Functional significance of recruitable collaterals during temporary coronary occlusion evaluated by 99mTc-sestamibi single-photon emission computerized tomography.

OBJECTIVES: The present study evaluated the impact of recruitable collaterals on regional myocardial perfusion measured by 99mtechnetium (Tc)-sestamibi single-photon emission computerized tomography (SPECT) during temporary coronary occlusion and related these estimates to the coronary wedge pressure and electrocardiographic (ECG) ST-segment changes. BACKGROUND: Clinical variables (angina and ECG changes) and intracoronary flow and pressure recordings have indicated a protective role of recruitable collaterals on myocardial perfusion during percutaneous transluminal coronary angioplasty (PTCA). METHODS: Thirty patients (mean age 55 years, SD 9; 20 men) with stable angina pectoris and proximal nonocluding single-vessel left anterior descending coronary artery (LAD)-stenosis scheduled for PTCA were included. Visualization of recruitable collaterals by ipsilateral and contralateral contrast injection, registration of coronary wedge pressure and injection of 99mTc-sestamibi during 90-s LAD occlusions were undertaken. A rest perfusion study was performed within four days before PTCA. As an estimate of the severity of regional hypoperfusion during occlusion, an occlusion/rest count ratio was calculated (mean defect pixel count during occlusion divided by mean pixel count in identical regions at rest). RESULTS: The scintigraphic occlusion/rest count ratio was higher in patients with recruitable collaterals (n = 16), 67 +/- 11%, compared to patients without collaterals (n = 14), 60 +/- 6% (p < 0.05). The occlusion/rest count ratio correlated with the coronary wedge pressure (R2 = 0.34; p < 0.001). The occlusion/rest count ratio was lower, 61 +/- 6%, in patients with ST-segment elevation (n = 23) versus 74 +/- 9% in patients without ST-segment elevation (n = 7) (p < 0.0001). CONCLUSIONS: Using 99mTc-sestamibi SPECT imaging during brief episodes of coronary occlusion, the severity of regional myocardial hypoperfusion was reduced by the presence of recruitable collaterals in a selected patient population with proximal LAD stenoses. Our results demonstrate a protective effect of recruitable collaterals on myocardial perfusion during temporary coronary occlusion.

Systolic blood pressure relates to the rate of decline of glomerular filtration rate in type II diabetes.

OBJECTIVE: To relate deterioration in kidney function to some potential cardiovascular risk factors in type II diabetic patients. RESEARCH DESIGN AND METHODS: Twenty-four normoalbuminuric and 13 microalbuminuric patients completed a 3.4-yr prospective observational study. Glomerular filtration rate, urinary albumin excretion rate, blood pressure, glycemic control, and lipids were measured on entry and at the end of the study. Of the patients, 19 normoalbuminuric and 8 microalbuminuric (73%) patients had no history of antihypertensive treatment. RESULTS: The glomerular filtration rate was significantly reduced during the follow-up period (-1.34 +/- 0.54 ml.min-1.1.73 m-2 [mean +/- SE], P < 0.02). The rate of decline varied considerably in normoalbuminuric and microalbuminuric patients (from -13.5 to 4.3 and from -7.0 to 4.2 ml.min-1.1.73 m-2 per year, respectively) but was on average not accelerated in normoalbuminuric or microalbuminuric patients (-1.3 +/- 0.7 and -1.5 +/- 0.8 ml.min-1.1.73 m-2 per year, respectively). Significant correlations were observed between the glomerular filtration rate fall rate and initial systolic blood pressure (r = -0.47, P < 0.01; patients without antihypertensive treatment: r = -0.42, P = 0.03) but not diastolic blood pressure. In a stepwise multiple linear regression analysis, baseline systolic blood pressure significantly determined the fall rate of the glomerular filtration rate (regression coefficient = -0.050, SE = 0.018, P = 0.011; patients without antihypertensive treatment: regression coefficient = -0.047, SE = 0.021, P = 0.030). CONCLUSIONS: In these type II diabetic patients neither normoalbuminuria nor microalbuminuria are at an average associated with an accelerated decline in kidney function. Still, systolic blood pressure is a determining factor for the rate of decline in the glomerular filtration rate. A longer follow-up time with consecutive glomerular filtration rate measurements are needed to determine the long-term implications of normoalbuminuria and microalbuminuria on kidney function in type II diabetic patients.

Unchanged extraction of atrial natriuretic factor across the chronic ischemic human kidney.

