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Fulltext Unusual mediastinal lymph node uptake and peritoneopleural fistula demonstrated on Technetium-99m macro-aggregated human serum albumin (Tc-99m MAA) peritoneal scintigraphy in a patient with portal hypertension

Tan CJ, Thang SP, Lam WW

Med J Malaysia, 2016 04;71(2):69-71.
PMID: 27326945

Peritoneal radionuclide scan is an established imaging modality for evaluating peritoneopleural communications. In this case report, unusual mediastinal lymph node radiotracer uptake is seen in a patient with portal hypertension on peritoneal scintigraphy. This was suspected to be due to marked lymphatic enlargement from longstanding portal hypertension since childhood, permitting passage of the large Tc-99m MAA particle. The nodes were morphologically benign on CT. Mediastinal lymph node uptake on peritoneal scintigraphy is rare but should not raise undue clinical concern, particularly in a patient with chronic portal hypertension. Anatomic correlation with SPECT-CT can provide reassurance.

Matched MeSH terms: Technetium; Technetium Tc 99m Aggregated Albumin/pharmacokinetics*
Uptake and clearance analysis of Technetium99m labelled iron oxide nanoparticles in a rabbit brain

Nadeem M, Ahmad M, Saeed MA, Shaari A, Riaz S, Naseem S, et al.

IET Nanobiotechnol, 2015 Jun;9(3):136-41.
PMID: 26023157 DOI: 10.1049/iet-nbt.2014.0012

Nanoparticles as solid colloidal particles are extensively studied and used as anticancer drug delivery agents because of their physical properties. This current research aims to prepare water base suspension of uncoated iron oxide nanoparticles and their biodistribution study to different organs, especially the brain, by using a single photon emission computed tomography gamma camera. The water-based suspension of iron oxide nanoparticles was synthesised by a reformed version of the co-precipitation method and labelled with Tc99m for intravenous injection. The nanoparticles were injected without surface modification. X-ray diffraction (XRD), energy dispersive spectrometry (EDS) and transmission electron microscope (TEM) techniques were used for characterisation. Peaks of XRD and EDS indicate that the particles are magnetite and exist in aqueous suspension. The average diameter of iron oxide nanoparticles without any surface coating determined by TEM is 10 nm. These particles are capable of evading the reticuloendothelial system and can cross the blood-brain barrier in the rabbit. The labelling efficiency of iron oxide nanoparticles labelled with Tc99m is 85%, which is good for the biodistribution study. The sufficient amount of iron oxide nanoparticles concentration in the brain as compared with the surrounding soft tissues and their long blood retention time indicates that the water-based suspension of iron oxide nanoparticles may be an option for drug delivery into the brain.

Matched MeSH terms: Technetium/pharmacokinetics*; Technetium/chemistry
Comparison of various creatinine-based estimates of glomerular filtration rate equations in the Malaysian setting

Mohd Hanafiah FH, Azrina MR, Abdul Rahim MS

Med J Malaysia, 2022 Nov;77(6):684-688.
PMID: 36448385

INTRODUCTION: Kidney disease is a worldwide health concern with an increasing mortality in the past 10 years. The Kidney Disease Improving Global Outcomes (KDIGO) guideline advocates the use of estimated glomerular filtration rate equation (eGFR) to estimate renal function. We evaluated the performance of Cockroft Gault (CG), Modified Diet of Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to measured GFR 99mTc- DTPA taking into account body mass index (BMI) and age group.
MATERIALS AND METHODS: This is a cross-sectional study of patients referred for 99mTc-DTPA scan at the Nuclear Medicine Centre of International Islamic University Malaysia. The record was taken from patients visiting the centre from January 2016 to December 2019.
RESULTS: The mean measured GFR by 99mTc-DTPA scan was 42.2 ± 20.38 ml/min. These were lower than that estimated by CG, MDRD, and CKD-EPI equations. CKD-EPI had the highest correlation of 0.72, least bias (mean bias of 11.08 ± 23.08) and was more precise (r2 = 0.4) as compared to MDRD and CG. In patients < 65 years old, CKD-EPI had the highest correlation; however, MDRD had the least bias and highest accuracy. In terms of BMI, CKD-EPI had the least bias and highest accuracy for BMI >30 and with the highest correlation for all classes of BMI.
CONCLUSION: CKD-EPI has the best estimation of GFR taking into account the effect of BMI and age. A further study can be done to determine the correlation of estimated GFR equations with different ethnicity in Malaysia.

