pyrophosphate and Myocarditis

The major value of hot-spot imaging of the myocardium is its ability to define areas of necrosis rather than areas of diminished blood flow or cellular function. Applications of hot-spot imaging include the diagnosis and quantitation of myocardial infarction, myocarditis, and cardiac transplant rejection. The two agents in clinical use, 99mTc-Pyrophosphate and radiolabeled antimyosin, are discussed.

Topics: Animals; Antibodies; Coronary Disease; Diphosphates; Graft Rejection; Heart Transplantation; Humans; Myocardial Infarction; Myocarditis; Myocardium; Myosins; Necrosis; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Clinical value of 111In-antimyosin monoclonal antibody F ab (AM) was compared with 99mTc-pyrophosphate (PYP) in 13 patients with myocardial infarction and 3 patients with myocarditis. Following PYP injection, PYP imaging was performed 3 hours later. Immediately after PYP imaging, AM was administrated and AM images were obtained 48 hours later. Abnormal accumulation in the infarcted myocardium was observed in 11 patients (85%) on AM images but only in 3 patients (23%) on PYP images. All patients within 8 days after the onset of infarction showed abnormal uptake on both images. Of 5 patients with 1 to 2 weeks after the onset of infarction, abnormal uptake was observed in all of them on AM images but only in one of them on PYP imaging. Furthermore, of 6 patients with more than 2 weeks after the onset, AM imaging showed abnormal uptake in 4 (67%) but PYP imaging did not show abnormal uptake in any of them. Similarly. Of 3 patients with myocarditis, diffuse uptake in the myocardium ws observed in 2 of them on AM images but none of them showed abnormal uptake on PYP images. We conclude that AM imaging is a useful means for identifying not only acute stages but also subacute stages of myocardial necrosis where PYP imaging did not show any abnormality.

Topics: Adult; Aged; Antibodies, Monoclonal; Clinical Trials as Topic; Diphosphates; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myocarditis; Myosins; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

Topics: Coxsackievirus Infections; Diphosphates; Humans; Infant, Newborn; Male; Myocarditis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Abdominal 99mTc-pyrophosphate (99mTc-PYP) scans were obtained in 15 neonates: 12 with neonatal necrotizing enterocolitis (NEC), two with osteomyelitis, and one with myocarditis. Ten of the babies with NEC had at least one positive scan; of these 10 studies, seven (Group A) showed both diffuse abdominal uptake and localized hepatic activity, two (Group B) showed abdominal uptake and questionable hepatic uptake, and one (Group C) demonstrated diffuse abdominal uptake only. The other two babies with NEC had normal scans (Group D). Pneumatosis intestinalis was unquestionably present in two patients from Group A and one from Group B. Upon resolution of the clinical findings, all NEC patients had normal scans. A patient with myocarditis had hepatic uptake of 99mTC-PYP while the abdominal scan in the two infants with osteomyelitis was normal. These preliminary observations suggest that further study of a relationship between abdominal scan findings and the course of NEC is warranted.

Topics: Abdomen; Diphosphates; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Liver; Male; Myocarditis; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A focal or diffuse pattern of Tc-99m pyrophosphate (Tc-99m PPi) myocardial uptake may occur in patients with acute myocardial necrosis from various causes. A recent study has shown intense Tc-99m PPi myocardial uptake in experimental viral perimyocarditis in mice. This report describes a patient with perimyocarditis, with intense, persistent, and generalized myocardial uptake of Tc99m PPi.

Topics: Diphosphates; Heart; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Myocarditis; Myocardium; Pericarditis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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