Noninvasive measurement of tracer extraction efficiency in tissue, illustrated with Tc-99m-MAG3

Abstract

Objective The aim of this study is to develop a noninvasive technique for measuring tissue tracer extraction efficiency (E) and illustrate it for Tc-99m-mercaptoacetyltriglycine (MAG3) and kidney. Methods E was measured in 10 patients with normal MAG3 renography. E is the ratio of tissue clearance-to-blood flow (Ki/F). For single-photon tracers, attenuation constants are unknown, so Ki and F cannot be separately measured. However, by deriving attenuation-uncorrected Ki’ and F’ from the same regions of interests (ROIs), these constants cancel out, giving E. Using a lung ROI for blood activity, F was measured from first-pass and Ki’ from Gjedde–Patlak–Rutland (GPR) analysis up to 130 s. Because of interference from right ventricle, a left ventricular ROI (LV) is unsuitable for F’ but was used in GPR analysis, making an adjustment for the ratio of respective blood pool signals arising from lung and LV ROIs in early frames (60–90 s). Results A lung ROI underestimates F’ by 4% at normal LV function. Chest wall interstitial activity (I), which does not affect F’, amounted to 53 and 30% of the lung and LV signals at 20 min, and 12 and 6% at 130 s, resulting in underestimations of Ki of 4 and 2%, respectively. Ignoring these opposing errors, E based on lung ROI for left and right kidneys was 43.5 (SD 8)% and 47.3 (9)%, and based on LV ROI for GPR analysis was 44.5 (10.9)% and 48.3 (10.6)%. Conclusion E can be measured by combining blood flow from first-pass with clearance from GPR analysis, and has potential value both clinically and in clinical research.