Matched MeSH terms: Technetium Tc 99m Pentetate*
Giant Liver Hemangioma Mimicking a Hydronephrotic Kidney on 99mTc-DTPA Scintigraphy

Boey CY, Mohamed Aslum Khan F, Amir Hassan SZ

Clin Nucl Med, 2021 Jan;46(1):88-89.
PMID: 33181737 DOI: 10.1097/RLU.0000000000003368

We report a case of a 56-year-old woman who underwent Tc-DTPA renal scintigraphy for the evaluation of a right pelviureteric junction calculi, which incidentally showed radiotracer uptake in a giant liver hemangioma. The initial scintigraphic images showed a large lobulated lesion with peripheral uptake of radiotracer at the right abdominal region, resembling a large hydronephrotic kidney. However, the pattern of progression of the radiotracer, coupled with the clinical history and available corresponding radiologic images, confirmed the uptake to be that of a giant liver hemangioma.

Matched MeSH terms: Technetium Tc 99m Pentetate*
Synthesis and characterization of potential tumor scintigraphic agents

Awaluddin AB, Jacobs JJ, Bourne DW, Maddalena DJ, Wilson JG, Boyd RE

Int J Rad Appl Instrum A, 1987;38(8):671-4.
PMID: 2822626

Potential tumor imaging radiopharmaceutical agents have been prepared by attaching a cisplatin derivative to a ligand capable of forming a stable complex with 99mTc. Three new organometallic compounds, with iminodiacetic acid as the 99mTc chelating group and 2,3-diaminopropionamide as the platinum complexing group, have been prepared and characterized. Preliminary biodistribution studies in tumor bearing mice support the utility of this approach.

Matched MeSH terms: Technetium*
Fulltext Myocardial infarct imaging using 99m technetium pyrophosphate and 99mtechnetium methylene diphosphonate: a clinical evaluation

Paramsothy M, Singham KT

Med J Malaysia, 1980 Mar;34(3):289-300.
PMID: 7412670

Radioisotope detection and localisation of myocardial infarction is discussed. Its clinical value and pitfalls are also discussed. The clinical application of this safe, simple, sensitive, repeatable, reproducible and non-invasive method in Malaysian patients performed during the period October 1978 to April 1979 at the University Hospital is reviewed. The main value of 99mTc labelled phosphate scan is in the demonstration and localisation of recent myocardial infarctions in patients where the electrocardiogram or serum enzymes changes are unhelpful.

Matched MeSH terms: Technetium*
Brain scans with Tc99m (pertechnetate) in children

Arumugasamy N

Med J Malaya, 1968 Dec;23(2):110-4.
PMID: 4240820
Matched MeSH terms: Technetium*
Fulltext An Incidental Detection of Popliteal Vein Aneurysm during Labeled Leukocyte Scintigraphy

Hassan HA, Nazri M, Azman RR

World J Nucl Med, 2012 May;11(2):81-3.
PMID: 23372443 DOI: 10.4103/1450-1147.103421

Technetium (99mTc) exametazime (hexamethylpropyleneamine oxime, HMPAO) labeled leukocyte scintigraphy is mainly used to exclude occult infection in our institution. On review of previously published article, no case of popliteal venous aneurysm was ever diagnosed and detected on labeled leukocyte scintigraphy. We present a rare case of popliteal venous aneurysm which was detected on labeled leukocyte scintigraphy and was further confirmed with single-photon emission computed tomography and computed tomography fusion.

