pyrophosphate and Acute-Disease

Technetium-99 (99Tc) pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. Although bone biopsy seems useful in diagnosing osteomyelitis underlying decubitus ulcers, its role in diabetic patients with foot infections is not established. I do not recommend biopsy of foot bones in diabetic patients, since culture of bone biopsy specimens often give unreliable results in these situations because of contamination with ulcer organisms.

Topics: Acute Disease; Bone and Bones; Chronic Disease; Costs and Cost Analysis; Diabetes Complications; Diagnostic Errors; Diphosphates; Foot Diseases; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Skin Ulcer; Staphylococcal Infections; Technetium; Technetium Tc 99m Pyrophosphate; Wound Infection

Topics: Acute Disease; Coronary Care Units; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Technetium-99m-phosphate imaging is particularly valuable in detecting (1) small transmural infarcts (3 g and larger in size); (2) new acute transmural infarcts in or near regions of old infarction; (3) acute subendocardial infarcts (larger than 3 g in size); (4) acute infarction in patients with left bundle branch block; and (5) perioperative myocardial infarction. Localization of inferior and posterior myocardial infarction is improved with imaging. Sizing of acute anterior and lateral infarcts has been accurately done in dogs and should prove helpful in patients. Extensive evaluation in both experimental animals and in patients has shown 99mTc-phosphate myocardial imaging to be a useful clinical tool, and it may be one of the most sensitive noninvasive ways presently available to identify acute myocardial necrosis. It is important to understand that 99mTc-phosphate imaging has a different pathophysiology basis from EKG's or serum enzymes. These tests do not compete but instead should complement one another.

Topics: Acute Disease; Animals; Burns; Diagnosis, Differential; Diphosphates; Diphosphonates; Dogs; Electric Countershock; Humans; Myocardial Infarction; Radionuclide Imaging; Rib Fractures; Sternum; Technetium; Thoracic Injuries

Radionuclide techniques that assess regional myocardial perfusion and detect acute myocardial infarction promise to provide critical information in the detection and evaluation of coronary artery disease and in the assessment of therapies aimed at limiting the degree of ischemia and the extent of tissue necrosis. Radioindicators such as 99mTc-tetracycline and 99mTc-pyrophosphate which are sequestered by acutely infarcted myocardium provide a direct method to detect an infarct and to determine its size. Regional alterations in myocardial perfusion can be assessed by myocardial scintigraphy performed after the injection of radiopotassium or one of its analogues with the patient either at rest or at exercise. A somewhat more accurate evaluation of the extent of altered perfusion can be obtained after the intracoronary injection of macro-aggregated particles. A quantitative index of altered perfusion can be obtained after the intracoronary injection of an inert gas such as 133Xe.

Topics: Acute Disease; Cesium Radioisotopes; Coronary Circulation; Diphosphates; Humans; Myocardial Infarction; Physical Exertion; Potassium Radioisotopes; Radioisotopes; Radionuclide Imaging; Rest; Rubidium; Technetium; Tetracyclines; Thallium; Xenon Radioisotopes

This study compared Tc-99m pyrophosphate (PPi) and Tc-99m methylene diphosphonate (MDP) for myocardial infarct imaging in 24 patients with diagnosed acute myocardial infarction. The radiopharmaceuticals were administered randomly and interpreted without knowledge of the sequence used. Twenty-three patients (96%) had positive Tc-99m PPi scintigrams, but only 17 (71%) had a positive Tc-99m MDP study (P less than 0.05). In addition, a comparison of the relative intensity with each agent revealed greater intensity with Tc-99m in 21 cases, equal intensity in two cases, and less intensity in only one case (p less than 0.001). These findings support the superiority of Tc-99m PPi as the agent of choice for myocardial scintigraphy in acute infarction.

Topics: Acute Disease; Diphosphates; Diphosphonates; Evaluation Studies as Topic; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Soft tissue calcification occurs in several common acquired pathologies, such as diabetes and hypercholesterolemia, or can result from genetic disorders. ABCC6, a transmembrane transporter primarily expressed in liver and kidneys, initiates a molecular pathway inhibiting ectopic calcification. ABCC6 facilitates the cellular efflux of ATP, which is rapidly converted into pyrophosphate (PPi), a major calcification inhibitor. Heritable mutations in ABCC6 underlie the incurable calcification disorder pseudoxanthoma elasticum and some cases of generalized arterial calcification of infancy. Herein, we determined that the administration of PPi and the bisphosphonate etidronate to Abcc6

Topics: Acute Disease; Animals; ATP-Binding Cassette Transporters; Calcinosis; Chronic Disease; Diphosphates; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Etidronic Acid; Female; Liver; Male; Mice, Inbred C57BL; Mice, Knockout; Multidrug Resistance-Associated Proteins; Phenotype; Pseudoxanthoma Elasticum; Transgenes

[99mTc]-pyrophosphate (PYP) and [201Tl]-chloride dual isotope single photon emission computed tomography (SPECT) is now available to detect the site and extent of acute myocardial infarction. In inflammatory myocardial disease, [99mTc]PYP makes hot image on damaged area. We performed dual isotope SPECT of [99mTc]PYP and [201Tl]Cl in two patients with acute myocarditis and severe rhythm disturbance to evaluate the severity of inflammation. Myocardial damage was estimated by [201Tl] perfusion coloring blue and myocardial inflammation was estimated by [99mTc]PYP uptake coloring red. The overlap display of both images made it clear to detect spatial extent of myocardial inflammation. Using this technique, we expect to estimate the severity of myocarditis and to make a decision of therapeutic plan.

Topics: Acute Disease; Adult; Diphosphates; Female; Heart; Humans; Myositis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Both acute myocarditis and myocardial infarction must be considered in the differential diagnosis of the young patient with angina-like chest pain. Initial assessment may be difficult, since both diseases may produce similar clinical presentations, electrocardiographic changes, and elevations in cardiac enzymes. Early differentiation is important, however, since myocarditis and myocardial infarction differ greatly in their management and prognosis. These difficulties are illustrated by the 2 cases presented, and guidelines for diagnosis and treatment are given.

Topics: Acute Disease; Adult; Angina Pectoris; Diagnosis, Differential; Diphosphates; Echocardiography; Electrocardiography; Heart; Humans; Male; Myocardial Infarction; Myocarditis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

A comparison of synovial fluid lactate levels has been made in cases of chronic pyrophosphate arthropathy (PA) with and without joint destruction, acute PA and osteoarthritis. No statistically significant difference could be observed between results of chronic PA and osteoarthritis. By contrast, synovial fluid lactate levels were significantly higher in acute PA in comparison with the two other groups. These data suggest that hypoxia is unlikely to play a role in destructive arthropathy commonly found in chronic PA.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Chondrocalcinosis; Chronic Disease; Diphosphates; Humans; Knee Joint; Lactates; Middle Aged; Osteoarthritis; Synovial Fluid

Nephroscintigraphy using a 67Ga-citrate complex and 99mTc-pyrophosphate was performed in 88 patients with acute pyelonephritis. Nuclide hyperfixation was revealed in 97.8% of the cases. Three groups of patients were singled out on the basis of the intensity of incorporation and nature of the distribution of the radiopharmaceuticals (RP) in the kidneys. In the 1st group the RP incorporation was insignificant but higher than normal values; the RP distribution in the affected kidney was diffuse-inhomogenous. These changes were considered to be typical of acute serous pyelonephritis. In the 2nd and 3rd groups a sharp rise of the RP accumulation was noted, being typical of acute purulent pyelonephritis. One could distinguish between diffuse and focal lesions by the picture of the RP distribution in the renal parenchyma. Diuresis stimulation made it possible to differentiate an actual nuclide fixation during inflammation from nuclide mechanical retention as a result of urine outflow disorder. According to the authors, both radiopharmaceuticals could be applied for the diagnosis of acute pyelonephritis as well as for differential diagnosis of various forms of the disease.

Topics: Acute Disease; Adult; Diphosphates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Pyelonephritis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Adult; Calcium Pyrophosphate; Carpal Tunnel Syndrome; Crystallization; Diphosphates; Female; Humans; Recurrence; Wrist

A study of 38 patients with acute myocardial infarction verified by clinical, laboratory and electrocardiographic data made use of single-photon emission computered tomography, a new radiodiagnostic method for the assessment of the extent of myocardial lesion. Its findings were compared with cardiospecific enzyme activity data and showed good correlation. The new technique was found to be more informative as compared to plane scintigraphy. Possibilities of single-photon emission computered tomography are discussed with reference to the diagnosis of acute infarction at different sites and showing different radionuclide inclusion patterns.

Topics: Acute Disease; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Humans; Isoenzymes; L-Lactate Dehydrogenase; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Computerized osteoscintigrams of 54 children with osseous diseases (osteomyelitis, osseous tumors and arthritis) were analysed. 99mTc-pyrophosphate elevated accumulation in inflammatory processes was observed not only in the pathological zone but also in the epiphyses of the affected limb. The accumulation of the radiopharmaceutical agent calculated in several zones of the affected and healthy limbs provides for significant differential diagnosis of acute hematogenic osteomyelitis. In case of bone symmetric involvement by an inflammatory process and in osteomyelitis of the flat bones and the vertebral column the potentialities of the method are limited.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Diphosphates; Extremities; Humans; Infant; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Adult; Aged; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Myocardial scintigraphy was carried out in 105 coronary heart disease patients using 99mTc -pyrophosphate. Twenty-nine of these patients suffered from acute myocardial infarction. The scintigrams were analyzed with the aid of original " MAREA " programmes devised for the diagnosis of acute myocardial infarction. The results obtained suggest the possibility of using this method of the scintigram processing for assessing the severity and predicting the course of coronary heart disease.

Topics: Acute Disease; Adult; Aged; Computers; Coronary Artery Bypass; Coronary Disease; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Coronary Circulation; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Postoperative Complications; Prognosis; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Tetracyclines; Thallium; Time Factors; Tomography, Emission-Computed

Topics: Acute Disease; Arthritis; Bruxism; Calcium Metabolism Disorders; Calcium Pyrophosphate; Diphosphates; Humans; Male; Middle Aged; Temporomandibular Joint Disorders; Wrist Joint

Topics: Acute Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The relationship between ST segment elevation on the right precordial lead V4R and the hemodynamic, echocardiographic, and myocardial scintigrapic signs suggestive of right ventricular (RV) infarction was studied in 42 patients with acute inferior myocardial infarction. Twenty-two patients had ST segment elevation in V4R. Among these patients, a significant correlation was demonstrated between V4R ST segment elevation and the hemodynamic (p less than 0.001), scintigraphic (p less than 0.001), and echographic (p less than 0.02) criteria for acute RV infarction. These results support the validity of this new electrocardiographic sign as a practical means in aiding the clinical detection of RV involvement with acute transmural inferior myocardial infarction.

