Extravasation of a Therapeutic Dose of <sup>131</sup>I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation

Bonta, Dacian; Halkar, Raghuveer; Alazraki, Naomi P.

doi:10.2967/jnumed.110.083725

Cited by 25 publications

(28 citation statements)

References 13 publications

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“…Eight publications reported a total of 10 cases of therapeutic radiopharmaceutical extravasation [46–53]. Radionecrosis was the most severe symptom reported in five cases [47, 49, 50], although three cases reported needle track necrosis that resolved spontaneously [47].…”

Section: Resultsmentioning

confidence: 99%

“…No symptoms arose during follow-up (no time indication).Minsky 1987 [48]1 32 P-sodium phosphate0,086765,02Raised area at infusion site (p.i. ).Patton 1950 [49]1 90 Y-hydroxy citrate complexNot reported0,21000Ulceration, 2cm in diameter.Bonta 2011 [46]1 131 I-metaiodobenzylguanidine11,1 (worst case)6020–40Forearm swelling (7d). Rash at injection site, 10x5cm (4w).…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacotherapeutical interventions have been reported in sporadic case reports. Ulcers were treated with antibiotics and discomfort was treated with topical steroids [46, 49, 50, 52, 53]. Intralesional corticosteroid therapy is advised by Williams, based on results after chemotherapy extravasation, but has not been reported in radiopharmaceutical extravasation [52].…”

Section: Discussionmentioning

confidence: 99%

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Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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PurposeRadiopharmaceutical extravasation can potentially lead to severe soft tissue damage, but little is known about incidence, medical consequences, possible interventions, and effectiveness of these. The aims of this study are to estimate the incidence of extravasation of diagnostic and therapeutic radiopharmaceuticals, to evaluate medical consequences, and to evaluate medical treatment applied subsequently to those incidents.MethodsA sensitive and elaborate literature search was performed in Embase and PubMed using the keywords “misadministration”, “extravasation”, “paravascular infiltration”, combined with “tracer”, “radionuclide”, “radiopharmaceutical”, and a list of keywords referring to clinically used tracers (i.e. “Technetium-99m”, “Yttrium-90”). Reported data on radiopharmaceutical extravasation and applied interventions was extracted and summarised.ResultsThirty-seven publications reported 3016 cases of diagnostic radiopharmaceutical extravasation, of which three cases reported symptoms after extravasation. Eight publications reported 10 cases of therapeutic tracer extravasation. The most severe symptom was ulceration. Thirty-four different intervention and prevention strategies were performed or proposed in literature.ConclusionsExtravasation of diagnostic radiopharmaceuticals is common. 99mTc, 123I, 18F, and 68Ga labelled tracers do not require specific intervention. Extravasation of therapeutic radiopharmaceuticals can give severe soft tissue lesions. Although not evidence based, surgical intervention should be considered. Furthermore, dispersive intervention, dosimetry and follow up is advised. Pharmaceutical intervention has no place yet in the immediate care of radiopharmaceutical extravasation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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“…In this same study, placement of the sensors approximately 7 cm from the injection site has provided improved sensitivity allowing for the detection of residual FDG in indwelling catheters. A similar approach of surface detection at locations proximal to the venous access site has also been demonstrated with technetium-99m probes [15]. …”

