Incidental accumulation of Technetium-99m pertechnetate in subacute cerebral infarction: A case report

BACKGROUND When interpreting nuclear medicine images,unexpected findings are sometimes encountered.Recognizing these findings and determining the mechanism of their occurrence could have a significant impact on early diagnosis of critical diseases and the appropriate management of patients.CASE SUMMARY A 59-year-old man was admitted to the emergency room due to left hemiparesis,left hemifacial palsy,and mild dysarthria.After 2 wk of hospitalization,the patient complained of dry eyes and mouth.Thus,salivary scintigraphy was performed to evaluate the functional status of his salivary glands.Incidental accumulation in the right frontoparietal area was found on salivary scintigraphy.Fluid-attenuated inversion recovery phase magnetic resonance(FLAIR phase MR)image showed diffuse high signal intensity in the same area.Anterior and posterior horns of the right lateral ventricle were obliterated and the midline was slightly shifted to the left side due to right frontoparietal swelling.On salivary scintigraphy,Tc-99m pertechnetate was incidentally accumulated in a subacute cerebral infarction lesion.Two years after the diagnosis of acute infarction,the second series of salivary scintigraphy showed no abnormal activity in the brain.FLAIR phase MR image also demonstrated markedly decreased high signal intensity in the previous infarction lesion without evidence of swelling indicating chronic cerebral infarction.CONCLUSION This case highlights that Tc-99m pertechnetate could accumulate in a subacute cerebral infarction lesion.The mechanism of an unexpected uptake of Tc-99m pertechnetate in unusual sites should be evaluated and kept in mind for better interpretation.

Differential Diagnosis of Warthin's Tumor Complicated with Lung Adenocarcinoma by 18F- FDG PET/CT Imaging and Radioisotope Scanning with Tc-99m Pertechnetate:A Case Report and Literature Review

A seventy eight years old male patient underwent a whole body 18F- FDG PET/CT imaging to diagnose the lesion which was showed in the right lung by a chest X ray test and CT scan before. Besides the intense 18F- FDG uptake of the lesion in the right lung, a lesion in the left parotid gland also showed intense 18F- FDG uptake. To evaluate the pathology of the lesion in the left parotid gland, a parotid gland scintigraphy imaging with Tc-99m pertechnetate was done and revealed a Warthin＇s tumor. Later a fine needle aspiration（FNA） confirmed that it was a Warthin＇s tumor.

Direct technetium-99m labeling of anti-hepatoma monoclonal antibody fragment:a radioimmunoconjugate for hepatocellular carcinoma imaging

AIM To directly radiolabel an anti-hepatomamAb fragment HAb18 F（ab’）2 with 99mTc bystannous-reduced method,and assess thestability,biodistribution and radioimmun-oimaging（RⅡ）.METHODS Immunoreactive fraction wasdetermined according to Lindmo’s method.Ellman’s reagent was used to determine thenumber of thiols in the reduced F（ab’）2.Labelingefficiency and homogeneity were measured bypaper chromatography,sodium dodecylsulphatepolyacrylamide gel electrophoresis（SDS-PAGE）and autoradiography.Challenge assay involvedthe incubation of aliquots of labeled antibody inethylenediaminetetraacetate（ EDTA ）and L-cysteine（L-cys）solutions with different molarratio at 37℃ for 1h,respectively.Investigationsin vivo utilized nude mice bearing humanhepatocellular carcinoma（HHCC）xenograftswith gamma camera imaging and tissuebiodistribution studies at regular intervals.RESULTS The labeling procedure was finishedwithin 1.5 h compared with the'pretinning'method which would take at least 21h.In vitrostudies demonstrated that the radiolabeled mAbfragment was homogeneous and retained itsimmunoreactivity.Challenge studies indicatedthat 99mTc-labeled HAb18 F（ab’）2 in EDTA is morestable than in L-cys.Imaging and biodistribution showed a significant tumor uptake at 24 h post-injection of 99mTc-labeled HAb18 F（ab’）2.Theblood,kidney,liver and tumor uptakes at 24hwere 0.56±0.09,56.45±11.36,1.43±0.27 and6.57±3.01（%ID/g）,respectively.CONCLUSION 99mTc-HAb18 F（ab’）2 conjugateprepared by this direct method appears to be aneffective way to detect hepatoma in nude micemodel.

Effect of Technetium-99 Conjugated with Methylene Diphosphonate on IgM-RF,IgG-RF and IgA-RF

To explore the effect of technetium-99 conjugated with methylene diphosphonate ( 99 Tc-MDP) on IgM-RF, IgG-RF and IgA-RF (RFs), 47 cases were selected for study, including 33 patients with rheumatoid arthritis (RA) and 15 patients with joint pain/arthritis. After 99 Tc-MDP for drips model being given to the patients by intravenous drip 0.2 g daily for 5 days, the injection A and B models of 99 Tc-MDP were used to the patients by intravenous injection one set daily for 10 days, that was one course of treatment. The next course started after 10 days. Each case used it from 2 to 4 courses of treatment. The RFs in serum were determined by the method of enzyme-linked immunoabsorption assay (ELISA) before and after 2 and 4 courses of treatment. In the patients with RA, the concentrations of IgM-RF were 296.2±108.4 IU/ml, 189.5±92.3 IU/ml and 107.8±72.5 IU/ml; the concentrations of IgG-RF were 325.6±126.2 IU/ml, 209.7±98.2 IU/ml and 160.2±80.8 IU/ml; the concentrations of IgA-RF were 330.4±136.3 IU/ml, 210.7±89.2 IU/ml and 148.8±72.2 IU/ml before and after 2 and 4 courses of treatment, respectively. The concentrations of the above RFs were significantly lower after 2 and 4 courses than those before treatment ( P <0.05 and P <0.01). There was no significant difference in RFs concentrations in the patients with joint pain/arthritis before and after use of 99 Tc-MDP. In the patients with positive RFs before treatment, the RFs concentrations were decreased significantly after 2 and 4 courses of treatment ( P <0.05 and P <0.01). There was no obvious change of RFs concentrations in the patients with negative RFs after treatment of 99 Tc-MDP. It was concluded that 99 Tc-MDP could obviously reduce the abnormally high concentrations of RFs, but not influence the normal RFs, which indicated that 99 Tc-MDP has an important effect on controlling the activities of RA.

Anti-sense oligonucleotide labeled with technetium-99m using hydrazinonictinamide derivative and N-hydroxysuccinimidyl S-acetylmercaptoacetyltriglycline: A comparison of radiochemical behaviors and biological properties

AIM:To explore and compare the radiochemical behavior and biological property of anti-sense oligonuc-leotide (ASON) labeled with technetium-99m using N-hydroxysuccinimidyl S-acetylmercaptoacetyltriglycl ine (NHS-MAG3) and hydrazinonictinamide derivative (HYNIC). METHODS:After HYNIC and NHS-MAG3 were synthesized, ASON was labeled with technetium-99m using HYNIC and NHS-MAG3 as a bifunctional chelator. The in vivo and in vitro stability, binding rates of labeled compounds to serum albumen, biodistribution of 99mTc-MAG3-ASON and 99mTc-HYNIC-ASON in BALB/C mouse and its HT29 tumor cellular uptake were compared. RESULTS:The labeling efficiency and stability of 99mTc-MAG3-ASON were significantly higher than those of 99mTc-HYNIC-ASON (P = 0.02, and P = 0.03, respectively). 99mTc-MAG3-ASON had a significantly lower rate of binding to serum albumen than 99mTc-HYNIC-ASON (P < 0.05). In contrast to 99mTc-HYNIC-ASON, the biodistribution of 99mTc-MAG3-ASON was significantly lower in blood, heart, liver and stomach (P < 0.05), slightly lower in intestines and spleen (P > 0.05) and significantly higher in lung and kidney (P < 0.05). The HT29 tumor cellular uptake rate of 99mTc-MAG3-ASON was significantly higher than that of 99mTc-HYNIC-ASON (P < 0.05). CONCLUSION:99mTc-MAG3-ASON shows superior radiochemical behaviors and biological properties than 99mTc-HYNIC-ASON. 99mTc-MAG3-ASON is a potential radiopharmaceutical agent for in vivo application.

