Abstract
Pneumocystis carinii pneumonia (PCP) has become a major cause of morbidity and mortality due to infectious diseases, largely as a result of the acquired immunodeficiency syndrome (AIDS) epidemic. Since the mortality from recurrent infection is between 40% and 60%, early diagnosis and therapy are the keys to survival. The role of technetium 99m diethylene triamine pentaacetate (DTPA) aerosol pulmonary clearance was studied in 81 patients with AIDS. The mathematical technique of curve stripping was found to be the optimal method of analysis and to provide an overall sensitivity of 94% for the detection of interstitial pneumonitis. The procedure was superior to standard pathology parameters and radiography and more convenient than gallium 67 scintigraphy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Askin F, Katzenstein AL (1981) Pneumocystis infection masquerading as diffuse alveolar damage. Chest 79:420–423
Allegra CJ, Chabner BA, Tuazon CU, Ogata-Arakaki D, Baird B, Drake JC, Simmons T, Lack EE, Shelhamer JH, Balis F, Walker R, Kovacs JA, Lane C, Masur H (1987) Trimetrexate for the treatment of pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med 317:978–985
Barron J, Birnbaum NSA, Shane LB, Goldsmith SJ, Rosen MJ (1985) Pneumocystis carinii pneumonitis studied by 67-gallium scanning. Radiology 154:791–793
Chamberlain MJ, Morgan WKC, Vinitski S (1983) Factors influencing the regional deposition of inhaled particles in man. Clin Sci 64:69–78
Chopra SK, Taplin GV, Tashkin DP, Elam D (1979) Lung clearance of soluble radioaerosols of different molecular weights in systemic sclerosis. Thorax 34:63–67
Coates G, O'Brodovich HM (1986) The contribution of lymphatic drainage to the clearance of inhaled 99m-Tc-DTPA from the lungs. Clin Invest Med 9:15–20
Delorenzo LJ, Huang CT, Maguire GP, Stone DJ (1987) Roentgenographic patterns of pneumocystis carinii pneumonia in 104 patients with AIDS. Chest 91:323–327
el-Sadr W, Sidhu G, Diamond G, Zuger A, Berman D, Simberkoff MS, Rahal JJ (1986) High-dose corticosteroids as adjunct therapy in severe pneumocystis carinii pneumonia. AIDS Res 2:349–355
Guillon JM, Rosso J, Denis M, Autran B, Plata F, Akoun G, Mayaud C (1989) 99m-Tc-DTPA lung clearance and gallium scanning in HIV related lymphocytic alveolitis. J Nucl Med 30(5):746
Hayes M, Taplin GV, Chopra SK, Knox DE, Elam D (1979) Improved radioaerosol system for routine inhalation lung imaging. Radiology 131:256–258
Jones JG, Minty BD, Lawler P, Hulands G, Crawley JCW, Veall N (1980) Increased alveolar epithelial permeability in cigarette smokers. Lancet 1:66–68
Kohn M, Armbruster C, Konig B, Vetter N, Mostbeck A (1989) Value of nuclear medicine procedures for diagnosis and monitoring of opportunistic lung infection in AIDS patients. Eur J Nucl Med 15:442
Kovacs JA, Hiemenz JW, Macher AM, Stover D, Murray HW, Shelhamer J, Lane C, Urmacher C, Honig C, Longo DL, Parker MM, Natanson C, Parrilo JE, Fauci AS, Pizzo PA, Masur H (1984) Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 100:663–671
MacFadden KM, Hyland RH, Inouye T, Edelson JD, Rodriguez CH, Rebuck AS (1987) Corticosteroids as adjunctive therapy of Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome. Lancet 1:1477–1479
Mason GR, Uszler JM, Effros RM, Reid E (1983) Rapidly reversible alterations of pulmonary permeability induced by smoking. Chest 83:6–11
Mason GR, Duane GB, Mena I, Effros RM (1987) Accelerated solute clearance in Pneumocystis carinii pneumonia. Am Rev Respir Dis 135:864–868
McCandless BK, Cooper JA (1989) Apical pattern of Ga-67 in patients with acquired immune deficiency syndrome treated with aerosolised pentamidine. J Nucl Med 30(5):744
O'Doherty MJ, Page CJ, Bradbeer CS, Shahmanesh M, Edwards A, Barlow D, Nunan TO, Bateman NT (1989) The place of lung 99m-Tc DTPA aerosol transfer in the investigation of lung infection in HIV positive patients. Respir Med 83:395–401
Picard C, Meignan M, Rosso J, Cinotti L, Mayaud C, Revuz J (1987) Technetium-99m DTPA aerosol and gallium scanning in acquired immune deficiency syndrome. Clin Nucl Med 12:501–506
Rinderknecht J, Shapiro L, Krauthamer M, Taplin G, Wasserman K, Uszler M, Effros RM (1980) Accelerated clearance of small solutes from the lungs in interstitial lung disease. Am Rev Respir Dis 121:105–117
Simani AS, Inove S, Hogg JC (1974) Penetration of the respiratory epithelium of guinea pigs following exposure to cigarette smoke. Lab Invest 31:75–81
Taplin GV, Isawa T (1968) Regional alveolar liquid diffusibility by lung scintigraphy. Semi-annual progress report submitted to USAEC, UCLA 12-686, UC-48 Biology and Medicine, pp 4–43, TID 4500
Thunberg S, Larsson K, Eklund A, Blaschke E (1989) 99m-TcDTPA clearance measured by a dual head gamma camera in healthy subjects and patients with sarcoidosis. Eur J Nucl Med 15:71877
Yoneda K, Walzer PD (1981) Mechanism of pulmonary alveolar injury in experimental Pneumocystis carinii pneumonia in the rat. Br J Exp Pathol 62:339–346
Zamman HK, White DA (1988) Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Am Rev Respir Dis 137:796–800
Zuckier LS, Onseng F, Goldfarb CR (1988) Lymphocytic pneumonitis: a cause of pulmonary gallium-67 uptake in a child with acquired immunodeficiency syndrome. J Nucl Med 29:707–711
Author information
Authors and Affiliations
Additional information
Offprint requests to: H. Van der Wall
Rights and permissions
About this article
Cite this article
Van der Wall, H., Murray, I.P.C., Jones, P.D. et al. Optimising technetium 99m diethylene triamine penta-acetate lung clearance in patients with the acquired immunodeficiency syndrome. Eur J Nucl Med 18, 235–240 (1991). https://doi.org/10.1007/BF00186646
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00186646