The extractions of atrial natriuretic factor (EANF) and the glomerular filtration marker 51Cr-ethylenediamine tetraacetic acid (EEDTA) were determined before and after intravenous injection of furosemide across each of the two kidneys during renal vein catheterization in hypertensive patients with unilateral or bilateral renovascular disease. Before administration of furosemide, EANF was approximately 55% across both the more and the less affected kidney while EEDTA was significantly decreased across the more affected kidney. Significant lateralization of renin secretion to the more affected kidney was found, demonstrating an enhanced ipsilateral formation of renin. Administration of furosemide caused a significant decrease in EEDTA across the less affected kidney while the ipsilateral EANF did not change. Furosemide caused no change in EEDTA or EANF across the more affected kidney. No significant correlations were found between EANF and EEDTA. These results demonstrate that the extraction of ANF is unchanged across the chronic ischemic human kidney. Furthermore, in the single kidney, changes in EEDTA, as induced by furosemide, are not related to changes in ipsilateral EANF. Since the relation between simultaneously determined single kidney extractions of ANF and 51Cr-EDTA reflects the relation between the single kidney clearance of ANF and the ipsilateral glomerular filtration rate, our data indicate a dissociation between changes in the single kidney glomerular filtration rate and the ipsilateral total renal clearance of ANF.

Chromium-51-EDTA clearance in adults with a single-plasma sample.

UNLABELLED: In 1996, a committee on renal clearance recommended a mean sojourn time-based methodology for single-sample determination of plasma clearance of 99mTc-diethylenetriamine pentaacetic acid (DTPA) to be used on adults if the patient's glomerular filtration rate (GFR) is suspected to be >30 ml/min. The main purpose of this study was to derive a mean sojourn time-based formula for calculation of 51Cr-ethylenediamine tetraacetic acid (EDTA) clearance in adults. METHODS: Two groups of patients with 51Cr-EDTA clearance (Cl) between 16 and 172 ml/min were studied. In Group I (n = 46), reference Cl was determined as a multiplasma sample, single-injection method (ClSM). Sixteen blood samples were drawn from 0 until 5 hr after a single intravenous injection of 51Cr-EDTA. In Group II (n = 1046), reference Cl was determined by the Brøchner-Mortensen four-sample clearance method (ClBM). The plasma time-activity curves of Group I were used to derive two mean sojourn time-based formulas (Formulas 1 and 2) for calculation of a single-sample clearance. Formula 1 was derived from the entire time-activity curve, whereas the derivation of Formula 2 used only the final slope of the time-activity curve. The accuracy of the two formulas and the Christensen and Groth 99mTc-DTPA formula was tested on Group II. RESULTS: Chromium-51-EDTA Cl calculated by Formula 1 was almost identical to the Cl calculated by the reference Cl method (r = 0.982; SDdiff = 5.82 ml/min). Both 51Cr-EDTA Cl calculated by Formula 2 and by the 99mTc-DTPA formula showed close correlation with the reference method (r = 0.976, r = 0.985, respectively) but systematically overestimated GFR for the whole range of clearance values by 3.5 and 3.2 ml/min (p<0.001), respectively. CONCLUSION: It is possible to get an accurate determination of 51Cr-EDTA Cl from a single-plasma sample in adults by the mean sojourn time methodology. The determination is marginally more accurate (p<0.001) if using a formula derived from the entire plasma time-activity curve than from only the final slope. The single-sample formula derived for determination of 99mTc-DTPA Cl tends slightly to overestimate GFR if used to calculate 51Cr-EDTA Cl.

Consensus report on quality control of quantitative measurements of renal function obtained from the renogram: International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology.

Among all the physiological indices that can be quantified using renography, measurement of renal function is the most basic. These measurements are used to make critical clinical management decisions and, as such, their reliability needs to be quality assured. This article seeks to address each aspect of the renography procedure, with particular emphasis on the effect on measurement of relative renal function. Estimation of individual kidney function is mentioned, but only briefly. A consensus approach was adopted, overseen, and directed by a chairman appointed by the Scientific Committee of the International Radionuclides in Nephro-Urology Group. The chairman selected the panel of experts from eight different countries based on their practical experience in the field. Where evidence exists to support the various recommendations it is given. Otherwise, the stated guidance represents the considered opinion of a body of experts, based on long experience and unpublished data. Some necessary compromises were made to account for the fact that renography is seldom performed solely with the purpose of measuring relative renal function. The technicalities of renography have always been a source of debate in nuclear medicine, which is reflected by the fact that a consensus could simply not be reached on a small number of issues. The structure of the report ensures that these are clearly indicated. This should serve to highlight gaps in our current knowledge, thus helping to direct future research. It is envisaged that the recommendations will be revised on a 2-year cycle to ensure that they remain up to date. An "open" process will be used to encourage participation and ownership. It is hoped that promotion of these guidelines, suitably complemented by audit processes, will raise standards in the practice of gamma camera renography.

Tissue distribution of 131I-labelled epidermal growth factor in the pig visualized by dynamic scintigraphy.

We visualized the metabolism of intravenously injected 131I-labelled epidermal growth factor in the pig using dynamic scintigraphy combined with repetitive samplings of blood, urine and bile. The labelled peptide was recognized in the samples by means of immunoprecipitation and high pressure liquid chromatography. The plasma elimination was extremely rapid, and it was described with a triexponential equation, C(t) = A*e -alpha*t+B*e-beta*t+C*e-gamma*t. The first two exponentials denoted the distribution phase, and the third the elimination phase. T1/2 alpha ranged from 0.4-0.7 min, T1/2 beta from 2.0-2.2 min and T1/2 gamma from 53.3-97.6 min. Concomitant with the rapidly declining plasma concentration, the gamma camera visualized the uptake by the liver and the kidneys. The liver was the principal organ for clearance and degradation of the labelled peptide, but only 0.12-0.30% of the injected dose was excreted into the bile. The renal uptake and the urinary excretion accounted for 6.6-13.0 and 2.5-4.9% of the given dose, respectively.

Haemodynamic effects of single-dose felodipine in normal man.

The haemodynamic effects of an oral solution of 15 mg felodipine were studied in 8 healthy males. Maximal plasma concentrations of felodipine were seen 30 to 40 minutes after administration, when significant decreases in diastolic and mean blood pressures were noted. Heart rate increased maximally by 45% after 30 minutes, accompanied by a 57% increase in cardiac output and 175% increase in forearm blood flow. Total peripheral resistance decreased by 40% and forearm vascular resistance by 66%. Apparent hepatic blood flow was unchanged.

Long term haemodynamic effects of pinacidil and hydralazine in arterial hypertension.

Eight patients with a diastolic blood pressure greater than or equal to 100mm Hg when treated with a diuretic and a beta-blocker participated in a randomised crossover study comparing the haemodynamic effects of adjunctive therapy with pinacidil or hydralazine. The vasodilator dose was increased until the diastolic blood pressure was less than 90mm Hg or the maximum dosage, hydralazine 100mg twice daily, or pinacidil 50mg twice daily, was reached. Treatment continued for 3 to 6 months and a haemodynamic study was performed. After washout, the patients received the alternative treatment. In the upright position, during supine rest and during isometric as well as dynamic exercise, pinacidil lowered blood pressure more effectively than hydralazine. No differences between the 2 treatments were found in heart rate, stroke index, cardiac index, end systolic wall stress or glomerular filtration rate. Pulmonary mean and wedge pressure were lower during treatment with pinacidil. Forearm blood flow was higher and forearm vascular resistance lower during treatment with pinacidil. Cardiac contractility, judged from the systolic time interval ratio PEP: LVET, was lower during treatment with pinacidil compared with hydralazine. The median daily dose of pinacidil was 50mg and that of hydralazine 200mg. It was also noted that during long term treatment, pinacidil seemed more effective in reducing blood pressure than hydralazine.

Myocardial perfusion imaging in breast cancer patients treated with or without post-mastectomy radiotherapy.

PURPOSE: To assess the occurrence and location of myocardial perfusion defects in left-sided mastectomized breast cancer patients, treated with or without postoperative radiotherapy according to the guidelines from the Danish Breast Cancer Cooperative Group (DBCG). PATIENTS AND METHODS: Seventeen left-sided breast cancer patients, with a median age of 59 years (range, 47-75 years), randomized to post-mastectomy irradiation plus systemic treatment, or systemic treatment alone, were examined after a median follow-up of 7.9 years (range, 6.0-12.2 years). The chest wall and the ipsilateral internal mammary nodes had been treated through two anterior-shaped electron fields, and the electron energy was chosen according to chest wall thickness, measured individually by ultrasound. The median absorbed dose was 50 Gy in 25 fractions, with 5 fractions/week. Information on clinical history was obtained and symptoms of ischemic heart disease (IHD), as well as major risk factors, were recorded. All patients had a physical examination, blood chemistry, electrocardiogram (ECG), chest X-ray and myocardial perfusion imaging by sestamibi-single photon emission computerized tomography (SPECT). SPECT-scanning was performed as a rest/dipyridamole 2-day protocol. The evaluation of regional myocardial perfusion was based on scintigrams using a 20-segment model. RESULTS: There was no significant difference between the scintigraphic findings in the two groups. Four of ten irradiated patients and four of seven non-irradiated patients showed scintigraphic defects. An anterior defect was found in one non-irradiated patient. CONCLUSIONS: This study does not indicate that the described radiotherapy technique induces detectable coronary artery disease. However, the small number of patients does not allow strong conclusions to be drawn.

