Watkinson, John Carmel; (1991) Some aspects of imaging squamous cell carcinoma using technetium-99m (v) dimercaptosuccinic acid (pentavalent dmsa). Doctoral thesis (M.S.), Royal Free Hospital School of Medicine.

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Abstract

The purpose of this study was to establish an animal tumour model with squamous carcinoma and use it to evaluate the pharmacokinetics, biodistribution and optimal imaging characteristics of the new head and neck tumour imaging agent Technetium-99m (v) Dimercaptosuccinic Acid (Tc 99m (v) DMSA). These parameters were then compared with similar studies in humans with squamous carcinoma and the combined data used to calculate the effective dose equivalent in man. Seventy one patients with malignant tumours and 10 with benign lesions were studied. Eighty nine rabbits were studied (27 non-tumour, 62 tumour). Tc 99m (v) DMSA had a bi-exponential blood clearance and cumulative urine excretion in rabbits and humans. The major organ biodistribution of Tc 99m (v) DMSA in rabbits was in bone, kidneys and the blood pool. There was no significant difference in biodistribution between non-tumour and tumour groups and the main route of excretion was in the urine. There was no evidence of active tumour accumulation or specific intracellular localisation of Tc 99m (v) DMSA in rabbits or humans. The optimal imaging time for rabbits was four hours and for humans between two and four hours. In man, the normal biodistribution of Tc 99m (v) DMSA was in the lacrimal glands, nasal mucosa, blood pool, kidneys and bladder. In rabbits, palpation was more efficient than Tc 99m (v) DMSA planar scintigraphy in detecting superficially transplanted tumours. In humans, clinical examination was superior to Tc 99m (v) DMSA scintigraphy (planar and SPECT) in detecting squamous carcinoma. Computerised tomography was as accurate as clinical examination (but more accurate than Tc 99m (v) DMSA planar imaging) in detecting patients with squamous carcinoma. Tc 99m (v) DMSA is a cheap safe radiopharmaceutical with a low radiation dose (5.1 uSv/MBq) which is stable to two hours in-vitro. However, Tc 99m (v) DMSA imaging has no role to play in the management of patients with head and neck squamous carcinoma.

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