Matched MeSH terms: Technetium
Fulltext Comparison of Low-Pass Filters for SPECT Imaging

Sayed IS, Ismail SS

Int J Biomed Imaging, 2020;2020:9239753.
PMID: 32308670 DOI: 10.1155/2020/9239753

In single photon emission computed tomography (SPECT) imaging, the choice of a suitable filter and its parameters for noise reduction purposes is a big challenge. Adverse effects on image quality arise if an improper filter is selected. Filtered back projection (FBP) is the most popular technique for image reconstruction in SPECT. With this technique, different types of reconstruction filters are used, such as the Butterworth and the Hamming. In this study, the effects on the quality of reconstructed images of the Butterworth filter were compared with the ones of the Hamming filter. A Philips ADAC forte gamma camera was used. A low-energy, high-resolution collimator was installed on the gamma camera. SPECT data were acquired by scanning a phantom with an insert composed of hot and cold regions. A Technetium-99m radioactive solution was homogenously mixed into the phantom. Furthermore, a symmetrical energy window (20%) centered at 140 keV was adjusted. Images were reconstructed by the FBP method. Various cutoff frequency values, namely, 0.35, 0.40, 0.45, and 0.50 cycles/cm, were selected for both filters, whereas for the Butterworth filter, the order was set at 7. Images of hot and cold regions were analyzed in terms of detectability, contrast, and signal-to-noise ratio (SNR). The findings of our study indicate that the Butterworth filter was able to expose more hot and cold regions in reconstructed images. In addition, higher contrast values were recorded, as compared to the Hamming filter. However, with the Butterworth filter, the decrease in SNR for both types of regions with the increase in cutoff frequency as compared to the Hamming filter was obtained. Overall, the Butterworth filter under investigation provided superior results than the Hamming filter. Effects of both filters on the quality of hot and cold region images varied with the change in cutoff frequency.

Matched MeSH terms: Technetium
Fulltext Compensatory renal hypertrophy in reflux nephropathy presenting as hypertensive emergency

Othman Tan SES, Mohamad SD, Ahmad MZ

Oxf Med Case Reports, 2021 Feb;2021(2):omaa132.
PMID: 33614043 DOI: 10.1093/omcr/omaa132

Hypertensive emergency in the paediatric population is not uncommon. However, due to its numerous etiologies, care should be taken in determining the approach of management. We report a case of a child who presented with double vision, giddiness and elevated blood pressure. Blood investigations were normal. Renal ultrasound and magnetic resonance imaging of the abdomen were performed which both showed findings suspicious of a large heterogeneous mass at the lower pole of the left kidney with dysplastic right kidney. A final diagnosis of bilateral vesicoureteric reflux with left compensatory hypertrophy was made based upon micturating cystourethrography findings and was later confirmed by 99mTc-dimercaptosuccinic acid (DMSA) study. The objective of this case is to share the importance of the appropriate choice of radiological examinations, not only in achieving an accurate diagnosis but to ensure that unnecessary investigations are avoided.

Matched MeSH terms: Technetium Tc 99m Dimercaptosuccinic Acid
Fulltext Tc99m-besilesomab with the added benefit of Single Photon Emission Computed Tomography/Computed Tomography (spect/ct): current role in infection detection and localisation

Farahnaz Mohamed Aslum Khan, Siti Zarina Amir Hassan, Noor Khairiah A. Karim, Khadijah Abdul Hamid, Leong, Chee Loon

Malaysian Journal of Medicine and Health Sciences, 2018;14(201):1-8.
MyJurnal

Imaging modality has become increasingly important in hospital setting especially in cases of unknown site of infection/pyrexia of unknown origin (PUO) and osteomyelitis (OM). In recent years, nuclear imaging has been used and is known to deliver prompt and precise diagnoses of numerous infectious diseases. The purpose of the study is to detect and localise the site of infection using Tc99m-besilesomab and to assess the added contributions of single photon emission computed tomography/computed tomography (SPECT/CT) over planar scan in patients with PUO and OM. Methods: Tc99m-besilesomab with SPECT/CT were prospectively performed in 23 patients (eight males, 15 females) with suspected infection. True findings were diagnosed by both cold and hot spot in the scan with reference to positive blood or tissue cultures, or other additional imaging. Results: Tc99m-besilesomab managed to detect presence of infection with high sensitivity of 87.5% and specificity of 71.4%. Interobserver variability agreement that was obtained between the presence of infection and the ability of Tc99m-besilesomab imaging to detect it was significant (p

Matched MeSH terms: Technetium
Fulltext Role of scintimammography in the diagnosis of breast cancer

Das BK, Biswal BM, Bhavaraju M

Malays J Med Sci, 2006 Jan;13(1):52-7.
PMID: 22589591 MyJurnal

X-ray mammography has been the backbone of early detection of breast cancer. Several large scale systematic studies have shown that judicious use of X-ray mammography can indeed save life. However, though reasonably sensitive, X-ray mammography lacks in specificity leading to many unnecessary biopsies. Scintimammography is a relatively new imaging method to demonstrate cancer tissue in the breast. A radiopharmaceutical agent (Tc-99m Sestamibi) is administered intravenously and images of the breast are taken under a Gamma Camera. There is no need for any manipulation like compression of the breast as required to be done during mammography. The radiopharmaceutical accumulates in the breast in the presence of cancer tissue which can easily be seen in the images. The affinity of the cancer tissue to this radiopharmaceutical is up to 9 times in comparison to normal breast tissue. Several multi centric studies with blinded image interpretation have established the sensitivity and specificity of scintimammography to be above 85 and 90 % respectively as compared to 89 and 14 % respectively for X-ray mammography. The positive and negative predictive values of scintimamography are 70 and 83 % as against 49 and 57 % respectively for X-ray mammography. With the increasing availability of Nuclear Medicine facilities it is expected that more and more patients will benefi with the use of this new imaging modality .

Matched MeSH terms: Technetium Tc 99m Sestamibi
Comparison of Shear Wave Elastography and Conventional Ultrasound in Assessing Kidney Function as Measured Using 51Cr-ethylenediaminetetraacetic Acid and 99Tc-Dimercaptosuccinic Acid

Leong SS, Wong JHD, Md Shah MN, Vijayananthan A, Jalalonmuhali M, Ng KH

Ultrasound Med Biol, 2019 06;45(6):1417-1426.
PMID: 30962016 DOI: 10.1016/j.ultrasmedbio.2019.01.024

The purpose of this study was to assess the potential of shear wave elastography (SWE) as an indicator of abnormal kidney function defined by radiolabeled glomerular filtration rate (GFR). Fifty-seven patients referred for 51Cr-ethylenediaminetetraacetic acid GFR and 99mTc-dimercaptosuccinic acid renal scintigraphy were included. Young's modulus (YM) measured with SWE and kidney length, volume, cortical thickness and parenchymal echogenicity measured with conventional ultrasound were correlated with patients' GFR and renal scintigraphy results. Spearman correlation coefficients between SWE and GFR were negative for the right (r = -0.635, p < 0.0001) and left (r = -0.817, p < 0.0001) kidneys. Positive correlations between left renal cortical thickness (r = 0.381, p = 0.04) and left kidney volume (r = 0.356, p = 0.019) with GFR were reported. SWE correctly predicted the dominant functioning kidney in 94.7% of cases. The area under the receiver operating characteristic curve for SWE (0.800) was superior to that for conventional ultrasound (0.252-0.415). The cutoff value of ≥5.52 kPa suggested a kidney function ≤60 mL/min/1.73 m2 (82.4% sensitivity and 76.2% specificity). SWE has advantages over conventional ultrasound in assessing kidney function and distinguishing the dominant functioning kidney.

Matched MeSH terms: Technetium*
Fulltext Mediastinal parathyroid adenoma: diagnostic and management challenges

Che Kadir S, Mustaffa BE, Ghazali Z, Hasan Z, Imisairi AH, Mustafa S

Singapore Med J, 2011 Apr;52(4):e70-4.
PMID: 21552777

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.

Matched MeSH terms: Technetium Tc 99m Sestamibi/pharmacology
Fulltext Swyer-James-MacLeod syndrome

Chan PWK, DeBruyne JA, Goh AYT, Muridan R

Med J Malaysia, 1999 Dec;54(4):520-2.
PMID: 11072474

Swyer-James-MacLeod syndrome is a rare complication of respiratory tract infection occurring in early childhood. We report two children with chronic cough and recurrent wheezing who fulfilled the diagnostic criteria for this disorder: 1) Unilateral loss of lung volume with hyperlucency on chest x-ray. 2) Unilateral reduction in vascularity on CT scan of the chest. 3) Unilateral loss of perfusion on Technetium 99c lung scan.

Matched MeSH terms: Technetium
Fulltext Standardized Uptake Value from Semiquantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography in Normal Thoracic and Lumbar Vertebrae of Breast Cancer Patients

Rohani MFM, Yonan SNM, Tagiling N, Zainon WMNW, Udin Y, Nawi NM

Asian Spine J, 2020 Oct;14(5):629-638.
PMID: 32213791 DOI: 10.31616/asj.2019.0308

STUDY DESIGN: Retrospective study.
PURPOSE: This study aims to semiquantitatively evaluate the standardized uptake value (SUV) of 99mTc-methylene diphosphonate (MDP) radionuclide tracer in the normal vertebrae of breast cancer patients using an integrated single-photon emission computed tomography (SPECT)/computed tomography (CT) scanner.
OVERVIEW OF LITERATURE: Molecular imaging techniques using gamma cameras and stand-alone SPECT have traditionally been utilized to evaluate metastatic bone diseases. However, these methods lack quantitative analysis capabilities, impeding accurate uptake characterization.
METHODS: A total of 30 randomly selected female breast cancer patients were enrolled in this study. The SUV mean (SUVmean) and SUV maximum (SUVmax) values for 286 normal vertebrae at the thoracic and lumbar levels were calculated based on the patients' body weight (BW), body surface area (BSA), and lean body mass (LBM). Additionally, 106 degenerative joint disease (DJD) lesions of the spine were also characterized, and both their BW SUVmean and SUVmax values were obtained. A receiver operating characteristic (ROC) curve analysis was then performed to determine the cutoff value of SUV for differentiating DJD from normal vertebrae.
RESULTS: The mean±standard deviations for the SUVmean and SUVmax in the normal vertebrae displayed a relatively wide variability: 3.92±0.27 and 6.51±0.72 for BW, 1.05±0.07 and 1.75±0.17 for BSA, and 2.70±0.19 and 4.50±0.44 for LBM, respectively. Generally, the SUVmean had a lower coefficient of variation than the SUVmax. For DJD, the mean±standard deviation for the BW SUVmean and SUVmax was 5.26±3.24 and 7.50±4.34, respectively. Based on the ROC curve, no optimal cutoff value was found to differentiate DJD from normal vertebrae.
CONCLUSIONS: In this study, the SUV of 99mTc-MDP was successfully determined using SPECT/CT. This research provides an approach that could potentially aid in the clinical quantification of radionuclide uptake in normal vertebrae for the management of breast cancer patients.

Matched MeSH terms: Technetium Tc 99m Medronate
The role of PET/CT amyloid Imaging compared with Tc99m-HMPAO SPECT imaging for diagnosing Alzheimer's disease

Suppiah S, Ching SM, Nordin AJ, Vinjamuri S

Med J Malaysia, 2018 06;73(3):141-146.
PMID: 29962497

BACKGROUND: Imaging such as Tc99m-HMPAO single photon emission computed tomography (SPECT), and positron emission tomography/ computed tomography (PET/CT) amyloid scans are used to aid the diagnosis of Alzheimer's disease (AD).
OBJECTIVE: We aimed to correlate the ability of these modalities to differentiate Probable AD and Possible AD using the clinical diagnosis as a gold standard. We also investigated the correlation of severity of amyloid deposit in the brain with the diagnosis of AD.
METHODS: A retrospective study of 47 subjects (17 Probable AD and 30 Possible AD) who were referred for PET/CT amyloid scans to our centre was conducted. Hypoperfusion in the temporo-parietal lobes on Tc99m-HMPAO SPECT and loss of grey-white matter contrast in cortical regions on PET/CT Amyloid scans indicating the presence of amyloid β deposit were qualitatively interpreted as positive for AD. SPECT and PET/CT were also read in combination (Combo reading). The severity of amyloid β deposit was semiquantitatively assessed in a visual binary method using a scale of Grade 0-4. The severity of amyloid β deposit was assessed in a visual binary method and a semi-quantitative method using a scale of Grade 0-4.
RESULTS: There was significant correlation of Tc99m-HMPAO SPECT, PET/CT amyloid findings and Combo reading with AD. The sensitivity, specificity, PPV and NPV were 87.5%, 73.7%, 58.3% and 93.3% (SPECT); 62.5%, 77.4%, 58.8% and 80.0% (PET/CT) and 87.5%, 84.2%, 70.0% and 30.0% (Combo reading) respectively. The grade of amyloid deposition was not significantly correlated with AD (Spearman's correlation, p=0.687).
CONCLUSION: There is an incremental benefit in utilizing PET/CT amyloid imaging in cases with atypical presentation and indeterminate findings on conventional imaging of Alzheimer's disease.