Section: Discussionmentioning

confidence: 99%

Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging

Williams

Arlinghaus

Rani

et al. 2016

Eur J Nucl Med Mol Imaging

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Purpose To dynamically detect and characterize 18F-fluorodeoxyglucose (FDG) dose infiltrations and evaluate their effects on positron emission tomography (PET) standardized uptake values (SUV) at the injection site and in control tissue. Methods Investigational gamma scintillation sensors were topically applied to patients with locally advanced breast cancer scheduled to undergo limited whole-body FDG-PET as part of an ongoing clinical study. Relative to the affected breast, sensors were placed on the contralateral injection arm and ipsilateral control arm during the resting uptake phase prior to each patient’s PET scan. Time activity curves (TACs) from the sensors were integrated at varying intervals (0–10, 0–20, 0–30, 0–40, and 30–40 min) post-FDG and the resulting areas-under-the-curve (AUCs) were compared to SUVs obtained from PET. Results In cases of infiltration, observed in three sensor recordings (30%), the injection arm TAC shape varied depending on the extent and severity of infiltration. In two of these cases TAC characteristics suggested the infiltration was partially resolving prior to image acquisition, although it was still apparent on subsequent PET. Areas under the TAC 0–10 and 0–20 min post-FDG were significantly different in infiltrated versus non-infiltrated cases (Mann-Whitney, p < 0.05). When normalized to control, all TAC integration intervals from the injection arm were significantly correlated with SUVpeak and SUVmax measured over the infiltration site (Spearman ρ ≥ 0.77, p < 0.05). Receiver operating characteristic (ROC) analyses, testing the ability of the first 10 minutes of post-FDG sensor data to predict infiltration visibility on the ensuing PET, yielded an area under the ROC curve of 0.92. Conclusion Topical sensors applied near the injection site provide dynamic information from the time of FDG administration through the uptake period and may be useful in detecting infiltrations regardless of PET image field of view. This dynamic information may also complement the static PET image to better characterize the true extent of infiltrations.

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“…Therefore, adverse reactions to radiopharmaceuticals are generally rare, mild, and reversible without medical treatment (9)(10)(11). However, extravasated therapeutic radiopharmaceuticals can cause tissue damage because of high radiation (12)(13)(14)(15).…”

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confidence: 99%

A Portable Database of Adverse Reactions and Drug Interactions with Radiopharmaceuticals

Perales

2013

Journal of Nuclear Medicine Technology

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Our objective was to develop a software application that allows us to easily manage a portable database of information on radiopharmaceutical interactions with drugs or other agents and on radiopharmaceutical adverse effects. Methods: The application was developed and compiled with a commercially available data management system and programming language. All data entered into the database came from the scientific literature and were accompanied by their bibliographic references. Results: We developed the database, which we have called Datinrad. To date, it contains 275 drug interactions and 44 records of adverse reactions to radiopharmaceuticals. Conclusion: Datinrad contains all the information published to date on drug-radiopharmaceutical interactions and adverse effects of radiopharmaceuticals and allows users to introduce new data from future publications. The collection of these data and their easy availability to all nuclear medicine personnel will be useful in the recognition of a possible adverse reaction or drug interaction that may alter the radiopharmaceutical biodistribution and lead to a misdiagnosis. This open-access database application is available free of charge in both English and Spanish at www.radiopharmacy.net.A radiopharmaceutical is a pharmaceutical that, when ready for use, incorporates one or more radioactive isotopes. Around 95% of radiopharmaceuticals are used for diagnostic purposes, and the rest are used for treatment of human diseases. Radiopharmaceuticals usually have no pharmacologic effects, as they are used in trace quantities. Thus, significantly unlike conventional drugs, there is no dose-response relationship for radiopharmaceuticals. Even when a radiopharmaceutical is used for therapeutic purposes, the effect achieved is not a pharmacologic consequence but a consequence of radioactivity. However, some exceptions exist, because radiolabeled particles present some potential mechanical issues, such as the embolic effect created by 99m Tc-macroaggregated albumin and 90 Y resin particles or beads. In the case of 99m Tc-macroaggregated albumin, a sufficient number of particles need to be administered to avoid a nonuniform spatial distribution of radioactivity in lung regions; on the other hand, an excess of particles can produce acute toxicity, especially in patients with severe pulmonary hypertension. Therefore, it is important to determine the ideal number of particles for a satisfactory lung scan (1,2). As for 90 Y resin particles or beads, which are used for therapy of primary and metastatic cancer in the liver, their particle size is 20-60 mm and about 20-40 million particles per administration are needed to deliver an equivalent amount of radioactivity into the tumor. These factors increase the probability of blood stasis in the arterial vessel that supplies the tumor during therapy (embolizing effect), as well as the probability of a backflow of spheres into small collateral arteries to the stomach, duodenum, or pancreas. This phenomenon may be eliminated by applying SPECT/C...

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Extravasation of a Therapeutic Dose of ¹³¹I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation

Cited by 25 publications

References 13 publications

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging

A Portable Database of Adverse Reactions and Drug Interactions with Radiopharmaceuticals

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Extravasation of a Therapeutic Dose of 131I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation

Cited by 25 publications

References 13 publications

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging

A Portable Database of Adverse Reactions and Drug Interactions with Radiopharmaceuticals

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Product

Resources

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Extravasation of a Therapeutic Dose of ¹³¹I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation