Aporte de la centellografía con trazadores tecneciados fosfatados al diagnóstico de amiloidosis cardíaca / Contribution of scintigraphy with technetium phosphated tracers to the diagnosis of cardiac amyloidosis / Contribuição da cintilografia com traçadores fosfatados com tecnécio para o diagnóstico de amiloidose cardíaca

Las amiloidosis son enfermedades causadas por el depósito patológico extracelular de un material proteico fibrilar e insoluble denominado amiloide, que puede estar vinculado a cadenas livianas (AL) o transtirretina (TTR). La amiloidosis cardíaca provoca una cardiomiopatía restrictiva de carácter progresivo caracterizada por falla cardíaca con función sistólica relativamente preservada, que se asocia a elevada mortalidad. Aunque el diagnóstico definitivo tradicionalmente se basa en la biopsia endomiocárdica, los avances en imagenología han mejorado su abordaje y la reciente introducción de terapias especificas permiten augurar cambios significativos en el pronóstico. El tratamiento difiere según el tipo de amiloide involucrado y su resultado depende de la instauración precoz de este, por lo cual resulta esencial un diagnóstico preciso y temprano. El centellograma cardíaco con fosfatos marcados (99mTc-PYP u otros), ampliamente disponible y de relativo bajo costo, se considera en la actualidad como una "biopsia molecular no invasiva" para el diagnóstico de la amiloidosis tipo ATTR, que debe ser usado en conjunto con la investigación de proteínas monoclonales en pacientes con sospecha clínica de la enfermedad.

Amyloidoses are diseases caused by the extracellular deposition of a fibrillar and insoluble protein material called amyloid, which can be linked either to light chains (AL) or transthyretin (TTR). Cardiac amyloidosis causes a progressive restrictive cardiomyopathy characterized by heart failure with relatively preserved systolic function, which is associated with high mortality. Although a definitive diagnosis is traditionally based on endomyocardial biopsy, advances in cardiac imaging have improved its approach, and the recent introduction of specific therapies predicts significant changes in prognosis. Since treatment differs according to the type of amyloid involved and the results depend on a prompt implementation, an accurate and early diagnosis is essential. Cardiac scintigraphy with labeled phosphates (99mTc-PYP or others), widely available and relatively inexpensive, is currently considered a "noninvasive molecular biopsy" for the diagnosis of ATTR type amyloidosis, which should be used in conjunction with investigation of monoclonal proteins in patients with clinical suspicion of the disease.

As amiloidoses são doenças causadas pela deposição patológica extracelular de um material proteico fibrilar e insolúvel, denominado amiloide, que pode estar ligado a cadeias leves (AL) ou transtirretina (TTR). A amiloidose cardíaca causa cardiomiopatia restritiva progressiva caracterizada por insuficiência cardíaca com função sistólica relativamente preservada, que está associada a alta mortalidade. Embora o diagnóstico definitivo seja tradicionalmente baseado na biópsia endomiocárdica, os avanços nos exames de imagem aprimoraram sua abordagem e a recente introdução de terapias específicas pode predizer mudanças significativas no prognóstico. O tratamento varia de acordo com o tipo de amiloide envolvida e seu resultado depende do início precoce, por isso um diagnóstico preciso e precoce é essencial. A cintilografia cardíaca com fosfatos marcados (99mTc-PYP ou outros), amplamente disponível e relativamente econômico, é atualmente considerada uma "biópsia molecular não invasiva" para o diagnóstico de amiloidose do tipo ATTR, que deve ser usada em conjunto com a investigação de proteínas monoclonais em pacientes com suspeita clínica da doença.

Nuclear Medicine Methods of Rejection Diagnosis in Transplanted Rat Model / 대한흉부외과학회지

BACKGROUND: An accurate diagnosis of the severity of the rejection after a heart transplantation relies on endomyocardial biopsy, but because of its invasiveness and the need for repeated examination makes it is an inappropriate monitoring method. Therefore, we have tried to find a monitoring method that is continuous and less invasive. MATERIAL AND METHOD: Heterotopic heart transplantation using Ono-Lindsey Method was done in 20 rats, and then 99mTc-Pyrophosphate (PYP) scan was done after a month. Uptake ratio of transplanted heart to vertebrae (H/V) was obtained to be compared with the biopsy result. RESULT: Rejection was defined when the H/V uptake ratio was higher than 0.09, and we compared the uptake ratio with the results of biopsy. The result was true positives was 3, true negatives 12, false negatives 2, andfalse positives 3. Therefore sensitivity was 60% and specificity was 80%, diagnostic value was 75%. CONCLUSION: 99mTc-Pyrophosphate (PYP) scan was a useful method for the evaluation of the heart transplantation rejection and it will be helpful for monitoring rejection as an non-invasive and simple method.

Captación miocárdica de pirofosfato en amiloidosis cardíaca: caso clínico / Myocardial pyrophosphate uptake in cardiac amyloidosis: clinical case

We report a previously healthy 73 years old woman, who was hospitalised with increasing dyspnea and signs of congestive heart failure. Echocardiography showed a normal left ventricular cavity with increased echogenicity of its walls and severe pulmonary hypertension. A lung ventilation/perfusion scintigraphy concluded that there was a low probability for pulmonary embolism. Coronary angiography was normal. A restrictive cardiomyopathy due to amyloid deposits was suspected. Myocardial pyrophosphate scintigraphy showed intense pyrophosphate uptake in the left ventricle wall. An abdominal fat tissue biopsy was positive for amyloid deposits

Effect of alpha-tocopherol on the ischemia/reperfusion lesions induced in the hindlimb of rats

Recentes estudos demonstraram que os radicais livres de oxigênio parecem desempenhar papel importante nas lesões de isquemia-reperfusão. O alfa-tocoferol(AT) age in vivo como um anti-oxidante. Nosso objetivo foi o de verificar se o AT atenuava as lesões de isquemia-reperfusão em pata direita de ratos. Os animais, randomizados, foram divididos nos seguintes grupos(G): G1-controle sem isquemia; G2 e G3 - quatro horas isquemia e duas reperfusão. Os animais do G2 foram tratados com salina e os do G3 com AT, 50mg/kg. Como parâmetros examinamos as alterações de volume e circunferência do pé direito ao longo do experimento, assim como a captação de 99mTc-pirofosfato e a microscopia eletrônica de transmissão do músculo soleus direito. Os aumentos de volume e circunferência do pé dos animais do G2 foram estatisticamente maiores quando comparados com o G1. As medidas do G3 não diferiram do G1. A captação de 99mTc-pirofosfato foi bem aumentada nos G2 e G3, quando comparados ao G1, porém sem diferenças entre os grupos isquêmicos. As lesões ao MET foram menos intensas em três animais do G3, quando comparados ao G2. Conclusão: O tratamento com AT diminuiu a formação do edema mas só protegeu parcialmente as células musculares contra as lesões de isquemia-reperfusão.

Correlation of semiquantitative Tc99m- pyrophosphate myocardial SPECT with the quantities of LVEF in determining the extent and intensity of acute MI

This study was performed to evaluate the Tc-pyp SPECT role in determination of AMI severity and extension. Pyp SPECT imaging was done for 54 patients with AMI, who met the WHO criteria. SPECT findings were correlated with LVEF measurements. The abnormal scan was graded according to the intensity and was compared with the activity of the sternum in the same image. In addition, a segmental myocardial model was used for location determination of abnormal tracer uptake. Resting LVEF was determined by 2D echocardiography in each patient 2 weeks after onset of pain. 79 patients had positive pyp SPECT scans. According to pyp uptake intensity, good correlation between severity and extension of pyp uptake and LVEF was seen. These factors can be considered suitable for prognosis estimation in early post AMI period