Matched MeSH terms: Technetium Tc 99m Exametazime
Fulltext Caroli's disease: functional diagnosis using 99mTc diethyl-iminodiacetic acid (IDA) hepatobiliary scintigraphy

Lai FM, Paramsothy M, Goh KL, Boey C

Singapore Med J, 1997 Apr;38(4):164-5.
PMID: 9269396

A case of Caroli's disease is presented and the findings of various imaging modalities are discussed with emphasis on the role of Technetium 99mTc diethyl-iminodiacetic acid scan in reaching the final diagnosis. The 'beaded' appearance of the dilated intrahepatic ducts seen in this scan is believed to be pathognomonic for this condition.

Matched MeSH terms: Technetium Tc 99m Diethyl-iminodiacetic Acid
Fulltext The role of 99mtechnetium (Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in the diagnosis of a rare cause of obstructive jaundice

Lai FM, Paramsothy M, George J, Yip CH

Singapore Med J, 1996 Jun;37(3):261-3.
PMID: 8942223

This paper illustrates the role of 99m-Technetium(Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in a patient who developed obstructive jaundice as a result of afferent loop syndrome, which is a rare occurrence. The computed tomographic (CT) and ultrasonographic findings are also described.

Matched MeSH terms: Technetium Tc 99m Lidofenin
Fulltext 99mTc-sodium phytate is a valid alternative to the gold-standard 99mTc-sulfur colloid in the measurement of gastric emptying among healthy multi-ethnic Asian population: results of a randomized cross-over trial

Mat Nawi N, Tagiling N, Mohd Rohani MF, Wan Zainon WMN, Zanial MS, Wong MS, et al.

BMC Gastroenterol, 2020 Aug 31;20(1):293.
PMID: 32867699 DOI: 10.1186/s12876-020-01426-5

BACKGROUND: It is unclear if the 99mTc-sodium phytate (99mTc-SP) is as reliable as the gold-standard 99mTc-sulfur colloid (99mTc-SC) for gastric emptying scintigraphy (GES). This study is aimed to compare the emptying rates of both radiotracers in a prospective, randomized cross-over trial and to determine the normative data of a healthy multi-ethnic Asian population.
METHODS: Out of the 44 healthy individuals screened, 31 (14 females; mean age: 28.4 ± 7.0 years) were enrolled and underwent GES using the standardized egg-white meal. All participants were randomly assigned to either 99mTc-SP or 99mTc-SC on the first GES session before crossed over to the other formulation after 2 weeks.
RESULTS: Both kits achieved the radiochemical purities of > 95%. The median rate (95th upper normative limit) of gastric emptying, reported as total gastric meal retention between 99mTc-SP and 99mTc-SC, was found to be comparable at all measured time points: 0.5 h [85.0% (96.6%) vs. 82.0% (94.0%)], 1 h [70.0% (86.4%) vs. 65.0% (86.6%)], 2 h [31.0% (55.8%) vs. 25.0% (64.4%)], 3 h [7.0% (26.3%) vs. 5.0% (29.9%)], and 4 h [3.0% (10.3%) vs. 2.0% (9.9%)]; P > 0.05. In addition, both radiotracers correlated well (Kendall's Tau (τ) coefficient = 0.498, P

Matched MeSH terms: Technetium Tc 99m Sulfur Colloid

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