technetium-tc-99m-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; Animals; Coronary Vessels; Heart; Humans; Myocardial Infarction; Polyphosphates; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

Among a group of patients (n = 15) with acute coronary syndrome, the results of using two new myocardial radiopharmaceuticals--123I-labelled 15-(p-iodo-phenyl)-3,R,S-methylpentadecanoic acid (BMIPP) and 123I-meta-iodobenzyl guanidine (MIBG)--were compared with dual 201Tl/99Tcm-pyrophosphate (Tl-PYP) imaging using single photon emission tomography (SPET). Defect scores were evaluated on a segment-by-segment basis for a total of 270 segments. For the 201Tl, BMIPP, and early and delayed MIBG studies, the mean (+/- S.D.) sums of defect scores were 9 +/- 8, 18 +/- 9, 22 +/- 12 and 29 +/- 9, respectively, revealing significantly higher scores for BMIPP and MIBG than 201Tl (P < 0.005). This was the case irrespective of various functional conditions, such as successful recanalization, failure of coronary angioplasty or restenosis. The culprit coronary artery was best identified using BMIPP, while MIBG SPET showed the most extensive defects. Normal perfusion with decreased BMIPP and MIBG uptake was frequently observed and associated with hypokinesis. 123I-BMIPP and MIBG are more sensitive for the detection of damaged myocardium, and the difference between perfusion and metabolism seems to reflect myocardial stunning.

Topics: 3-Iodobenzylguanidine; Acute Disease; Adult; Aged; Coronary Artery Bypass; Coronary Disease; Coronary Vessels; Decanoic Acids; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Stunning; Syndrome; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

Transthyretin amyloid deposition is present in 17% of autopsies of patients with heart failure and a preserved ejection fraction (HFpEF). Technetium-pyrophosphate scintigraphy (Tc-PYP) is sensitive and specific to diagnose cardiac transthyretin amyloid deposition (ATTR). The prevalence of ATTR by Tc-PYP was evaluated along with echocardiographic parameters in patients with HFpEF. One-hundred consecutive patients with HFpEF, who had Tc-PYP, were retrospectively evaluated. Echocardiographic variables were analyzed to compare patients with positive versus negative ATTR infiltration. Myocardial ATTR was present in 19% of patients. Individuals with ATTR were older with a mean age of 82 ± 7 versus 75 ± 13 years (P = 0.03), had increased left ventricular hypertrophy with the interventricular septum measuring 1.6 (IQR, 1.4-2.0) versus 1.4 (IQR, 1.3-1.6) cm (P = 0.002), had a greater mean left ventricular mass index of 160 ± 50 g/m versus 131 ± 44 g/m (P = 0.01), and a reduced global longitudinal strain measuring -11% (IQR, -9 to -12) versus -12% (IQR, -10 to -16), P = 0.04. The prevalence of ATTR myocardial deposition demonstrated by Tc-PYP in patients with HFpEF is comparable to that of autopsy studies. It is more common in older patients, with increased left ventricular hypertrophy and reduced global longitudinal strain.

Topics: Acute Disease; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Abdominal Pain; Acute Disease; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Vasculitis

The incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by a new imaging modality. In the present study, the clinical significance of (99m)Tc-pyrophosphate (PYP), (123)I-beta-methyl-p-iodephenyl-pentadecanoic acid (BMIPP), (201)TlCl scintigraphy (imaging) and T2-weighted inversion-recovery magnetic resonance imaging (MRI) for the detection of culprit lesion in patients with acute coronary syndromes (ACS) was compared.. The study group comprised 18 patients with ACS: 12 patients with acute myocardial infarction (AMI) (11 males; mean age, 63+/-11 years) and 6 patients with unstable angina (UA) (3 males, mean age, 67+/-5 years). Of the 12 patients with AMI, 10 underwent (201)TlCl and PYP single photon emission computed tomography (SPECT) studies as a dual-energy acquisition ((201)TlCl/PYP) and 8 underwent (201)TlCl SPECT within 1 week of the BMIPP study. All 18 patients underwent BMIPP SPECT and MRI. The MRI pulse sequence was black blood turbo short-inversion-time inversion recovery (STIR) (breath-hold T2-weighted studies). The T2-weighted inversion-recovery MRI showed higher sensitivity and negative predictive value than PYP and (201)TlCl, and higher specificity and positive predictive value than BMIPP and (201)TlCl. The area under the receiver-operating characteristic curve for PYP, BMIPP, (201)TlCl and MRI was 0.787, 0.725, 0.731 and 0.878, respectively. The difference between the areas of MRI and BMIPP was significant (p<0.05).. Accurate detection of culprit lesion is improved by using MRI rather than BMIPP, particularly for patients with ACS.

Topics: Acute Disease; Aged; Coronary Disease; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Male; Middle Aged; ROC Curve; Syndrome; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Topics: Acute Disease; Aged; Asthma; Atrial Fibrillation; Biopsy; Electrocardiography; Heart Septum; Humans; Hypereosinophilic Syndrome; Male; Myocarditis; Myocardium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Radionuclide scintigraphy is commonly utilized as a screening examination before performing more invasive procedures in the work-up of patients with lower gastrointestinal (GI) bleeding. We reviewed our institutional experience with technetium-labelled red blood cell scintigraphy (TRCS) in detecting and localising acute lower GI bleeding. The study group included 72 patients who had 80 red cells scans over a five year period. Thirty-eight scans were positive (47.5%), and 42 were negative (52.5%). Sites of lower GI bleeding were confirmed by endoscopy, arteriography, surgery and/or pathology in 22 of the 38 positive scans. There were four false-negative scans (9.5%). The overall sensitivity and specificity of TRCS in detecting lower GI bleeding was 84.6% (22/26) and 70.4% (38/54), respectively. The accuracy of localization of bleeding sites in the patients with confirmed positive scans was 72.7% (16/22). Thirty mesenteric arteriograms were performed on patients in this series. Eleven arteriograms were performed after negative TRCS; one was positive. Technetium-labelled red blood cell scintigraphy appears to be a useful screening examination for patients with lower GI bleeding who are hemodynamically stable. This may avoid the potential morbidity of arteriography in patients who are not actively bleeding.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Colonic Diseases; Erythrocytes; False Negative Reactions; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pyrophosphate; Time Factors; Tin Polyphosphates

Diagnosis of acute myocardial necrosis by means of conventional electrocardiographic criteria or the release of cardiac enzymes is often difficult or even impossible in patients with out-of-hospital cardiac arrest due to ventricular fibrillation with subsequent cardiopulmonary resuscitation including several DC countershocks. Simultaneous thallium-201/technetium-99m pyrophosphate (PYP) tomography was prospectively applied to 57 patients without typical clinical or electrocardiographic signs of acute myocardial infarction within 48 h after successful resuscitation from out-of-hospital cardiac arrest. Scintigraphic evidence of acute necrosis was present in 23/57 patients (40%). Increased 99mTc-PYP uptake in the pericardial tissue was found in 24 patients (42%). Maximal creatine kinase (CK) concentration was increased in 50/57 patients (88%). CK-MB activity averaged 68+/-52 U/l in patients with positive and 17+/-13 U/l in patients with negative tomograms (P<0.0005), demonstrating the validity of 201Tl/99mTc-PYP tomography. It may be concluded that simultaneous 201Tl/99mTc-PYP tomography is a valuable tool for evaluation of myocardial necrosis after cardiopulmonary resuscitation including DC countershock. Acute myocardial necrosis, as indicated by scintigraphy, represents a potential trigger for the occurrence of ventricular fibrillation. Therefore, 201Tl/99mTc-PYP tomography can be recommended in order to guide further diagnostic and therapeutic interventions in patients after cardiopulmonary resuscitation in whom the underlying cause of the occurrence of ventricular fibrillation is obscure.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Creatine Kinase; Electric Countershock; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myocardium; Necrosis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Ventricular Fibrillation

In an in vivo prospective study, we examined the lumbar spine of 18 patients presenting with a first episode of acute low-back pain with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Scintigraphic activity at L2 was considered 100%, and the other levels were quantified in relation to L2. MRI scans were rated for disc signal intensity on T2-weighted images. The results show that an abnormal intervertebral MRI signal corresponds with an abnormal image on tomoscintigraphy. On tomoscintographic profiles, the disappearance of the 'discal dip' corresponds well with degeneration on MRI. Furthermore, a positive MRI at one level appears to influence other levels at which a significantly higher scintigraphic activity was observed. Of patients with acute LBP 50% had a normal disc SPECT; it is concluded that in these cases a non-discal origin for the pain must be sought.

Topics: Acute Disease; Adult; Female; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Prospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Tc-99m PYP scintigraphy performed on a patient with severe anterior chest pain showed diffuse intense uptake with central decreased activity corresponding to the left ventricular cavity. Tl-201 myocardial perfusion scintigraphy at rest revealed a minimal perfusion abnormality with decreased apical uptake in the lateral view. Because of these findings, diffuse subendocardial infarction was suggested.

Topics: Acute Disease; Aged; Endocardium; Female; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

[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

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

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; 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

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

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

We evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +/- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p less than 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p less than 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients.

Topics: Acute Disease; Adult; Aged; Angina Pectoris; Cardiomegaly; Coronary Disease; Electrocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Radiography; Radionuclide Imaging; Regression Analysis; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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

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