Guava extract (Psidium guajava) alters the labelling of blood constituents with technetium-99m

Psidium guajava (guava) leaf is a phytotherapic used in folk medicine to treat gastrointestinal and respiratory dis-turbances and is used as anti-inflammatory medicine. In nuclear medicine, blood constituents (BC) are labelled with techne-tium-99m (99mTc) and used to image procedures. However, data have demonstrated that synthetic or natural drugs could modify the labelling of BC with 99mTc. The aim of this work was to evaluate the effects of aqueous extract of guava leaves on the labelling of BC with 99mTc. Blood samples of Wistar rats were incubated with different concentrations of guava extract and labelled with 99mTc after the percentage of incorporated radioactivity (%ATI) in BC was determined. The results suggest that aqueous guava extract could present antioxidant action and/or alters the membrane structures involved in ion transport into cells, thus decreasing the radiolabelling of BC with 99mTc. The data showed significant (P<0.05) alteration of ATI in BC from blood incubated with guava extract.

Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.

Leukocyte-technetium-99m uptake in Crohn's disease:Does it show subclinical disease?

AIM:To evaluate inflammatory activity in patients with Crohn's disease (CD) using technetium-99m-hexamethylpropyleneamine oxime (99mTc-HMPAO) granulocyte scintigraphy.METHODS: Twenty patients (7 male and 13 female) with CD and five healthy volunteers were selected for 99mTc-HMPAO granulocyte scintigraphy. The Crohn's Disease Activity Index (CDAI), blood tests and C-reactive protein (CRP) of each patient were performed 7 d before the scintigraphic images. The leukocytes were labeled according to the International Society of Radiolabeled Blood Elements (ISORBE) consensus protocol and the scintigraphic images, including single photon emission computed tomography, were obtained 30 min and 2 h after injection of the radiolabeled leukocytes.RESULTS:The labeling yield of the leukocytes with the lipophilic complex 99mTc-HMPAO was 55.0%±10%. Six of the 20 patients (30%) presented congruent results for the three parameters investigated (CDAI, Scintigraphic Index and CRP). On the other hand, 14 patients (70%) did not show congruent results. There was no significant correlation between the indices analyzed according to the Spearman test (P>0.05,n=20).CONCLUSION: The results suggest that 99mTc-HMPAO-labeled leukocyte scintigraphy could be important for determining inflammatory activity in CD even in the absence of clinical symptoms.

Technetium-99m-labeled annexin V imaging for detecting prosthetic joint infection in a rabbit model

Accurate and timely diagnosis of prosthetic joint infection is essential to initiate early treatment and achieve a favorable outcome. In this study, we used a rabbit model to assess the feasibility of technetium-99m-labeled annexin V for detecting prosthetic joint infection. Right knee arthroplasty was performed on 24 New Zealand rabbits. After surgery, methicillin-susceptible Staphylococcus aureus was intra-articularly injected to create a model of prosthetic joint infection （the infected group, n = 12）. Rabbits in the control group were injected with sterile saline （n= 12）. Seven and 21 days after surgery, technetium-99m-labeled annexin V imaging was per- formed in 6 rabbits of each group. Images were acquired 1 and 4 hours after injection of technetium-99m- labeled annexin V （150 MBq）. The operated-to-normal-knee activity ratios were calculated for quantitative ana- lysis. Seven days after surgery, increased technetium-99m-labeled annexin V uptake was observed in all cases. However, at 21 days a notable decrease was found in the control group, but not in the infected group. The operated-to-normal-knee activity ratios of the infected group were 1.84 ±0.29 in the early phase and 2.19 ±0.34 in the delay phase, both of which were significantly higher than those of the control group （P=0.03 and P=0.02）. The receiver operator characteristic curve analysis showed that the operated-to-normal-knee activity ratios of the delay phase at 21 days was the best indicator, with an accuracy of 80%. In conclusion, technetium- 99m-labeled annexin V imaging could effectively distinguish an infected prosthetic joint from an uninfected prosthetic joint in a rabbit model.

Quantitative Analysis of the Tomographic Technetium-99m MIBI (^(99m)Tc-MIBI) Myocardial Bullseye Display: Application to Diagnosis of Coronary Artery Disease

In this study, the 99mTc-MIBI myocardial bullseye display of 31 healthy persons and 34 patients with myocardial ischemia and 17 patients with myocardial infarction were analyzed quantitatively, and compared with the results of myocardial tomography analysis and qualitative bullseye analysis. The sensitivities of the three methods were 88.2%, 91.2 % and 94.1 % respectively (P>0.05),and the specificities were 93. 5%, 83, 9% and 83. 9% respectively (P<0.05).On the other hand, the quantitative analysis obviously outperformed the other two methods in the detection of ischemic segments of myocardium near infarction zone (P<0. 01). The quantitative analysis of 99mTc-MIBI myocardial bullseye (quantitative bullseye) was an objective, specific and sensitive method for diagnosis of coronary artery disease.