Topics: Acute Disease; Cardiac Output; Diphosphates; Echocardiography; Electrocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging

Topics: Acute Disease; Diphosphates; Electrocardiography; Heart; Humans; Male; Middle Aged; Myocarditis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Aged; Calcium Pyrophosphate; Chondrocalcinosis; Diphosphates; Female; Humans; Male; Synovial Fluid

Topics: Acute Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Tc-99m-pyrophosphate myocardial scintigraphy was performed on 1,077 patients admitted to the Coronary Care Unit. Results of scintigraphy were compared to the diagnosis as established by ECG, enzymes, and clinical findings to determine the sensitivity and specificity of scintigraphy for the diagnosis of acute myocardial infarction (AMI). Scintigrams were graded according to the intensity of myocardial radioactivity and the distribution pattern of activity as either diffuse or localized. In a coronary care unit, a scintigram of positive intensity grade is 92% sensitive and 68% specific for the diagnosis for AMI. A localized pattern of myocardial radioactivity is 66% sensitive and 93% specific for AMI. With a localized pattern of the highest intensity, the sensitivity is 28% with a specificity of 99.8% for AMI. Therefore, a myocardial scintigram of normal intensity grade excludes the diagnosis of AMI with a 92% probability. A localized pattern is a strong indicator of an AMI and a localized pattern of the greatest intensity is very specific for AMI.

Topics: Acute Disease; Diphosphates; Evaluation Studies as Topic; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Time Factors

A clinical comparison between a new bone seeking radiopharmaceutical, Tc-99m hydroxymethylene diphosphonate (TcHMDP) and the standard agent, Tc-99m pyrophosphate (TcPPi), was performed in 18 patients with acute myocardial infarction. Each patient was imaged initially with either TcHMDP or TcPPi, and imaged 24 hr later with the other tracer. All 18 patients had images positive for acute myocardial infarction with TcPPi, whereas 16 of 18 patients (89%) had positive studies with TcHMDP. The TcPPi images were graded significantly superior to those obtained with TcHMDP in 61% of the patients, and they were equal in 33%. In only one patient (6%) was TcHMDP better. The results indicate that compared with TcHMDP, TcPPi not only has a superior sensitivity for acute myocardial infarction but also has a significantly increased intensity of uptake in positive areas. TcPPi remains the agent of choice for myocardial infarct imaging.

Topics: Acute Disease; Diphosphates; Diphosphonates; Heart; Humans; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Myocardial scintigrams with 99mTc-pyrophosphate (PYP) were performed in 30 patients with acute myocardial infarct (AMI) and positive scintigrams were obtained in the 24 patients. In 12 patients the size of the AMI estimated from the scintigram with 99mTc-PYP was compared with the pulmonary capillary wedge pressure (PCWP). In the 7 patients with PCWP below 10 mmHg the mean area of the AMIs was 22 +/- 5.5 cm2 and that of in the 5 patients with PCWP beyond 10 mmHg was 41 +/- 12.4 cm2. This difference was statistically significant (p less than 0.05). In comparison with chest X-ray findings, the average size of the AMIs among 6 patients with alveolar and/or interstitial edema was 43 +/- 11.9 cm2 and that of among 8 patients without pulmonary edema was 25 +/- 9 cm2. The left ventricular ejection fraction (LVEF) was obtained by first pass method. In 12 patients LVEF and PCWP was compared. The 7 patients with PCWP below 10 mmHg did show significantly larger LVEF (49 +/- 8.2%) than that of 5 patients with PCWP beyond 10 mmHg (33 +/- 6.1%) (p less than 0.01). The mean LVEF in the 7 patients with pulmonary edema was 35 +/- 10.2% and that of in the 8 patients without pulmonary was 48 +/- 5.3%. Myocardial scintigram and radionuclide angiocardiography with 99mTc-PYP were useful for evaluation of the left ventricular function as well as detection of the AMI.

Topics: Acute Disease; Diphosphates; Evaluation Studies as Topic; Heart Ventricles; Humans; Myocardial Infarction; Pulmonary Artery; Radionuclide Imaging; Technetium

Fifty-nine patients with suspected osteomyelitis were referred to the Nuclear Medicine Service for bone scanning during a twelve month period. The bone scan correctly identified abnormal sites in 18 of 19 patients with osteomyelitis (sensitivity of 95%) while the radiograph detected only 6 of 19 (sensitivity of 32%). In this clinical setting, the bone scans and radiographs had specificities of 92% and 89% respectively. Technetium-99m phosphate radiopharmaceuticals are superior to the previously used isotopes of fluorine and strontium in that they are readily available, can be imaged with conventional instruments, and allow high quality scans to be completed within 4 h. Routine bone scanning should be performed in patients presenting with suspected osteomyelitis and normal radiographs. The scan can be helpful in confirming or excluding the clinical suspicion and can lead to a more rapid institution of appropriate treatment.

Topics: Acute Disease; Adolescent; Adult; Aged; Bone and Bones; Child; Child, Preschool; Diphosphates; Female; Humans; Infant; Male; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium

Technetium-99m hydroxymethylene diphosphonate (Tc-99M HMDP) is a new diphosphonate skeletal imaging agent. Animal studies show that Tc-99m HMDP has a higher uptake on bone and a more rapid clearance from the blood than any of the three technetium-labeled bone imaging agents in current use: Tc-99m methylene diphosphonate (DMP), Tc-99 (1-hydroxyethylidene) diphosphonate (HEDP), and Tc-99m pyrophosphate (PPi). On the basis of these animal studies, Tc-99m HMDP is a highly promising candidate for skeletal imaging.

Topics: Acute Disease; Animals; Bone and Bones; Diphosphates; Diphosphonates; Dogs; Etidronic Acid; Guinea Pigs; Injections, Intravenous; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors; Tissue Distribution

While the technetium-99m-pyrophosphate scintigram enables diagnostic proof of acute myocardial infarction, its use in the evaluation of the extent of infarction has not been clearly established. This study, in 30 patients with acute myocardial infarction was, thus, undertaken to assess the relationship between the findings of the technetium-99m-pyrophosphate scintigram, with respect to infarct area and uptake pattern, the infarct size, as determined from the total CK an CK-MB curves, and the mortality. The scintigraphically determined infarct areas ranged between 1.7 and 29.3 cm2; the 20.2 plus or minus 6.0 cm2 average for anterior wall infarction (n=18, range 7.4 to 29.3 cm2) was significantly greater (p smaller than 0.005) than the 8.3 plus or minus 5.3 cm2 average for inferior infarction (n=12, range 1.7 to 15.8 cm2). Correlation coefficients between the scintigraphically and enzymatically determined infarct sizes for the entire patient population ranged from 0.71 to 0.80. Anterior infarctions correlated more closely (0.66 to 0.84) than inferior infarctions (0.46 to 0.66). The technetium-99m-pyrophosphate uptake pattern was focal in 20 patients and ring-shaped (doughnut) in ten. Infarcts with focal uptake patterns were significantly smaller than those displaying a doughnut pattern (12.2 plus or minus 6.4 vs. 24 plus or minus 4.0 cm2, p smaller than 0.005). The infarct weight calculated from the CK-MC curve with application of individually determined disappearance rate for those infarcts displaying a focal uptake pattern was 34 plus or minus 29 grams while that associated with a doughnut uptake pattern was significantly greater at 86 plus or minus 25 grams (p smaller than 0.005). During the 18 -month observation period there were six deaths; the average scintigraphic infarct area of 22.8 plus or minus 3.6 cm2 in those who died was significantly greater (p smaller than 0.005) than that of the 13.8 plus or minus 8.2 cm2 of the survivors. Of the non-survivors, five had a doughnut uptake pattern and one displayed focal uptake. In the 24 survivors, a focal uptake pattern was found in 19 and a doughnut pattern in five. Conversely, 19 of the 20 patients with a focal uptake pattern survived while only five of the ten patients with a doughnut pattern were alive after 18 months. Thus, comparison with the enzymatically determined infarct weight as well as the mortality indicate that the technetium-99m-pyrophosphate scintigram yields clinically relevant data with r

Topics: Acute Disease; Body Surface Area; Creatine Kinase; Diphosphates; Humans; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium

Of the wide range of radiopharmaceuticals which accumulate in acutely myocardial tissue and subsequently enable its scintigraphic detection compounds of 99mtechnetium phosphate have proven clinically practicable in numerous investigations. As opposed to the similarly non-invasive method of myocardial scintigraphy with ionic tracers (201thallium scintigraphy), infarct detection through positive delineation is possible, at the earliest, six to twelve hours faster the onset of pain and meaningful for those in whom the classical ECG and enzyme changes are equivocally diagnostic and for patients with delayed hospital admissions. After approximately one week the concentration of activity in the necrotic zone and, in turn, its detectability, declines. Persistent activity is indicative of extensive infarction and poor prognosis. The sensitivity of the infarct scintigram, which is primarily carried out with 99mTc-pyrophosphate or 99mTc-methylendiphosphonate, is about 86% with small and sudbendocardial infarcts more frequently eluding detection. The method corresponds with electrocardiographic assessment of localization. The combination with 201thallium scintigraphy is useful in differentiating remote from acute infarction and in detection of right ventricular involvement associated with inferior infarction. In spite of a good correlation between the experimentally-determined infarct weight and scintigraphic findings, clinical investigations employing conventional methods of measurement (scintillation camera) have not been able to yield an early and accurate quantification of the appearance may occur, for example, in unstable angina pectoris. Thus, a negative infarct scintigram carried out at the optimal time of uptake assumes its most useful role in ruling out acute myocardial infraction in the presence of otherwise equivocal clinical findings.

Topics: Acute Disease; Diphosphates; Diphosphonates; Evaluation Studies as Topic; False Negative Reactions; Humans; Ligands; Myocardial Infarction; Radionuclide Imaging; Technetium

Pyrophosphate arthropathy has a wide spectrum of clinical symptoms and is a common cause of synovitis in the elderly. The acute "pseudogout" attack is the most commonly recognized, but chronic synovitis might be just as prevalent. Familial pyrophosphate arthropathy with a dominant autosomal heredity is a rare form, with an earlier debut and a more severe prognosis. Another rare expression of pyrophosphate arthropathy is severe joint destruction. The cause of pyrophosphate arthropathy is still unknown. Both individual reactivity and crystal properties determine the intensity of the inflammatory response to crystals.

Topics: Acute Disease; Adult; Aged; Anti-Inflammatory Agents; Calcium Pyrophosphate; Cartilage, Articular; Chondrocalcinosis; Chronic Disease; Diphosphates; Female; Humans; Intervertebral Disc; Knee Joint; Male; Middle Aged; Radiography; Synovial Fluid; Synovitis

Scintigraphy with pyrophosphate 99mTc was performed in 230 patients with various forms of ischemic heart disease and in 15 persons with pain in the region of the heart caused by osteochondrosis of the cervical and thoracic spinal segments or vegetovascular dystonia (control group). It was found that labelled purophosphate accumulated in the myocardium in necrosis of the heart muscle or when coronary insufficiency takes a course in which necrosis of the myocardial cells is quite possible. Positive results of scintigraphy with pyrophosphate 99mTc are not a strict criterion of acute myocardial infarction because they are also encountered in a chronic course of ischemic heart disease and are evidence in this case that "a state of risk" has occurred during the disease.

Topics: Acute Disease; Angina Pectoris; Cervical Vertebrae; Coronary Disease; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Neurocirculatory Asthenia; Osteochondritis; Radionuclide Imaging; Technetium

To determine the sensitivity of myocardial scintigraphy with technetium-99m pyrophosphate during the early phase of acute myocardial infarction, 31 patients admitted to the coronary care unit with prolonged ischemic pain underwent imaging within 4 to 8 hours and again at 24 hours after the onset of symptoms. In 11 of 15 patients with documented acute myocardial infarction, increased focal myocardial uptake was demonstrated on early myocardial scintigraphy. Focal uptake was observed in only 2 of 16 patients with unstable angina pectoris. Three or four patients with normal early scintigrams had massive transmural myocardial infarction. Normal early scintigrams in these three patients may have reflected poor perfusion because the images were abnormal at 24 hours. In four patients the extent of technetium-99m pyrophosphate uptake increased more than 20 percent at 24 hours without other evidence of infarct extension. In the other seven patients, there was no significant change in the area of the abnormal radioactive uptake between early and delayed scintiscans. This study suggests that technetium-99m pyrophosphate scintigraphy can defect acute myocardial infarction as early as 4 hours after the onset of symptoms although the sensitivity rate (73 percent) is less than that at 24 hours.

Topics: Acute Disease; Angina Pectoris; Diphosphates; Humans; Methods; Myocardial Infarction; Radionuclide Imaging; Technetium; Time Factors

Fifteen patients with clinical and electrocardiographic features of acute pericarditis underwent myocardial scintigraphy using 99mTc-pyrophosphate. All had normal images. In 5 additional patients with acute pericarditis and evidence of ischemic heart disease, 99mTc-pyrophosphate images showed focal abnormalities in 2 patients and equivocal findings in 2. Serial myocardial radionuclide images were obtained 2 to 18 days after induction of pericarditis in 8 dogs; all images were normal. No stainable tissue calcium was demonstrated histochemically in the pericardium or myocardium of these dogs. Our results suggest that 99mTc-PYP myocardial radionuclide images are normal in acute pericarditis in the absence of ischemic heart disease.

Topics: Acute Disease; Animals; Diphosphates; Dogs; Heart; Humans; Myocardium; Pericarditis; Radionuclide Imaging; Technetium

Topics: Acute Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

We evaluated dual imaging with thalium-201 (201TI) and technetium-99m (99mTc) pyrophosphate in 80 patients with documented acute myocardial infarction (55 transmural, 25 nontransmural infarction). Color-coded isocount display of 201TI images was essential for interpretation in 16 patients. Combined 201 TI and 99mTc-pyrophosphate imaging for infarct detection was 100% sensitive; however, either was falsely negative in 12 of 80 patients. False-negative individual 201TI or 99mTc-pyrophosphate infarct images were most common in patients with small infacts or left ventricular hypertrophy. Thallium-201 images correctly localized the site of acute transmural infarction in all 51 patients with a positive image, while 99mTc-pyrophosphate localized the site of infarction in 49 of 53 with an abnormal image. Comparison of the size of the imaged infarct region revealed size discordance in 25 of 49 patinets, with 99mTc-pyrophosphate larger in 21 of 49 and 201TI larger in only four of 49. Thus dual radionuclide imaging provides definition of the presence and location of acute myocardial infarction.

Topics: Acute Disease; Adult; Aged; Diagnosis, Computer-Assisted; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Topics: Acute Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Diphosphates; Humans; Osteomyelitis; Radionuclide Imaging; Technetium

Topics: Acute Disease; Age Factors; Aged; Calcium Pyrophosphate; Cartilage, Articular; Chronic Disease; Diphosphates; Humans; Middle Aged; Synovial Membrane; Synovitis

Fifty-five patients with old (9 days to 10 yr) transmural infarcts but with no evidence of recent infarction, were imaged with Tc-99m pyrophosphate. Discrete uptake was rare in the setting of an old infarct. Diffuse uptake was neither sensitive to, nor specific for, acute infarction. Prior infarction will rarely cause diagnostic error if the discrete pattern is required for a positive diagnosis.

Topics: Acute Disease; Adult; Aged; Diphosphates; Evaluation Studies as Topic; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Tin

Imaging of acute myocardial injury is possible with a large number of agents. All of these agents share similar patterns of uptake in acutely injured myocardial tissue. The technique appears to be a reliable way of ruling in or out the diagnosis of acute myocardial infarction.

