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Low-Density Lipoprotein e (LDL) Distribution Shown by 99mTechnetium-LDL Imaging in Patients with Myeloproliferative Diseases

Shankar Vallabhajosula, PhD; Harriet S. Gilbert, MD; Stanley J. Goldsmith, MD; Michael Paidi, PhD; Magdy M. Hanna, MD; and Henry N. Ginsberg, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support from grants HL 21006, HL 36000, and RR-71 from the New York Heart Association and the National Institutes of Health.

Requests for Reprints: Shankar Vallabhajosula, PhD, Department of Physics-Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Current Author Addresses: Drs. Vallabhajosula and Goldsmith: Department of Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Dr. Gilbert: Albert Einstein School of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.Dr. Paidi: Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Dr. Hanna: Department of Hematology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Dr. Ginsberg: Columbia University College of Physicians and Surgeons, Department of Medicine, New York, NY 10032.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(3):208-213. doi:10.7326/0003-4819-110-3-208
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Study Objective: To image and identify by noninvasive methods the sites of low-density lipoprotein (LDL) catabolism in patients with myeloproliferative disease in whom chronic hypocholesterolemia was previously reported.

Study Design: The 99mTechnetium-LDL (Tc-LDL) distribution in patients with myeloproliferative diseases was compared with that in normal subjects. The Tc-LDL distribution was also compared with the distribution and organ uptake of a macrophage-seeking radiotracer, 99mTc-sulfur colloid (Tc-SC).

Setting: Major metropolitan referral center and institutional practice.

Patients: Three normal subjects, two patients with polycythemia vera, two with post polycythemia myeloid metaplasia, and one with agnogenic myeloid metaplasia. The patients were being managed with hydroxyurea or phlebotomy.

Intervention: Ten mCi of Tc-LDL (homologous) was injected intravenously.

Measurements and Main Results: Gamma camera images of Tc-LDL biodistribution and organ uptake were obtained 4 hours after injection of the tracer. In normal subjects, the Tc-LDL was predominantly taken up by the liver, with relative nonvisualization of spleen and central or peripheral marrow. Patients with myeloproliferative disease showed marked splenic uptake of Tc-LDL. Peripheral bone marrow uptake extended to the lower tibia in two patients with post-polycythemia myeloid metaplasia. Splenic and bone marrow uptake paralleled that of Tc-SC. Hypercellularity of central and peripheral marrow at the sites of Tc-LDL uptake was confirmed by biopsy specimens. The Tc-LDL uptake, however, was not correlated with collagen fibrosis.

Conclusions: These results indicate that spleen and bone marrow are sites of LDL catabolism in patients with myeloproliferative disease and suggest the role of macrophages in the hypocholesterolemia and accelerated LDL catabolism of myeloproliferative disease.





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