A NEW BIFUNCTIONAL CHELATING AGENT α,ε-N,N'-BIS(L-CYSTEINYL)-L-LYSINE FOR RADIOLABELLING OF MONOCLONAL ANTIBODIES WITH TECHNETIUM-99M

α,ε-N,N'-bis(L-cysteinyl)-L-lysine was synthesized and char- acterized for the first time.It was then employed as a bifunctional chelating agent to chelate technetium-99m and subsequently conjugated to fragment F(ab')_2 of anti-gastric tumor monoclonal antibody 3G9.The radiolabelled antibody was satisfactorily stable and immunoreactive.

小儿消化道出血^(99)Tc^m高锝酸盐对异位胃黏膜显像的特征

目的 研究小儿消化道出血99Tcm 高锝酸盐异位胃黏膜的显像特征 ,建立美克尔憩室和小肠重复畸形影像学的诊断标准。方法 对 14 1例消化道出血患儿作了99Tcm 高锝酸盐异位胃黏膜显像 ,按 7.4MBq/kg静脉注射99Tcm 高锝酸盐 ,以脐为中心进行动态 17min和静态 30min或 1h的采集。结果 14 1例患儿中 5 9例显像阳性 ,阳性检出率为 41.84%。 14 1例消化道出血中 ,经手术和病理证实了 48例。其中美克尔憩室 18例 ,形态呈小圆形或近似小圆形 1～ 3cm的异常浓集区。小肠重复畸形 2 2例 ,其中呈条索肠袢状 12例 ,团块状 5例 ,4cm以上大圆形异常浓集区 4例。食管、胃重复畸形 3例。在 48例患儿中 ,假阴性率为 2 .0 8% (小肠重复畸形 1例 ) ,假阳性 5例 ,为 10 .42 %。结论 美克尔憩室与小肠重复畸形在 99Tcm 高锝酸盐异位胃黏膜显像中 。

HPLC对^(99)Tc^(m)发生器洗脱液中高锝酸盐的分析和测定

利用反相ＨＰＬＣ对凝胶型￣（９９）Ｍｏ－￣（９９）Ｔｃ￣ｍ发生器洗脱液中高锝酸盐（ＴｃＯ）进行了分析鉴定和含量测定，并与液闪法测量结果进行了比较。在实验条件下，ＴｃＯ的ＨＰＬＣ色谱峰的保留时间（Ｒ＿ｔ）为（３．００±０．０５）ｍｉｎ，其峰高与浓度呈线性关系（相关系数为０．９９９）。方法对ＴｃＯ的检测限为１。５×１０￣（－８）ｍｏｌ／ｌ，化学回收率为９５％－１０５％，方法还可用于￣（９９）Ｔｃ￣ｍ标记放射性药物（药盒）中高锝酸盐的检测。

含碘食物对Graves病患者甲状腺^(131)I与^(99m)Tc摄取的不同影响

目的探讨含碘食物对Graves病患者摄取99mTc与131I的影响。方法选择曾食含碘食物的Graves病患者20例,在禁食含碘食物前后分两次进行摄131I试验与甲状腺99mTc显像,前者测定3、24 h摄131I率,后者计算摄锝指数(TI)及估算甲状腺质量(TW)。采用Wilcoxon 符号秩和检验对数据进行对比分析。结果20例患者禁止含碘食物前后的摄131I率显著不同,所有患者禁食含碘食物后3和24 h摄131I率均显著增高。TI 2例未变、2例增高、16例降低;TM18例减小、2例增大。较未禁食含碘食物的首次检测,两者均有显著性变化。结论含碘食物对甲状腺摄取Na99mTcO4的影响与Na131I显著不同,含碘食物100%减低甲状腺131I的摄取而90%锝摄取增高。