Topics: Acute Disease; Coronary Circulation; Diphosphates; Heart; Humans; Methods; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Diphosphates; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Topics: Acute Disease; Animals; Diphosphates; Dogs; Endothelium, Vascular; Evaluation Studies as Topic; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Wounds and Injuries

Topics: Acute Disease; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Adult; Aged; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Etidronate and pyrophosphate, labeled with Tc-95m and Tc-99m, were studied in experimentally infarcted mongrel dogs. A distribution study was conducted 2 hr after simultaneous administration of both agents in two groups of dogs. In one group, the injection was made 15 min after release of a 2-hr coronary arterial ligation. Another group was injected 48 hr after release of the ligation. The uptakes for each radiopharmaceutical and the ratio of uptakes for each sample were computed. The data show pyrophosphate to be a superior agent for the imaging of acute myocardial infarcts because of the higher uptake by infarcted myocardium and the greater contrast between infarcted myocardium and neighboring organs.

Topics: Acute Disease; Animals; Diphosphates; Dogs; Etidronic Acid; Myocardial Infarction; Radionuclide Imaging; Technetium

Ninety-one patients with chest pain suggestive of acute myocardial infarction were studied by static technetium Tc 99m stannous pyrophosphate scintigraphy and dynamic sodium pertechnetate Tc 99m cardioangiography. Twenty-three of 26 patients (88%) with acute transmural infarcts and 12 of 17 patients (71%) with nontransmural infarcts had abnormal static studies. In 45 patients with negative scintigrams, ECG or serum enzyme changes consistent with acute infarction failed to develop. Three false-positive static studies (6%) were recorded. Twenty of 43 (47%) patients with acute infarction had hemodynamic or structural abnormalities identified by cardioangiography. The dynamic study also proved helpful in localizing the site of infarction and in ruling out certain causes of false-positive static scintigrams.

Topics: Acute Disease; Angiocardiography; Diagnosis, Differential; Diphosphates; False Positive Reactions; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Adult; Aged; Diphosphates; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Animals; Autoantibodies; Coronary Circulation; Coronary Disease; Diphosphates; Dogs; Gallium Radioisotopes; Myocardial Infarction; Myosins; Oxygen Radioisotopes; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Rubidium; Strontium Radioisotopes; Tetracyclines

Topics: Acute Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

To further explore the usefulness of technetium 99m pyrophosphate (99mTc-PYP) myocardial imaging and test its validity in the diagnosis of acute myocardial infarction, 99mTc-PYP myocardial scintigrams were performed in 50 patients. Out of 28 patients with acute myocardial infarction, myocardial scintigrams demonstrated localized activity in the 15 patients with transmural, and diffuse activity in the 13 patients with subendocardial myocardial infarction. Twenty-two patients with significant coronary artery disease documented by coronary angiography but without acute myocardial infarction were also studied. Nine of ten patients with clinical evidence of left ventricular aneurysm from previous myocardial infarction and definite left ventricular dyskinesis had positive scintigrams with activity localized to the site of the wall motion abnormality. Two of five patients without definite aneurysm but with left ventricular akinesis also had localized uptake in the involved area of the left ventricle. Seven patients with normal left ventricular wall motion had negative scintigrams. These findings suggest caution in interpreting positive 99mTc-PYP scintigrams as being indicative of acute myocardial infarction when evidence of a left ventricular aneurysm is also present.

Topics: Acute Disease; Adult; Diphosphates; Electrocardiography; Female; Heart Aneurysm; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Tin

The concordance of transmural electrocardiographic (ECG) changes and myocardial infarct imaging in detecting myocardial injury in the perioperative period was evaluated in 50 patients undergoing coronary artery bypass surgery and in 6 patients without coronary artery disease undergoing valve replacement. Scintigraphy with technetium-99m (Sn) labeled pyrophosphate was performed 3 to 7 days after surgery. Plasma creatine phosphokinase (CPK) levels were determined preoperatively and daily for 7 days postoperatively. Plasma MB-CPK was assayed fluorometrically in samples obtained at 12 hour intervals for 36 hours. Total CPK and MB-CPK concentrations were normal in all patients preoperatively but increased in every patient postoperatively. A total of 8 patients (16%) had evidence of perioperative infarction. Six of these patients (12%) with coronary artery disease exhibited abnormal images after bypass surgery, associated with transmural ECG changes in each case. The other 2 patients (4%) with coronary artery disease who had abnormal images were among 4 patients who developed bundle branch block after the operation. Abnormal images did not occur in any patient undergoing valve replacement despite total CPK and MB-CPK elevations. These results indicate that total CPK and MB-CPK elevations occur consistently after cardiac surgery and cannot be relied upon for detection of transmural infarction. Furthermore, new conduction defects may not necessarily be a sign of perioperative infarction, and infarct imaging may be a useful means of establishing myocardial infarction in this group of patients.

Topics: Acute Disease; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart Valve Diseases; Humans; Isoenzymes; Male; Myocardial Infarction; Radionuclide Imaging; Technetium

In 17 dogs with acute myocardial infarcts produced by ligation of the proximal left anterior descending coronary artery, a comparative study was made of myocardial scintigrams obtained with technetium-99m stannous pyrophosphate (99mTc-PYP) and thallium-201 (201T1), tissue levels of 99mTc-PYP and 201T1 uptake, histopathologic alterations, and regional myocardial perfusion measured with radioactive microspheres. 9 of the 10 hearts examined histologically had transmural infarcts with outer peripheral, inner peripheral, and central zones characterized by distinctive histopathologic features. A progressive reduction in myocardial blood flow was demonstrated between normal myocardium and the centers of the infarcts, and correlated well with progressive reduction in 201T1 upatke in the same regions. Marked 99mTc-PYP concentration occurred in areas with partial to homogeneous myocardial necrosis and residual perfusion located in the outer peripheral regions of the infarcts. The latter areas also were characterized by the presence of muscle cell calcification. The patterns of distribution of 99mTc-PYP and 201T1 explained the filling defects on 201T1 myocardial scintigrams and the doughnut patterns on 99mTc-PYP myocardial scintigrams in dogs with transmural infarcts. One dog with a subendocardial infarct had a small homogeneous area of activity on the 99mTc-PYP myocardial scintigram, and showed marked uptake of 99mTc-PYP in subendocardial areas of extensive necrosis and calcification still receiving some coronary perfusion. Thus, the data indicate that the status of regional myocardial perfusion is a key determinant for the occurrence of distinctive patterns of myocardial necrosis and for the scintigraphic detection of acute myocardial infarcts with 99mTc-PYP and 201T1.

Topics: Acute Disease; Animals; Diphosphates; Dogs; Iodine Radioisotopes; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Twenty-six patients suspected of having acute myocardial infarction (AMI) underwent myocardial scintigraphy sequentially with 201Tl and 99mTc-stannous pyrophosphate (99mTc-PPi). Of the 26 patients, 24 had AMI documented by enzyme and electrocardiographic changes. Nineteen had transmural and five had subendocardial myocardial infarctions. The remaining two patients had "unstable angina pectoris." The mean time from onset to imaging was 4 days. Of the 24 patients with AMI, 22 had positive 99mTc-PPi scintigrams. In 20 the area of acute myocardial damage appeared to be the same by 99mTc-PPi scintigram as by ECG; in two, the location could not be precisely determined. The two patients with negative 99mTc-PPi scintigrams at the time of combined myocardial imaging had had positive 99mTc-PPi images previously. In all 24 patients, the 201Tl images were abnormal in at least the location suggested by the electrocardiogram. In seven patients, the area of decreased 201Tl activity was grossly equal to the positive area on the 99mTc-PPi images; in 15, the 201Tl defect was definitely larger; and in two, the 201Tl defect appeared slightly smaller. Although the 99mTc-PPi and 201Tl myocardial images provide different information, both are valuable in determining the overall integrity of the myocardium in patients with ischemic heart disease.

Topics: Acute Disease; Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Topics: Acute Disease; Coronary Disease; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Physical Exertion; Radioisotopes; Technetium; Thallium

Topics: Acute Disease; Diphosphates; Female; Humans; Male; Myocardial Infarction; Radionuclide Imaging; Technetium

The accuracy of the scintigraphic diagnosis of acute myocardial infarction with 99mTc-pyrophosphate, 99mTc-tetracycline and 99mTc-glucoheptonate was assessed in 63 patients, 43 of whom had clinical evidence of acute myocardial infarction. In 15, studies with both 99mTc-tetracycline and 99mTc-pyrophosphate were performed. Accuracy was greatest with 99mTc-pyrophosphate (17/17 true positives, 8/10 true negatives) contrasted with 99mTc-tetracycline (12/25 true positives, 6/11 true negatives) and 99mTc-glucoheptonate (3/13 true positives, 2/2 true negatives). 99mTc-pyrophosphate was the most sensitive tracer for the detection of acute myocardial infarction. The diagnostic accuracy with 99mTc-glucoheptonate was poor.

Topics: Acute Disease; Diagnostic Errors; Diphosphates; Evaluation Studies as Topic; Heptoses; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Sugar Acids; Technetium; Tetracycline

The feasibility of acute infarct scintigraphy for the clinical evaluation of patients with known or suspected acute myocardial infarction is established. Further development of this methodologic approach may result in even better agents for the visualization of infarcts. Radiotracers with high affinity for the infarct, rapid blood clearance, and low concentrations in surrounding organs, such as liver and bone, would be more suitable than available radiopharmaceuticals for acute myocardial infarct scintigraphy. Ultimately, labeling these tracers and ultra-short-lived radionuclides will enable rapid sequential imaging to assess changes in the extent of infarction and to determine the efficacy of therapies aimed at limiting infarct size.

Topics: Acute Disease; Diphosphates; Humans; Mercury Radioisotopes; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Tetracycline; Time Factors

Bacteria and crystals were simultaneously recovered from the synovial fluid of two patients with acutely inflamed joints. The bacteria were initially identified on Gram stain and subsequently grown on supplemented peptone broth, and the crystals were readily identified by polarizing microscopy. Although cause-and-effect relationship between these two types of arthritis cannot be established, the need for thorough examination of synovial fluid is evident.

Topics: Acute Disease; Aged; Arthritis, Infectious; Calcium; Crystallization; Diagnosis, Differential; Diphosphates; Haemophilus influenzae; Humans; Knee Joint; Leukocyte Count; Male; Middle Aged; Neisseria gonorrhoeae; Sternoclavicular Joint; Synovial Fluid; Uric Acid; Wrist Joint

Eighty-eight patients admitted to a coronary care unit with chest pain of varying etiology but without ECG evidence of an acute transmural myocardial infarction had myocardial scintigrams using technetium-99m stannour pyrophosphate (99m-Tc-PYP). Seventeen of these patients had ECG and enzymatic evidence suggestive of acute subendocardial myocardial infarction. In each of these the scintigrams were postivie demonstrating increased 99m-Tc-PYP uptake either in a faintly but diffusely positive pattern or in a well-localized strongly positive one. The remaining 71 patients did not evolve ECG or enzymatic evidence of acute myocardial infarction. In each of these patients the myocardial scintigram was negative. Thus 99m-Tc-PYP myocardial scintigrams are capable of identifying the presence of acute subendocardial myocardial infarction in patients. The absolute frequency with shich subendocardial myocardial infarction can be recognized utilizing this technique will have to be established in a larger number of patients in the future.

Topics: Acute Disease; Aged; Diphosphates; Electrocardiography; Endocardium; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

Pseudogout, or calcium pyrophosphate arthropathy, is a crystalline synovitis, characterised either by acute attacks of joint pain, which usually occur in the large joints, or by a more chronic, progressive form of joint disease. The essential features of the disease are chondrocalcinosis and the presence of pyrophosphate crystals in the synovial fluid. The exact pathogenesis is unknown. Case reports of 2 patients with confiemed pseudogout, and of 1 who is suspected to be suffering from the disease, as well as a summary of the outstanding aspects of the condition, are presented.

Topics: Acute Disease; Aged; Chondrocalcinosis; Chronic Disease; Diagnosis, Differential; Diphosphates; Female; Humans; Knee; Male; Middle Aged; Radiography; Wrist

To obtain insight into the mechanism(s) responsible for the direct visualization of acute myocardial infarcts by myocardial scintigraphy with technetium-99m stannous pyrophosphate (99mTc-PYP), scintigraphic and morphologic studies were performed in 22 dogs subjected to occlusion of the proximal left anterior descending coronary artery (LAD). Grossly visible myocardial infarcts occurred in ten of 11 dogs with LAD occlusion for one day, five with LAD occlusion for two days, two with LAD occlusion for seven days and two with LAD occlusion for 13 days. Rare, microscopic foci of necrosis were observed in one dog with LAD occlusion for one day, and no lesions were present in two dogs subjected to temporary LAD occlusion for eight minutes and reflow for 24 hours. In the latter three dogs, 99mTc-PYP myocardial scintigrams were negative. In the 19 dogs with gross infarcts, 99mTc-PYP myocardial scintigrams were strongly positive at one and two days after LAD occlusion, much less positive at seven days and faintly positive at 13 days after occlusion. Positive myocardial scintigrams in most showed "doughnut" patterns, with marked peripheral concentration of radioactivity around central zones of much lower activity. On histologic examination, the one and two-day-old infarcts exhibited subendocardially located central zones and surrounding peripheral zones, both of which showed distinctive histopathological and histochemical features, including the selective occurrence in the peripheral zones of calcified muscle cells with ultrastructurally demonstrable apatite-like crystals in mitochondria. Selective occurrence of high tissue levels of 99mTc-PYP radioactivity also was demonstrated in the peripheral zones of four infarcts. Hearts with older infarcts (seven and 13 days) showed progressive replacement of necrotic myocardium by granulation tissue and progressive reduction in calcium deposits in the areas of damage. The data obtained in this study establish a temporal and topographical relationship between calcium accumulation in acute myocardial infarcts and 99mTc-PYP uptake responsible for scintigraphic detection of the lesions with this radionuclide in dogs subjected to proximal LAD occlusion.

Topics: Acute Disease; Animals; Calcium; Diphosphates; Dogs; Homeostasis; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Time Factors; Tin

With the use of 99mTc-labelled stannous pyrophosphate scans positive for myocardial infarction were obtained from 28 patients in the acute stage of the disease. In some cases the scan was positive when the initial electrocardiogram gave equivocal results. Negative scans were obtained from a control group of patients and from eight patients in hospital with chest pain but with no other evidence of recent myocardial infarction.

Topics: Acute Disease; Adult; Aged; Child; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Tin

Topics: Acute Disease; Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acromegaly; Acute Disease; Aged; Arthritis, Rheumatoid; Bursitis; Calcium Phosphates; Chondrocalcinosis; Chronic Disease; Colitis, Ulcerative; Crystallization; Diphosphates; Female; Gout; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Pyrophosphatases; Radioisotope Dilution Technique; Synovial Fluid

Topics: Acute Disease; Adult; Aged; Diphosphates; Electrocardiography; Female; Follow-Up Studies; Humans; Hydroxyapatites; Male; Middle Aged; Mitochondria, Muscle; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium

Topics: Acute Disease; Age Factors; Aged; Calcium; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Female; Hospitals; Humans; Knee Joint; Male; Middle Aged; Postoperative Care; Postoperative Complications; Sex Factors; Syndrome; Synovitis

Topics: Acute Disease; Adenosine Monophosphate; Adenosine Triphosphate; Animals; Cell Membrane Permeability; Cyclic AMP; Dermatitis; Diphosphates; Epinephrine; Female; Histamine; Histamine Release; Inflammation; Injections, Subcutaneous; Male; Mast Cells; p-Methoxy-N-methylphenethylamine; Rats; Rats, Inbred Strains; Skin; Xanthines