propranolol
Decreased myocardial uptake
Digitalis glycosides
Decreased myocardial uptake
Furosemide
Increased myocardial uptake
Isoproterenol
Increased myocardial uptake

Hepatobiliary imaging with 99mTc IDA
derivatives
Cholecystokinin
Increased gallbladder contraction
Narcotic analgesics
Prolonged liver to duodenum transit time
Atropine
Prolonged gallbladder activity
Nicotinic acid
Decreased hepatic uptake

Thyroid uptake and imaging
with
131I NaI

TcO4,Br, ClO4, SCN
Decreased uptake
Iodide containing preparations
Decreased uptake
(Lugols solution, SSKI, cough medicine, kelp, etc.)
Decreased uptake
Contrast media
Decreased uptake
Antithyroid drugs (Tapazole,
propylthiouracil)
Decreased uptake
Natural or synthetic thyroid
preparation (Cytomel,
Synthyroid)
Decreased uptake

Tumor and inflammatory process
imaging with 67 Ga citrate
Iron dextran (before 67Ga injection)
Decreased uptake
Iron dextran (after 67Ga injection)
Increased uptake
Desferoxamine (before67Ga injection)
Decreased uptake
Desferoxamine (after67Gainjection)
Increased uptake
Chemotherapeutic agents
Diffuse lung uptake
Antibiotics
Uptake in colon and kidneys
Estrogens
Uptake in mammary tissue
In-vivo 99mTc labeling of RBCs
Heparin
Poor labeling
Dextran
Poor labeling
Doxorubicin
Poor labeling
Penicillin
Poor labeling
Hydralazine
Poor labeling