Acute unilateral obstruction of ureter. Disparity in divided renal function calculated from 131I-hippuran and 99mTc-DTPA renography.

Fifteen patients with acute unilateral obstruction of ureter and 30 control patients were studied with simultaneous 131I-Hippuran and 99mTc-DTPA gamma camera renography. In severe outflow obstruction the relative function of the obstructed kidney was higher when calculated with Hippuran than with DTPA. No difference was found in the control subjects. This means that the glomerular filtration rate of an obstructed kidney may be relatively more reduced than the renal blood flow. Therefore, measurement of the single kidney fraction of total glomerular filtration rate has to be calculated with a glomerular filtered tracer, e.g., 99mTc-DTPA.

Approximation of arterial input curve data in MRI estimation of cerebral blood-tumor-barrier leakage: comparison between Gd-DTPA and 99mTc-DTPA input curves.

Accurate and reproducible MRI measurements of the blood-brain-barrier transport rate constant Ki require measurements of the arterial Gd-DTPA concentration to characterise the arterial input function to the brain. Methods of measuring [Gd] in human plasma are not common practice in clinical departments. In this study we present a fast and easy method of substituting Gd-DTPA with 99mTc-DTPA as the 'tracer' to be measured for the characterisation of the arterial input curve in MRI blood-brain-barrier (BBB) measurements. Gd-DTPA and 99mTc-DTPA was injected intravenously as a bolus into six brain tumor patients during dynamic, fast gradient-echo MRI. Arterial blood samples were collected with an interval of 10(5) during imaging. 99mTc-DTPA and Gd-DTPA were measured in the same blood samples by scintillation counting and Inductively Coupled Plasma Atomic Emission Spectroscopy respectively. The two methods yield the concentrations of both the tracers in mmol/l Gd-DTPA and hence the results are directly comparable. The data results showed no statistically significant difference between the two methods. However, the 99mTc-DTPA method had fewer 'bad points' than the direct Gd-DTPA measurement method. The input curves were in agreement. Conclusively, we found that Gd-DTPA and 99mTc-DTPA were equivalent with regard to distribution and elimination-kinetics during the first 10 min after administration and, therefore, characterisation of arterial input curves may be done using simultaneous injection of 99mTc-DTPA and Gd-DTPA in facilities where means of measuring Gd-DTPA is not available.

Plasma clearance of 99Tcm-MAG3: accuracy of five single-sample methods.

The aim of this study was to compare the accuracy of five single-injection, single-sample methods for the assessment of plasma clearance of 99Tcm-MAG3 in adults. In 51 patients, a reference plasma clearance was determined on the basis of 16 blood samples. It ranged from 13 to 313 ml.min-1. In patients with a plasma clearance less than 75 ml.min-1, there was a large difference between the clearance obtained by a single-sample method and the reference method. Thus single-sample methods should not be used with these patients. In patients with a plasma clearance higher than 75 ml.min-1, the relative difference was (mean +/- s): 6.07 +/- 9.96% (Russell et al., 1989), 14.22 +/- 8.08% (Müller-Suur et al., 1991), 7.29 +/- 6.21% (Bubeck et al., 1992), 6.64 +/- 7.71% (Russell et al., 1996) and 17.39 +/- 7.39% (Piera et al., 1997). Reference clearance was overestimated by all five single-sample methods, especially by the methods of Müller-Suur et al. and Piera et al. The smallest standard deviation was obtained using the method of Bubeck et al. This method is recommended for use in patients with a plasma clearance greater than 75 ml.min-1.

Protein binding of 99Tcm-DTPA compared with other GFR tracers.

