technetium-tc-99m-exametazime and Myocarditis

We compared the results of comprehensive scintigraphic examination of 35 patients with suspected myocarditis and the data of clinical, immunological, laboratory and instrumental studies. The patients were divided into 3 groups. Group 1 included 11 patients with preliminary diagnosis of acute myocarditis, group 2--11 patients with chronic myocarditis, group 3--13 patients with postmyocarditic cardiosclerosis. All patients were tested for antimyocardial antibodies, underwent 99mTc-HMPAO-labeled leukocyte and perfusion scintiography of myocardium. The study did not reveal significant differences between the three groups as regards the results of laboratory and instrumental studies. Elevated titers of antimyocardial antibodies were found in 70% of the patients in group 1, 100% in group 2, and 46% in group 3. Patients with chronic myocarditis had the highest titers of antibodies. Pathological accumulation of 99mTc-HMPAO-labeled leukocytes in myocardium was documented in 36.4 and 81.8% of the patients of groups 1 and 2 respectively. They were absent in the heart of group 3 patients. Disturbed myocardial perfusion was recorded in 45.5, 81.8 and 84.6% in groups 1, 2 and 3 respectively. The magnitude of accumulation of leukocytes was not significantly different between the groups. Results of the study suggest rather high specificity of radionuclide techniques for diagnostics of inflammatory lesions in myocardium. However, further studies are needed to confirm their sensitivity and accuracy.

Topics: Adult; Autoantibodies; Female; Heart; Humans; Leukocytes; Male; Myocarditis; Myocardium; Radionuclide Imaging; Radiopharmaceuticals; Sclerosis; Technetium Tc 99m Exametazime; Young Adult

Twenty-eight children (5 girls, 23 boys; age, 20.3 +/- 16.2 months) with Kawasaki disease (KD) were included in this study. The children were treated with aspirin plus intravenous injection of gamma globulin (IVGG). Both Tc-99m HMPAO labeled WBC heart imaging (Tc-WBC) and two-dimensional echocardiograms (2D-Echo) were used to evaluate the effects of IVGG on the most common cardiac presentations--carditis and dilated coronary arteries--in KD. After IVGG therapy, the results showed that 32.1% (9/28) carditis patients had improved; 39.3% (11/28) of patients had no significant change; 28.6% (8/28) of patients had severe changes, and there was no significant difference among the three groups by the evidences of Tc-WBC. Dilated coronary arteries (CA) became smaller in 32.1% (9/28) of patients; 53.6% (15/28) of patients had no definite change; 14.3% (4/28) of patients had dilated LCA that became larger; and borderline difference existed among the three groups, proved by 2D-Echo. Between the Tc-WBC and 2D-Echo, 35.7% (10/28) of patients had similar changes, and 64% (18/28) of patients showed incongruous changes; and there was little difference. In conclusion, Tc-WBC and 2D-Echo provide strong evidence of the existence of carditis and dilated coronary arteries in certain patients, even after IVGG treatment. The improvements of carditis and dilated coronary arteries were not correlated with each other after IVGG therapy.

Topics: Aspirin; Coronary Disease; Echocardiography; Female; Heart; Humans; Immunoglobulins, Intravenous; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Marfan syndrome is a heritable disorder of connective tissue in which the most prominent abnormalities occur in the ocular, cardiovascular and skeletal systems. Although cardiovascular complications are infrequent in patients under 20 years of age, whenever they do occur, they are the major cause of death. Here we report three cases in a Chinese family with clinical evidence of myocarditis associated with Marfan syndrome. The 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cell and 201Tl single photon emission computed tomographic heart scans show indications of an inflammatory process involving the myocardium. After comparison with the pathology results, the accuracy of these studies is seen to be 100%. We thus introduce these simple methods to evaluate myocardial viability in patients with Marfan syndrome.

Topics: Female; Humans; Leukocytes; Male; Marfan Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Pedigree; Taiwan; Technetium Tc 99m Exametazime; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Eighteen patients with Kawasaki disease and suspected carditis (11 boys, 7 girls, mean age 18 months) in acute stages underwent Tc-99m HMPAO WBC imaging of the heart. Signs and symptoms subsided after conventional aspirin therapy and the intravenous injection of high-dose (400 mg/kg per day for 5 days) gamma-globulin treatments. Tc-99m HMPAO WBC imaging of the heart was arranged a second time to evaluate the effects of the treatments for carditis. The results showed that a significant difference existed in the severity of carditis before and after the treatments (P less than 0.001, by signed rank test), 39% (7/18) with significant improvement in severity of carditis, 50% (9/18) without definite change. However, 11% (2/18) became more severely ill after the treatments. Tc-99m HMPAO WBC imaging may be useful in detecting carditis in Kawasaki disease and in evaluating the effects of aspirin plus the newly recommended gamma-globulin for the treatment of carditis in Kawasaki disease.

Topics: Child, Preschool; Female; gamma-Globulins; Humans; Immunization, Passive; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Ten children (6 boys and 4 girls, aged 1-9 years old) underwent operations with a cardiopulmonary bypass, and the technetium-99m hexamethylpropylene amine oxine (99mTc-HMPAO) labelled white blood cell (WBC) heart scans were used to detect postoperative leukocyte infiltration in the hearts. The results showed that 80% (8/10) of the cases had subclinical inflammation in the hearts (grading of WBC scans > or = score 2), and a positive correlation (R = 0.77) was noted between the severity of the inflammation (grading of the WBC scans) and the duration of the cardiopulmonary bypass in the operations. Another control group (9 boys and 2 girls, aged 2-13 years old) underwent operations without a cardiopulmonary bypass, and subclinical inflammation of hearts was demonstrated in only 1 case (9%) by the 99mTc-HMPAO labelled WBC scans (grading of WBC scans < score 2) after the operations. There was a significant difference (P < 0.001, by a Wilcoxon rank sum test) based upon the severity of the ischaemic heart damage in the two groups. In our preliminary conclusions, the 99mTc-HMPAO labelled WBC heart scans may provide non-invasive and directly discernible evidence of subclinical inflammation in the heart due to a transient ischaemic state during a cardiopulmonary bypass, even if the clinical symptoms and signs of carditis are not apparent.

Topics: Cardiopulmonary Bypass; Child; Female; Heart; Heart Defects, Congenital; Humans; Leukocytes; Male; Myocardial Reperfusion Injury; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Cardiomyopathy, Dilated; Female; Humans; Infant; Leukocytes; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Myocardial imaging with Tc-99m HMPAO WBC was used to detect myocarditis of Kawasaki disease in 103 infants and children (66 boys and 37 girls, mean age 3 years and 4 months). The clinical course of Kawasaki disease may be divided into three phases, from the onset of illness onset until all clinical symptoms and signs have disappeared. Twenty-four hour myocardial imaging was performed in anterior, LAO, and left lateral views. The grading system was as follows: score 0 less than bone uptake; 1 = bone uptake; 2 greater than bone uptake; and 3 greater than or equal to liver uptake. If the score was greater than or equal to 2, significant myocarditis was considered. The appearing ratio of myocarditis was 57% (13/23) in the first phase; 65% (15/23) in the second phase; 54% (31/57) in the third phase. No significant difference was demonstrated among the three groups of patients (P greater than 0.1, by Chi-square test). In conclusion, an occult myocarditis may continue in all three phases of Kawasaki disease, even if the clinical symptoms and signs had improved by the evidence of Tc-99m HMPAO labeled WBC scan to avoid advanced cardiac complication.

Topics: Child; Child, Preschool; Female; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Myocardial imaging with 99Tcm-HMPAO-labelled white blood cells (WBC) and 67Ga citrate was used to detect myocarditis in the acute phase of Kawasaki disease among 22 infants and children; 18 cases of myocarditis were detected by 99Tcm-HMPAO-labelled WBC heart scans, but only one case was detected by 67Ga citrate heart scans. In conclusion, 99Tcm-HMPAO-labelled WBC scanning provides a more sensitive method than 67Ga citrate scanning in the detection of myocarditis in Kawasaki disease.

Topics: Child, Preschool; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime