technetium-tc-99m-pyrophosphate and Myositis

Our objective was to study the value of 99mtechnetium-pyrophosphate (99mTc-PYP) muscle scintigraphy and magnetic resonance imaging (MRI) in detecting areas of likely muscle inflammation and in increasing the rate of positive muscle biopsies in patients with suspected myositis. The results showed that in 13 out of 13 patients with clinical and/or signs of inflammatory muscle disease, increased 99mTc-PYP uptake was demonstrated at different muscle sites 3 h after isotope injection. Subsequent MRI of symmetric muscle areas with enhanced 99mTc-PYP uptake revealed signal patterns suggesting inflammation in all cases. Biopsy of these targeted muscles demonstrated characteristic histopathologic signs of muscle inflammation in 9 out of 13 patients. Four of these 9 patients had clinically atypical disease or did not show elevated creatine phosphokinase levels. Seven of these 9 patients had not been pretreated with corticosteroids. In 4 patients only muscle fiber atrophy and/or necrosis without cellular infiltrations was seen. These 4 patients had received either high doses of corticosteroids or low doses over longer periods of time before muscle biopsy. In conclusion, the combination of 99mTc-PYP muscle scintigraphy and MRI demonstrated muscle areas with maximum inflammatory signal patterns. Targeting of muscles by MRI only will probably yield reliable results of muscle biopsy in cases of clinically and serologically characteristic myositis. 99mTc-PYP muscle scintigraphy may provide useful initial information about localization of inflamed muscle tissue, especially in atypical disease. Treatment with corticosteroids prior to histologic diagnosis may abolish inflammatory infiltrations in affected muscle tissue.

Topics: Adolescent; Adult; Aged; Antibodies, Antinuclear; Autoantibodies; Biopsy; C-Reactive Protein; Creatine Kinase; Female; Glycine-tRNA Ligase; Histidine-tRNA Ligase; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Myositis; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Idiopathic focal myositis is a rare clinical entity and is mostly localized in the neck and thigh muscles presenting as a pseudotumor. We describe a 49-year-old patient with inflammation restricted to the small muscles of one forefoot. Systemic disease was not present and progression to polymyositis did not occur within 2 years of follow-up. The myositis improved promptly after initiation of immunosuppressive therapy with corticosteroids and azathioprine. This unusual location of focal myositis has not been previously reported.

Topics: Adrenal Cortex Hormones; Antirheumatic Agents; Azathioprine; Biopsy; Female; Foot Diseases; Humans; Middle Aged; Muscle, Skeletal; Myositis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

A patient with polymyositis who had cardiac involvement underwent myocardial scan with technetium-99m-pyrophosphate. We used Activity Index for evaluating myocardial uptake of technetium-99m-pyrophosphate, which correlated with the degree of serum creatine phosphokinase elevation. Our findings indicate that these examinations may be helpful for identifying patients who have cardiac involvement and evaluating their response to the treatment with corticosteroids or immunosuppressants.

Topics: Cardiomyopathies; Humans; Male; Middle Aged; Myositis; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

99mTc-pyrophosphate musculoskeletal imaging and 99mTc-red blood cell gated blood pool imaging were performed on 10 patients with documented polymyositis/dermatomyositis. Abnormal 99mTc-pyrophosphate uptake by peripheral muscles was found in 8 patients (6 mild, 2 marked). Cardiac uptake occurred in 5 patients and was 3+ in 2 with cardiovascular symptoms. These 2 patients also had abnormal EF on gated blood pool imaging. Patients without myocardial 99mTc-pyrophosphate uptake had normal EF. Patients with myocardial 99mTc-pyrophosphate uptake had abnormal wall motion, in proportion to the degree of uptake. Response to therapy and outcome were poorer in patients with marked scintigraphic changes. These findings suggest that the magnitude of 99mTc-pyrophosphate myocardial uptake may have prognostic implications in these patients.

Topics: Adolescent; Adult; Cardiomyopathies; Child; Dermatomyositis; Female; Heart; Humans; Male; Middle Aged; Musculoskeletal System; Myositis; Papillary Muscles; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

[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

Topics: Aged; Cardiomyopathies; Diphosphates; Electrocardiography; Female; Heart; Humans; Myositis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Thirteen patients with systemic lupus erythematosus, 8 patients with polymyositis, and 6 patients with spondylitis ankylopoetica (Bechterew's disease) underwent clinical cardiologic examination and scintigraphy of the myocardium (99mTc-pyrophosphate), ECG, echocardiography, polygraphy, and their blood pressure was taken. The aim of the study was to ascertain how such a combination of non-invasive examinations can help in recognizing a cardiac involvement. In systemic lupus erythematosus cases one or more positive findings were revealed in 9 patients (69%), in 4 patients all examinations were negative (31%). Four patients (50%) with polymyositis had positive findings. In patients with spondylitis ankylopoetica positive findings occurred in 2 cases (33%). The study has shown that a combination of non-invasive cardiologic methods increases the probability of detecting cardiac involvement in systemic connective tissue diseases.

Topics: Cardiomyopathies; Connective Tissue Diseases; Diphosphates; Electrocardiography; Humans; Lupus Erythematosus, Systemic; Myositis; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Technetium-99M pyrophosphate (TcPYP) nuclear scans of extremities were performed on 15 patients at 10 minutes and 2 hours after isotope injection. Scans were carried out both to confirm the diagnosis of myositis and to direct subsequent muscle biopsy. Five of six patients with clinical features strongly suggestive of inflammatory muscle disease had positive scans. All muscle biopsies performed at areas of increased isotope uptake showed inflammatory muscle disease. All nine patients not suspected of active inflammatory muscle disease had negative scans. Two of these underwent muscle biopsy with negative results. Our observations suggest that TcPYP muscle scans may be useful both to confirm the clinical suspicion of inflammatory muscle disease and in directing the choice of site for muscle biopsy.

Topics: Biopsy; Diphosphates; Humans; Muscles; Myositis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

99mTechnetium pyrophosphate (99mTc PYP) muscular scanning was carried out in 28 patients affected by neuromuscular diseases. To express the muscle tracer retention quantitatively, the soft tissue to bone uptake ratio was calculated in the thigh and in the lower leg. Significantly increased ratio values were found in all the patients with polymyositis and in most patients with different types of muscular dystrophy, while high values were seen in a few subjects with myasthenia gravis and with neurogenic disorders. These findings are compared with those of previous studies, and the factors playing a role in determining some discrepant observations are discussed. The use of 99mTc muscular scanning in the investigation of patients with suspected inflammatory myopathy is suggested.

Topics: Adolescent; Adult; Aged; Child; Diphosphates; Female; Humans; Male; Middle Aged; Muscles; Muscular Dystrophies; Myositis; Neuromuscular Diseases; Technetium; Technetium Tc 99m Pyrophosphate