ABSTRACT
Aim/Introduction: Myocarditis is the one of the serious complications that occurs in 15-60% of patients who have had a new coronavirus infection COVID-19. Coronaryitis was the main feature of the COVID-19-associated myocarditis, as well as a possible combination of myocarditis and lymphocytic endo-and pericarditis. Previous world studies have shown that the sensitivity of SPECT with 99mTc-HMPAO-leukocytes in the diagnosis of inflammatory changes in the myocardium was 62%, the specificity was 92%, and the diagnostic accuracy was 85%. Material(s) and Method(s): Patient N, a man, 54 years old, was admitted to hospital in critical condition with a diagnosis of coronavirus infection COVID-19, the virus was identified. The complications were bilateral polysegmental pneumonia, respiratory failure, intoxication syndrome. Comorbidities were ischemic heart disease, atherosclerotic and postinfarction atherosclerosis, hypertension, dyscirculatory encephalopathy. According to the results of laboratory and instrumental tests, myocarditis was suspected. To clarify the diagnosis, it was recommended to perform scintigraphy with 99mTc-HMPAO labeled leukocytes.Leukocytes were labeled with 99mTc-exametazim (99mTc-HMPAO). The scintigraphy method that described for the topical diagnosis of inflammatory diseases of the heart (Patent RU 2136218 C1, IPC: A61B 8/13) was used. This technique involves the implementation of two scintigraphic studies: with 99mTc-HMPAO-labeled leukocytes to determine the focus of inflammation and with 99mTc-sestamibi for myocardial topography.The method proposed for the detection of foci of inflammation using multiple organ scintigraphy for the process of leukocytes' selection and labeling was used (patent RU 2648877 C1, IPC: A61B 6/03, A61K 49/04, A61P 43/00). Result(s): Scintigraphy was performed 20 hours after the administration of the radiopharmaceutical with Symbia T SPECT/CT. We used highresolution collimators, a matrix: 64x64 pixels, 32 positions, 40 seconds each. Using the 'Fusion' software, a combination of two conducted SPECT studies was carried out according to radioactive labels previously applied to the patient. In that case, the focus of inflammation was located in the apex region of the heart.The patient continued appropriate therapy, and the control echocardiography showed recovery of the ejection fraction to the original 53% and akinesia regression. During the treatment, all clinical and laboratory criteria for recovery were achieved. Conclusion(s): Scintigraphy with autoleukocytes labeled with 99mTc-HMPAO, a method for noninvasive diagnosis of myocarditis, including those associated with COVID-19. The implementation of the dual protocol with 99mTc-HMPAO and 99mTc-sestamibi allows precise localization of the inflammatory focus, as well as assessment of myocardial perfusion.