Visualización de rabdomiólisis con cintigrafía con Tc99m pirofosfato: presentación de un caso clínico / Visualization of rhabdomyolysis with scintigraphy with Tc99m pyrophosphate: presentation of a clinical case

Se presenta un caso de rabdomiolisis de causa isquémica secundaria a disección aorta ascendente y obstrucción de la arteria femoral izquierda como consecuencia de consumo de cocaína. Un cintigrama con Tc99m-pirofosfato demostró la presencia de rabdomiolisis de ambas extremidades inferiores

Dolor precordial y elevación de CPK-MB posejercicio que simula infarto agudo de miocardio: presentación de 2 casos y revisión de la literatura / Precordial pain with increase of CK-MB fraction after exercise that mimics acute myocardial infarction: report of two cases, with review of references

Se detallan 2 casos de dolor y elevación de la fracción B de la creatinfosfoquinasa posejercicio, que requirieron coronariografía (coronarias normales) para descartar infarto agudo de miocardio. En ambos casos hubo una elevación absoluta de la creatinfosfoquinasa y de la fracción MB de la creatinfosfoquinasa; en el segundo caso también aumentó la relación porcentual de la fracción MB de la creatinfosfoquinasa (18,6 por ciento de la creatinfosfoquinasa total). Es común el aumento de la fracción MB de la creatinfosfoquinasa luego de lesiones y/o traumatismos musculares; en algunos casos incluso aumenta la relación aumento de la fracción MB de la creatinfosfoquinasa/creatinfosfoquinasa total o el índice de las subformas de aumento de la fracción MB de la creatinfosfoquinasa, semejándose su perfil enzimático al del infarto agudo de miocardio

Desgarro muscular, arritmia supraventricular y aumento de la CPK-MB que simula un evento coronario: reporte de un caso / Muscular dilaceration, supraventricular arrhytmia and increase of CPK-MB that seems a coronary event: report of a case

A 47 year old man without coronary risks factors had an acute pain in his right quadriceps following a kick to a soccer ball. Four hours later, he had a paroxysmal atrial fibrillation with a moderate ventricular response. He never had precordial pain. His first CK was increased, and the MB fraction was 20 per cent of total CK. He was admitted to the Coronary Care Unit, and the second sample shows again an increase of both CK and its MB fraction. He recovered his sinus rhythm with amiodarone and quinidine, and his EKG's never showed ST-T segments alterations. A bidimensional echocardiography, and a stress test with Tc99-pirophosphate showed no abnormality. An ecography of his right quadriceps shows an 20 x 25mm lesion in the rectus anterior portion, which was compatible with an acute strain of thid muscle. An electrophoretic study of the CK (done on the fouth day), shows that 95 per cent was MM-CK and 5 per cent MB-CK, without BB fraction present in the sample. The patient was discharged with betablockers and remained asymptomatic in the follow-up. In the discussion, it is showed that MB-CK could increase its absolute values following several events: after marathon training and/or race, in professional athletes, and after acute muscular injuries. In some cases the enzymatic curve an the ratio MB/total CK (no matter which test is used) could mimic an acute myocardial pirophosphate scan wich is always normal, and also can show the skeletal lesion. Although troponin T test was claimed to be more specific than MB-CK, there are exceptions, so it could be better to do a troponin I test, if there is any diagnostic incertainty.(A U)

Estudios cardioisotopicos en las miocardiopatias y miocarditis / Radioisotope studies in cardiomyopathies and myocarditis

Se revisa la utilidad de la ventriculografia nuclear en el estudio de la funcion y de los volumenes telediastolicos y telesistolicos de ventriculo izquierdo en los pacientes con miocardiopatias dilatadas, hipertroficas y restrictivas. Tambien se valora el aporte de los estudios al seguimiento de pacientes a quienes se les realiza una miocardioplastia dinamica, incluyendo la determinacion del indice de regurgitacion o relacion entre las amplitudes ventriculares. En el caso de la miocarditis, enfermedad especifica del musculo cardiaco, se comentan los metodos de deteccion de dano miocardico y se hace hincapie en el empleo de la gammagrafia con anticuerpos monoclonales antimiosina

Tecnecio 99 Pirofosfato en el Diagnóstico de Infarto Agudo de Miocardio: Correlación con el electrocardiograma

La utilidad de imágenes con tecnecio 99 Pirofosfato (Tc-99-PPi) para detectar necrosis e isquemia en pacientes con dificultad para establecer el diagnóstico de infarto agudo de miocardio (IAM), fue estudiado en 37 pacientes. Estudios con Tc-99-PPi fueron obtenidos en todos los pacientes al 3 y 5 días de sospecha diagnóstica. Electrocardiogramas y mediciones seriadas de niveles de isoenzimas CPK MB fueron realizados durante la evolución del paciente. 34 pacientes tuvieron grammagramas anormales asociados a alteraciones electrocardiográficas características de IAM, pero solo 26 pacientes demostraron diagnóstico definitivo de IAM indicado a través de electrocardiograma, niveles de CPK MB y gammagrafía con Tc-99-PPi. La presencia de alteraciones en la captación de Tc-99-PPi se demostró en 34 estudios con sensibilidad de 92 por ciento, especificidad de 70 por ciento con índice de exactitud de 81 por ciento con chi elvado al cuadrado de 8,79. Los cabios electrocardiográficos isquémicos demostraron sensibilidad de 65 por ciento y especificidad de 63 por ciento. Nuestro estudio concluye que la gammagrafía conn Tc-99-PPi tuvo mejor sensibilidad y especificidad, mientras que el electrocardiograma sólo demostró una especificidad comparable al estudio radioisotópico con chi al cuadrado de 5,59.

Imaging diagnosis of venous malformation in head and neck

The venous malformation in head and neck is a developmental vascular disease which arises from the arrest in the certain stage of vascular embryogenesis. However, the lesion extends along the fascia and has a tendancy to recur after incomplete therapy. Retrospectively, the authors reviewed radiologic studies of 20 patients diagnosed as venous malformation during the last 5 years. The diagnosis was verified by histopathology (5 patients) and direct puncture angiography (15 patients). The radiologic studies included. CT with intravenous contrast injection (20 patients), RI angiography with 99m Tc-pyrophosphate (6 patients), and direct puncture angiography (15 patients). Multiplicity of venous malformation was noted in 9 patients. On CT scan, the lesions had lobulated irregular shape, with heterogeneous appearance, showed delayed enhancing characteristics, and had the phleboliths(21 lesions). The venous malformations were located at the masticator space (including masseter muscle) (n=12), retrobulbar space(n=6), submandibular space(n=4), paravertebral space(n=3) and so on. In two cases, the lesions were very extensive involving entire neck and parapharynx. On RI angiography using 99mTc-pyrophosphate, all of the lesions showed persistent and delayed uptake. With direct punture angiography the lesions could be classified as acinar pattern (n=17) and mixed pattern (acinar and saccular) (n=2). Venous connections were noted in 10 lesions. In conclusion, if a soft tissue mass on head and neck shows a heterogeneous attenuation density with or without calcified phlebolith on CT scan, RI angiography is recommended as a next diagnostic study. If it shows delayed persistent uptake, venous malformation can be suspected. Finally direct puncture angiography can verify the nature and extent of the lesions.

Sensitivity of 99mTc-pyrophosphate scintigraphy in diagnosis of acute myocardial infarction

No abstract available.

value of technetium 99m stannous pyrophosphate myocardial scintiscan in detection of acute myocardial infarction

As electrocardiogrophic criteria of acute myocardial infarction is not specific in some situation as in the case of non Q wave infarction, left bundle branch block and patients with previous infarction. Also elevation of cardiac enzymes can occur with other circumstances rather than acute myocardial infarction. The previous reports have encouraged us to perform this work in which we utilized technetium 99m pyrophosphate myocardial scintiscan as additional diagnostic tool in the diagnosis of acute myocardial infarction both Q and non Q wave. This work was done on fifty patients with prolonged chest pain suspicions of coronary insufficiency and ECG changes wether Q or non Q admitted to CCU of Ain-Shams university hospital. All patients were injected intravenausly by 10mci of Technetium 99m pyrophosphate which was prepared in the hot lab of nuclear medicine department, then injected in the patients after 20 minutes. The patient were transfered to nuclear medicine department 90-120 minutes after injection for myocardial scanning. The scanning was done by using gamma camera the adjoined computer system transfer the image to the special films. Evaluation of resultant images were done as regards type, grading and wall location of technetium 99m Pyrophosphate uptake. The myocardium scintiscan by Technetium 99m Pyrophosphate was positive in 42 patients, 32 patients with Q wave infarction and 10 patients with non Q wave infarction among those 42 patients only one patient considered as false positive. On the other hand we have 8 patients with negative scan, 4 of them proved to be lost false negative. Three types of scan uptake were recognized. The discrete type, which was seen in 22 patients, 20 of them were found to have Q wave infarction the other two were non Q. The diffuse type was the commonest finding of non Q infarction [in 70% of positive cases]. And lastly the doughnut type present in only two patients, one with Q wave infarction while the other with non Q wave infarction. As regards the sensitivity and specificity of this test among those patients presented with Q - wave infarction. The sensitivity was 94.1% and the specificity was 100%. The diagnostic accuracy this test was 94.2%. Among those patients with non Q ware infarction the sensitivity was 81%, the specificity was 75%, the diagnostic acuracy of this test was 80%

99mTc Pyrophosphate Knee Scintigraphy as a Diagnostic tool for the Tear of the Meniscus of the Knee / 대한정형외과학회잡지

We tried to evaluate the possibility that the radionuclide imaging of the knee with 99mTc-pyrophosphate be the diagnostic tool for the patients with the suspected tear of the meniscus of the knee. Among the 142 cases in which 99mTc-pyrophosphate scan was performed, both arthrogram and knee scintigraphy were performed in 60 cases, but only 25 cases were done arthroscopy & arthrotomy for identification to intraarticular legion. We observed 4 types of abnormally increased uptake in the scintigraphy from 16 cases of 19 cases that identified to the meniscus tear. These patterns were seen with 1) diffuse increased uptake, 2) focal increased uptake, 3) plate-like increased uptake in or near the joint space, 4) diffuse increased uptake with plate-like accentuation. Among the 25 cases, 18 cases were found to have consistent scintigraphy & operative findings, 3 cases were observed not tear of meniscus but other legions in the knee joint. And only 4 cases were seen differented to findings of arthrotomy & scintigraphy. We could conclude that the knee scintigraphy with 99mTc-pyrophosphate could be used as a helpful method of the initial evaluation of the internal derangement of the knee in the patients with the suspected tear of the meniscus of the knee.

An experimental study on radionuclide imaging of bowel infarction using (99m)Tc-pyrophosphate

99m Tc-pyrophosphate was investigated for use as an indicator of intestinal infarction in intussusceptedbowel. Irreducible intussusceptions were created in 18 rabbits by surgery. 99mTc-pyrophosphate was then injectedintravenously 6-12, 18, 24 and 30-40 hours later for external scanning. In 15 of the rabbits, infaractiondeveloped with intussusception, and 13 of them demonstrated increased uptake of 99m Tc-pyrophosphate on externalinvivo scintiscans. The remained 2 of them showed no evidence of increased uptake. So false negative cases were2(sensitivity 86.7%). The 3 rabbits without infarction showed no increased uptake of radionuclide. Specimenscanning confirmed increased uptake of radionuclide in the infarcted segments. These observations suggest that 99mTc-pyrophosphate is a reliable indicator of the intestinal infarction that sometimes occures with intestinal intussusception.