Thallium-201 scintigraphy in the evaluation of graft dysfunction in lung transplantation. Newark Beth Israel Medical Center Lung Transplant Group

Abstract

T Th ha al ll li iu um m--2 20 01 1 s sc ci in nt ti ig gr ra ap ph hy y i in n t th he e e ev va al lu ua at ti io on n o of f g gr ra af ft t d dy ys sf fu un nc ct ti io on n i in n l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n ABSTRACT: The object of this study was to evaluate graft dysfunction utilizing thallium-201 scintigraphy in patients who had undergone lung transplantation.We studied 11 patients who had undergone single-lung transplantation and had 44 evaluations for suspected graft dysfunction. All evaluations included a lung thallium-201 scan and chest radiography. In addition, 42 transbronchial biopsies, 19 gallium-67 scans and 28 pulmonary function tests were obtained. Rejection was defined by histopathology and/or the response to an empirical pulse of methylprednisolone, while cultures of protected specimen brushes and blood with a positive chest radiograph were used to define infection.The sensitivity of thallium scintigraphy for diagnosing rejection and/or infection (94%) was higher than that for transbronchial biopsy (86%), gallium scintigraphy (47%), chest radiography (67%), or spirometry testing (30%). Specificity was 100% for thallium scintigraphy and transbronchial biopsy, as compared to chest radiography and spirometry, which were 75 and 80% respectively. This study indicated that thallium-201 scintigraphy is useful for screening lung transplant recipients for episodes of acute rejection and/or infection. A positive scan is confirmation of graft parenchymal dysfunction and may then be followed by empirical treatment or bronchoscopy with transbronchial biopsy and culture to differentiate rejection and infection.

Single-breath test in lateral decubitus reflects function of single lungs grafted for emphysema

“…Several imaging techniques have been proposed to overcome this problem and assess specifically the function of single grafts, including krypton-81m ventilation and/or technetium-99m perfusion scintigraphy (11,20), single-photon-emission computerized tomography (4,22,23), thallium-201 scintigraphy (15), contrast-enhanced dynamic magnetic resonance imaging (3), and, more recently, helium-3 magnetic resonance imaging (10,28). However, the complex and/or expensive nature of these techniques makes them ill-suited for wide clinical use.…”

Increased Thallium-201 Accumulation in the Transplanted Lung

“…While thallium-201 scintigraphy is an extremely sensitive method for detecting an inflammatory process in the lung (up to 94% sensitive in some studies), unlike bronchoscopy, it is not capable of detecting a specific histologic process or a specific organism causing an infection. 7 There is also literature to support decreased uptake of Tc-99m during stress by lungs afflicted by COPD. The exact mechanism for decreased or absent uptake of Tc-99m on stress imaging remains unknown.…”