technetium-tc-99m-pyrophosphate and Syndrome

We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.. We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).. Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.. Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

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

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

The thesis of primariness of the disease and of its osseous tissue manifestations is discussed on the grounds of the results from a complex study on 3 patients. The periosteal ossifying hyperplasia and disturbances in the osseous tissue structure develop with no other organ symptomatics and in the absence of any changes in the available laboratory and immunological indices. The macromorphological X-ray characteristic corresponds to the radionuclide tests of the study with 99MTc-pertechnetate, 99MTc-pyrophosphate and 99MTc-sulfocolloid, informing about abnormal vascularization index, growth of bone-marrow tissue and intensified joint-tissue anabolism.

Topics: Adult; Arthrography; Diphosphates; Humans; Joints; Middle Aged; Osteoarthropathy, Primary Hypertrophic; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Syndrome; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Bone and Bones; Diphosphates; Humans; Male; Osteoarthropathy, Primary Hypertrophic; Radionuclide Imaging; Skin Diseases; Syndrome; Technetium; Technetium Tc 99m Pyrophosphate