99Tcm-Diethylenetriaminepentaacetic acid (99Tcm-DTPA) has been postulated to be more bound to plasma proteins than are other radiopharmaceuticals used for measurement of glomerular filtration rate (GFR). The results of protein binding experiments are, however, highly related to methodology. The aim of the present study was to compare the protein binding of the 99Tcm-DTPA preparation we use in our daily routine with that of the other five 99Tcm-DTPA preparations available and with other GFR tracers by using the same ultrafiltration method. Protein binding was studied in vitro after incubation in donor plasma and in vivo after single injection in patients. A correction for the uneven distribution of ultrafiltrable ions ('Donnan effect') was included. Quality control of six 99Tcm-DTPA preparations performed with thin layer chromatography showed a high labelling efficiency (96.2-99.9%). The in vitro protein binding ranged from 9.25% to 11.12%. The in vitro protein binding of 99Tcm-DTPA was not significantly different from that of 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) and 125I-iothalamate (10.99% vs 12.15%, and 9.55%). There was no difference in the in vivo protein binding of 99Tcm-DTPA 5 and 40 min after injection (13.28% vs 12.58%), and there was no difference in the protein binding of 99Tcm-DTPA and 51Cr-EDTA (12.93% vs 12.54%). In conclusion, in vitro and in vivo protein binding of 99Tcm-DTPA was 10-13%. The protein binding was not different from the binding of 51Cr-EDTA and 125I-iothalamate.

Patients with ovarian cancer have elevated (51)Cr-EDTA plasma clearance early post-operatively.

Plasma clearance of (51)Cr-EDTA (Clp(EDTA)) is widely used to determine glomerular filtration rate prior to carboplatin based chemotherapy. We have observed that many patients with ovarian cancer have elevated Clp in the early post-operative phase compared to later phases. The purpose of this study was to examine whether this observation reflects a systematic difference. We retrospectively analysed data from 53 patients who had undergone surgery for ovarian cancer. Twenty-six patients had Clp(EDTA) measured early after the operation (mean, 8 days (range, 3-16 days)) (early group), and 27 patients had Clp(EDTA) measured late post-operatively (mean, 32 days (range, 19-48 days)) (late group). Clp(EDTA) values was measured before the first, third and fifth course of chemotherapy. Additionally, age, height, weight, cancer stage, ascites and tumour histology were noted. Mean Clp(EDTA) in the early group was significantly higher than in the late group (104+/-4.4 vs 89+/-3.5 ml.min(-1) per 1.73 m(2); P =0.005). Clp(EDTA) declined significantly in the early group from the first measurement after the operation until measurement before the third course of chemotherapy but remained constant in the late group. Clp(EDTA) was not correlated to ascites, cancer stage or tumour histology. It is concluded that patients with ovarian cancer have significantly higher Clp(EDTA) in the early post-operative phase than similar patients with Clp(EDTA) measured late post-operatively.

Location of adrenal medullary pheochromocytoma by I-123 metaiodobenzylguanidine SPECT.

This is a retrospective study evaluating the efficacy of SPECT in the location of pheochromocytoma. Thirty patients with a suspected pheochromocytoma underwent I-123 metaiodobenzylguanidine (I-123 MIBG) SPECT 4 and 22 hours after intravenous injection of 370 MBq I-123 MIBG. SPECT was compared with planar scintigraphy, CT scanning, histology, and clinical course. Twenty-two-hour I-123 MIBG SPECT correctly identified 10 patients with adrenal medullary pheochromocytoma and correctly excluded pheochromocytoma in 19 patients. The sensitivity of the 22-hour MIBG SPECT was 1.00 and the specificity was 0.95. The positive predictive value was 0.95 and the negative predictive value was 1.00. In 16 patients, planar scintigraphy was compared with SPECT. SPECT located normal adrenal glands and tumors with greater confidence in three dimensions, but the patients with adrenal medullary pheochromocytoma were all correctly identified by planar scintigraphy. The results of SPECT and CT agreed in 29 of 30 patients (96.7%). I-123 MIBG SPECT for the location of pheochromocytoma has a high sensitivity, specificity, and positive and negative predictive values. I-123 MIBG SPECT or CT scanning alone were equally good for locating adrenal medullary pheochromocytoma but the combination of MIBG SPECT and CT makes it possible to distinguish between functioning and nonfunctioning adenomas. I-123 MIBG SPECT may be used alone or in combination with planar scintigraphy when three-dimensional location of a lesion is wanted.

Limited value of 99mTc depreotide single photon emission CT compared with CT for the evaluation of pulmonary lesions.

OBJECTIVES: A contrast-enhanced multidetector CT (MDCT) scan is the first choice examination when evaluating patients with suspected lung cancer. However, while the clinical focus is on CT, research focus is on molecular biological methods whereby radiolabelled pharmaceuticals are injected into participants and target malignant lung tumours. We examined whether a contrast-enhanced MDCT scan supplied with an additional non-contrast enhanced high-resolution CT scan, or a newer but more expensive (99m)Tc depreotide single photon emission CT (SPECT) scan, was the better first-choice examination for the work-up of pulmonary lesions. Furthermore, we examined whether a (99m)Tc depreotide SPECT scan was an appropriate second-choice examination for patients with indeterminate lesions. METHODS: 140 participants were included in the analysis. CT images were given a malignancy potential rating of 1, 2 or 3 with higher rating being indicative of disease. (99m)Tc depreotide SPECT images were graded either positive or negative. Histopathology and CT follow-up were used as reference standard. Sensitivity, specificity and diagnostic accuracy were calculated. RESULTS: Overall sensitivity, specificity and diagnostic accuracy of CT were 97%, 30% and 84%, respectively. Overall sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 94%, 58% and 76%, respectively. For indeterminate lesions sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 71%, 68% and 69%, respectively. CONCLUSION: Both CT and (99m)Tc depreotide SPECT made valuable contributions to the evaluation of pulmonary lesions. (99m)Tc depreotide SPECT results were not superior to CT results and did not contribute further to the diagnostic work-up. Regarding indeterminate lesions,( 99m)Tc depreotide SPECT sensitivity was too low.

Stability, protein binding and clearance studies of [99mTc]DTPA. Evaluation of a commercially available dry-kit.

[99mTc]DTPA has achieved widespread use for the measurement of glomerular filtration rate (GFR) with the single injection plasma clearance technique and for gamma-camera renography. However, the quality of the commercial preparations varies. The purpose of the present investigation was to study the quality of a commercial [99mTc]DTPA preparation (C.I.S., France) with reference to stability, protein binding and accuracy of the determined plasma clearance values as a measure of GFR. The stability of the preparations was studied by thin-layer chromatography, the in vitro protein binding by Sephadex filtration after incubation with human serum albumin and in vivo protein binding by filtration of human plasma. The accuracy of the plasma clearance values was investigated by comparison with the simultaneously measured plasma clearance of [51Cr]EDTA. There was no detectable free pertechnetate or hydrolysed reduced technetium in eight vials five and six hours after the preparation. The in vitro protein binding 10 (20), 120 and 300 min after the preparation of eight vials was 2.3% (0.8%), 0.2% and 0.1%, respectively. The in vivo protein binding in 12 patients 5, 90 and 180 min after the injection was 0.3%, 0.7% and 1.1%, respectively. The plasma clearance of [99mTc]DTPA was on an average 3.7% higher than that of [51Cr]EDTA in 27 patients. It is concluded that the [99mTc]DTPA preparation is reliable for the measurement of GFR. The preparation is stable for at least six hours at room temperature. It is recommended not to use the [99mTc]DTPA until 30 min after the preparation.

Measurement of glomerular filtration rate in adults: accuracy of five single-sample plasma clearance methods.

After an intravenous injection of a tracer that is removed from the body solely by filtration in the kidneys, the glomerular filtration rate (GFR) can be determined from its plasma clearance. The method requires a great number of blood samples but collection of urine is not needed. In the present investigation the total plasma clearance of 51Cr-EDTA (ethylenediaminetetra-acetate) was assessed from 13 blood samples taken 5-300 min post-injection in 44 adult patients with GFR greater than 15 ml min-1. In 34 of these patients the plasma clearance of 99Tcm-DTPA (diethylenetriaminepenta-acetate) was determined simultaneously. Using these clearance values as reference the accuracy of six simplified methods were studied: five single-sample methods and one five-sample method. The standard error of estimate (SEE) of the single-sample methods ranged from 4.2 to 7.5 ml min-1 using EDTA, and from 3.8 to 6.3 ml min-1 using DTPA. SEE of the five-samples method was 3.0 ml min-1 (EDTA) and 3.1 ml min-1 (DTPA). The single-sample methods given by Christensen & Groth (1986) and by Tauxe (1986) are recommended for daily use, as SEE was small even at low GFR values. In patients with GFR less than 80 ml min-1, in whom a highly accurate determination is needed, a multiple samples method is recommended, e.g., Brøchner-Mortensen (1972).