甲状腺^(99)Tc^mO_4^-显像冷结节的临床诊断价值

目的 探讨甲状腺99TcmO-4 显像冷结节对不同性质甲状腺疾病的诊断价值。方法 采用静脉注射99TcmO-4 185MBq ,2 0min后甲状腺前位静态显像 ,采集总计数 1× 10 6。显像显示甲状腺结节局部放射性分布缺损或低于正常甲状腺组织则定性为冷结节。结果 34 2例甲状腺99TcmO-4 显像发现冷结节 85例 ,发生率为2 4.9% ,85例冷结节中 ,37例 (4 3.5 % )为甲状腺瘤 ,15例为甲状腺癌 (17.6 % ) ,2 0例 (2 3.5 % )为结节性甲状腺肿 ,8例 (9.4% )为甲状腺炎 ,4例 (4 .7% )为单纯性甲状腺囊肿 ,1例 (1.3% )为甲状腺外肿物。结论 冷结节在甲状腺99Tcm O-4 显像时较为常见 ,且不同性质甲状腺疾病的冷结节及其周围组织有一定的特征性表现 ,因此99TcmO-4显像冷结节对甲状腺腺瘤、甲状腺癌、甲状腺囊肿、甲状腺炎等常见疾病具有较高的临床价值。

Hepatic clearance measured with ^(99m)Tc-GSA single-photon emission computed tomography to estimate liver fibrosis

AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.

Is there a role for Tc-99m (V) DMSA scintigraphy in ischemic colitis?

AIM: To evaluate the role of pentavalent Tc-99m dimercaptosuccinic acid [Tc-99m (V) DMSA] in the diagnosis of ischemic colitis. METHODS: Fourteen patients with endoscopically and histologically confirmed ischemic colitis were included in the study. Tc-99m (V) DMSA scintigraphy was performed within 2 d after colonoscopy. Images were considered positive when an area of increased activity was observed in the region of interest and negative when no abnormal tracer uptake was detected. RESULTS: In 3 out of the 14 patients, Tc-99m (V) DMSA images showed moderate activity in the bowel. The scintigraphic results corresponded with the endoscopic findings. In the other 11 patients, no abnormal tracer uptake was detected in the abdomen. CONCLUSION: Besides the limited number of patients, Tc-99m (V) DMSA could not be considered as a useful imaging modality for the evaluation of ischemic colitis.

LABELLING OF METALLOTHIONEIN WITH ^(99m)Tc

99mTc-labelled metallothionein (99mTc-MT) was prepared through both direct and transcomplexation labelling approaches. Buffer systems and a variety of other parameters in the direct labelling procedure were studied in detail. High radiolabelling yields of 93-96% and the specific radioactivity of 3.7 MB/μg were obtained under optimal conditions by the direct labelling method. The prepared 99mTc-MT was stable in vitro. The chelate-exchange kinetics of MT with 99mTc-glucohepatonate and 99mTc-citrate were also studied. Biodistribution and imaging studies showed that 99mTc-MT was accumulated in the animal kidneys at an exceptionally high level, indicating that 99mTc-MT might be a potential renal imaging agent.

Assessment of Warm and Cold Ischemia on Functions of the Operated Kidney with ^99mTc-DMSA in Renal Masses: A Prospective and Randomized Study

Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.

Removal of Technetium (⁹⁹Tc) from Aqueous Waste by Manganese Oxide Nanoparticles Loaded into Activated Carbon

Technetium-99 is a radioactive isotope with a half-life of 2.13 × 105 year. 99Tc is a significant contaminant of concern to the world. For this reason, a detailed understanding of technetium chemistry is essential for the protecting the public and the environment especially after increasing the various applications and uses of isotopes in the medical practices. Therefore, treatment of waste increases prior to the safe discharge to the environment or the storage. The sorption of technetium in the form of pertechnetate on a nano manganese oxide loaded into activated carbon has been investigated. Nano manganese oxide (NMO) was synthesized from manganese chloride and potassium permanganate by co-precipitation and forming a new composite by loading a nanoparticle into a modified activated carbon by different ratios. Modifications of activated carbons using different concentrations of HNO3 (4 M, 6 M and 8 M) are used in prepared composites. Fourier transform infrared spectroscopy (FT-IR), X-Ray Diffraction (XRD) and Scanning Electron Microscope (SEM) were used to characterize the prepared composites. The adsorption of anions from low level radioactive aqueous waste was examined using batch technique. Different parameters affecting on the adsorption process were studied for the removal of . The results revealed that NMO/AC (4 M, 6 M and 8 M) has a high adsorption efficiency (93.57%, 90.3% and 90.3%) respectively compared to NMO and AC which have a lower adsorption efficiency (41% and 38.9%) respectively. Moreover, the adsorption isotherm belonged to Freundlich model, the adsorption data followed pseudo-second order model and the thermodynamic study indicated that the adsorption of on Nano-composites was an exothermic and spontaneous process.