technetium-tc-99m-pyrophosphate and Sarcoidosis

Topics: Aged; Cardiomyopathies; Humans; Magnetic Resonance Imaging; Male; Myocardial Perfusion Imaging; Radiopharmaceuticals; Sarcoidosis; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

A young adult patient with untreated sarcoidosis spontaneously developed a left ventricular (LV) aneurysm in the anterolateral free wall. Single-photon emission computed tomography (SPECT) using Gallium-67 clearly demonstrated widespread abnormal uptake, including the LV aneurysm. Thallium-201 SPECT revealed a perfusion defect in the anterolateral wall, and abnormal uptake of technetium-99m pyrophosphate was seen, especially in the borders of the defect lesion.

Topics: Adult; Echocardiography; Electrocardiography; Gallium Radioisotopes; Heart Aneurysm; Heart Ventricles; Humans; Male; Sarcoidosis; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

A 62-year-old woman was admitted to our hospital because of diplopia and muscular weakness. She had been diagnosed as having sarcoidosis histologically by skin biopsy 5 years before. Although neither CT nor MRI could detect the granulomas, 99mTc-pyrophosphate scintigraphy successfully detected the involvement of sarcoidosis not only in the skeletal muscles but also in the external ocular muscles. After treatment with prednisolone, the symptoms markedly subsided and increased uptake of radionucleotide disappeared. Although 67Ga scintigraphy is also known to be useful in investigating the sites affected by sarcoidosis throughout the body, it was not effective in detecting the involvement of external ocular muscle due to the physiological uptake of 67Ga to the lacrimal grands. While the granulomas are frequently observed histologically in skeletal muscles, usually they are not associated with muscle symptoms. In our study 99mTc-pyrophosphate scintigraphy has proven to be useful in investigating the nodular lesions in skeletal muscles of sarcoidosis than 67Ga scintigraphy.

Topics: Female; Follow-Up Studies; Humans; Middle Aged; Muscle, Skeletal; Muscular Diseases; Oculomotor Muscles; Ophthalmoplegia; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis; Technetium Tc 99m Pyrophosphate

A 62-year-old woman with skin sarcoidosis was admitted to our hospital to ascertain whether she had cardiac involvement. Although she displayed no cardiac signs or symptoms, the electrocardiogram showed first-degree atrioventricular block, right bundle branch block with left anterior fascicular block, and giant negative T waves in the V3 lead. Echocardiography revealed marked hypertrophy localized in the basal portion of the interventricular septum (IVS) without systolic dysfunction, mimicking hypertrophic cardiomyopathy (HCM). Exercise thallium-201 myocardial imaging revealed redistribution in the anteroseptal region. Both gallium-67 (67Ga) and technetium-99m pyrophosphate (99mTc-PYP) scintigraphy revealed abnormal uptake in the myocardium. These findings disappeared after 2 months of steroid treatment. Reports of cardiac sarcoidosis mimicking HCM are rare. However, hypertrophy in the basal portion of the IVS is an important sign of early cardiac involvement in sarcoidosis. 67Ga and 99mTc-PYP scintigraphy were useful and necessary to differentiate this type of cardiac sarcoidosis from HCM.

Topics: Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Gallium Radioisotopes; Heart Block; Humans; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Eighty-one consecutive patients, 32 males and 49 females, with biopsy-proven systemic sarcoidosis, none of whom had clinical evidence of heart disease, underwent M-mode and two-dimensional echocardiography, ECG and chest X-ray in order to investigate the frequency of sarcoid pericardial effusion. Mild or moderate size pericardial accumulations were found by echocardiography in 17 patients (21%), four males and 13 females (mean age 49.7 +/- 9.2 years). Pericardial effusion could not be correlated with clinical symptoms or physical signs, chest X-ray and ECG findings. All 17 patients with pericardial effusion were also studied by technetium-99m pyrophosphate radionuclide myocardial imaging, targeting to reveal the coincident presence of specific heart muscle disease or 'infiltrative cardiomyopathy'. The results showed abnormal scans in 13 of 14 patients with technically satisfactory scans, indicating the coincidence of sarcoid myocardial involvement in 92% of the patients with pericardial effusion, representing 16% of the total population studied. Thus, pericardial effusion in sarcoidosis should not be considered a rare condition, while concomitant presence of positive technetium-99m pyrophosphate radionuclide myocardial imaging could suggest that sarcoid pericardial effusion is often accompanied by specific heart muscle disease. This observation has not been well established previously in the literature.

Topics: Cardiomyopathies; Echocardiography; Female; Humans; Male; Middle Aged; Pericardial Effusion; Radionuclide Imaging; Sarcoidosis; Technetium Tc 99m Pyrophosphate

A case report of patient with cardiac sarcoidosis is presented. Advanced atrioventricular (AV) block and abnormalities of radionuclide imaging were improved by steroid therapy. We stress the effectiveness of steroid therapy together with usefulness of radionuclide techniques.

Topics: Cardiomyopathies; Diphosphates; Female; Heart Block; Humans; Middle Aged; Pacemaker, Artificial; Prednisone; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

This study was aimed to determine whether nuclear methods were useful for examining cardiac pathology and for making a decision of corticosteroid therapy in patients with sarcoidosis. Thirty six patients were divided into two groups; GpA consisted of 19 patients with cardiac sarcoidosis and abnormal ECG findings, and GpB of 17 patients with sarcoidosis without ECG abnormalities. Cardiac uptake of 67Ga-citrate in 2 and 99mTc-PYP in one of GpA was observed and steroid therapy resulted in the disappearance of the uptake. 201Tl-CL cardiac tomograms disclosed perfusion defects in 10 of 14 patients (71%) in GpA, including defects with redistribution in 8 of the 10 pts, but only one case in GpB. Radionuclide ventriculography using 99mTc-RBC revealed abnormal response of left ventricular (LV) function to exercise and LV dysfunction in GpA. These data suggest that nuclear study is a useful tool for diagnosing cardiac sarcoidosis, evaluating therapeutic effectiveness and long-term follow-up in patients with sarcoidosis.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Marked clinical or electrocardiographic changes, suggestive of heart disease, were only detected in 14 (7%) of 190 patients with sarcoidosis. Diffuse myocardial accumulation of 99mTc pyrophosphate (2+ or 3+) was seen in 12 (43%) of 28 patients with active sarcoidosis. Repeated scintigraphy showed normal values in 3 patients after a course of corticosteroid therapy. Echocardiographic signs of heart disease were found in 33 (37%) of 89 patients, including left-ventricular contractility disorders in 21, thinning (5) or thickening (7) of left-ventricular wall and ventricular septum, mitral prolapse in 3 and limited pericardial exudate in 5. Signs of pulmonary heart were detected in 17 patients. Clinical and electrocardiographic symptoms of cardiac sarcoidosis were significantly more frequent in patients with myocardial Tc-pyrophosphate accumulation and echocardiographic changes. It is suggested that myocardial Tc-pyrophosphate scintigraphy and echocardiography may be used for the diagnosis of cardiac sarcoidosis, including its latent forms.

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; False Negative Reactions; Heart; Humans; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

A patient had severe congestive cardiomyopathy secondary to myocardial sarcoidosis. The clinical diagnosis was confirmed by radionuclide ventriculography, thallium 201 (201Tl), gallium-67 (67Ga), and technetium-99m (99mTc) pyrophosphate (TcPYP) scintigraphy. Myocardial TcPYP uptake has not been reported previously in sarcoidosis. In this patient, TcPYP was as useful as gallium scanning and thallium imaging in documenting the myocardial process.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Radioisotopes; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium