Abnormal technetium-99m pyrophosphate images in unstable angina: Ischemia versus infarction?

Jaffe, Allan S.; Klein, Milton S.; Patel, Bharti R.; Siegel, Barry A.; Roberts, Robert

doi:10.1016/0002-9149(79)90165-6

Cited by 31 publications

(7 citation statements)

References 20 publications

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“…cells, but do not accumulate in normal myocardial cells.8' 12-14 Although both experimental" and clinical15 studies have raised the possibility that "mTc-PYP can accumulate to a slight degree in reversibly damaged myocardial cells, accumulation of "9mTc-PYP generally indicates irreversible myocardial damage.6 7,13 A recent study from our laboratory using scanning electron microscopy with elemental x-ray dispersive microanalysis indicated that substantial levels of iodine were measured in myocardial cells within the infarcted region, but no iodine was detected in normal myocardium. 15 The damaged myocardial cells that accumulated iodine showed drastic alteration of intracellular sodium-potassium ratio, suggesting the loss of cellular membrane integrity and probably irreversible cellular damage. Whether iodine accumulation occurs to any degree in reversible damaged myocardial cells has not been established.…”

Section: Relationship Of Distribution Of Iodine and "9mtc-pyp To Resimentioning

confidence: 99%

Contrast enhancement of myocardial infarction: dependence on necrosis and residual blood flow and the relationship to distribution of scintigraphic imaging agents.

Higgins¹,

Hagen²,

Newell³

et al. 1982

Circulation

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SUMMARY All or part of a myocardial infarction (MI) can be preferentially enhanced on computerized transmission tomography after i.v. administration of iodinated contrast material. To examine the relationship of this phenomenon to the presence of myocardial necrosis, the blood flow profile of the MIs and the distribution of radionuclide infarct imaging agents, collateralized infarcts were produced in six dogs (group A) and noncollateralized infarcts were produced in nine dogs (group B). After 48 hours of coronary occlusion, each dog received technetium-99m pyrophosphate ( mTc-PYP), thallium-201 (201T1), indium-111-labeled microspheres and meglumine sodium diatrizoate (Renografin-76) before sacrifice.Residual blood flow in the center of the MI was 3-27% in group A and less than 3% in group B. In group A, the iodine concentration in the center (1.33 mg/g myocardium), periphery (1.48 mg/g), and margin (1.09 mg/g) were several times higher than normal myocardium (0.45 mg/g). The distribution of "9mTc PYP was similar to that of iodine; the distribution of 201TI was roughly the inverse of that of iodine.In group B, the average iodine and OmTc concentrations in the margin, and periphery of the MI were several times higher than that in normal myocardium, but in the center neither concentration was significantly higher than normal. However, there was no consistent relationship between iodine and 201TI, as concentrations of iodine and 201TI were low in the center of the infarct and were inversely related at other sites.The results show that contrast material has a distribution in MI similar to that of "9mTc PYP and both are markers of ischemic myocardial necrosis. Distribution of both agents in the MI depends on a threshold level of residual myocardial blood flow.COMPUTERIZED transmission tomography (CTT) has been used to image myocardial infarctions in experimental animalsl-3 and, in a few instances, in man.' After i.v. or intracoronary administration of iodinated contrast material to dogs with myocardial infarctions, CTT scans have shown delayed and differential enhancement of the area of ischemic damage compared with normal myocardium. Measurement of myocardial tissue concentration of iodine have confirmed this preferential accumulation of contrast material in infarcted myocardium and have shown peak concentrations of iodine in the infarct at 10 minutes after i.v. administration of the contrast material.5Contrast material therefore can provide a positive image of the infarct on the CTT scan, similar to the image produced by technetium-99m pyrophosphate (99mTc-PYP) on scintigraphic scans of acute myocardial infarction.6 Moreover, like the BmTc-PYP scan, the pattern of contrast enhancement has been homogeneous in some infarcts and only partial or peripheral in others" 2 ( fig. 1) cumulation of iodinated contrast material in areas of ischemic myocardial damage has not been determined.The purpose of the current study was to determine the significance of contrast enhancement of myocardial infarctions by studying the relatio...

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Section: Relationship Of Distribution Of Iodine and "9mtc-pyp To Resimentioning

confidence: 99%

Contrast enhancement of myocardial infarction: dependence on necrosis and residual blood flow and the relationship to distribution of scintigraphic imaging agents.

Higgins¹,

Hagen²,

Newell³

et al. 1982

Circulation

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“…' 12 Properly performed, this technique can diagnose myocardial infarction in more than 95% of patients with transmural myocardial infarction and in 38-100% of patients with nontransmural myocardial infarction. 4 12 Of interest, 2542% of patients with un-tigrams.6 ' 8,10, 12-16 It has been suggested that these patients may have clinically undetected myocardial necrosis.6' 16 The natural history of unstable angina patients with positive scintigrams is unknown. The purpose of the present investigation was to assess the natural history of patients with unstable angina pectoris, especially those with positive myocardial scintigrams; and to assess the prognostic value of technetium-99m pyrophosphate scintigraphy, by itself, and in combination with other clinical measurements in a large population of patients admitted to the coronary care unit with a diagnosis of unstable angina.…”

mentioning

confidence: 99%

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

Olson¹,

Lyons²,

Aronow³

et al. 1981

Circulation

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“…12 However, another report suggested only 8% could be classified as having positive scan without CK-MB elevation, 10 thus indicating that the clinical utility of PYP myocardial scintigraphy may be limited.…”

Section: Discussionmentioning

confidence: 99%

“…7 99m Tc-pyrophosphate (PYP) also uses a flow tracer to assess the severity and extent of ischemia, and that of myocardial viability. In UA the uptake of PYP is visualized as diffuse, slightly positive findings [8][9][10] and others have suggested that there is uptake of this agent by injured myocardial cells in the absence of infarction. 11,12 Preliminary clinical results suggest that breath-held, black blood turbo short-inversion-time inversion recovery (STIR) imaging may be sensitive to focal changes of contrast between edematous and normal myocardium.…”

mentioning

confidence: 99%

Diagnostic Use of T2-Weighted Inversion-Recovery Magnetic Resonance Imaging in Acute Coronary Syndromes Compared With 99mTc-Pyrophosphate, 123I-BMIPP and 201TlCl Single Photon Emission Computed Tomography

Takahashi

Inoue

Oka

et al. 2004

Circ J

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large, multicenter study reported that the incidence of unintentional failure to hospitalize patients presenting at the emergency department with acute myocardial infarction (AMI) or unstable angina pectoris (UA) was low, although possibly associated with a poor outcome, and it was suggested that the incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by using a new imaging modality.Recently, the clinical usefulness of a perfusion tracer in the diagnosis of acute coronary syndromes (ACS) was reported. [1][2][3][4] Rest myocardial perfusion imaging with 99m Tc sestamibi had a high sensitivity for identifying patients with ACS 1 and the sensitivity of 99m Tc perfusion tracer and 201 TlCl imaging for detecting coronary artery lesions ranged from 82% to 95% and from 80% to 84%, respecCirculation Journal Vol. 68, November 2004 tively, with a specificity of 75-100% and 75-82%. [2][3][4] 123 I--methyl-p-iodephenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) imaging is considered suitable for patients with UA or severe coronary artery disease because it does not require a provocative test and thus would be useful for detecting the culprit lesion in patients with ACS. 5,6 This imaging modality represents the lesions as ischemic memory. 7 99m Tc-pyrophosphate (PYP) also uses a flow tracer to assess the severity and extent of ischemia, and that of myocardial viability. In UA the uptake of PYP is visualized as diffuse, slightly positive findings 8-10 and others have suggested that there is uptake of this agent by injured myocardial cells in the absence of infarction. 11,12 Preliminary clinical results suggest that breath-held, black blood turbo short-inversion-time inversion recovery (STIR) imaging may be sensitive to focal changes of contrast between edematous and normal myocardium. 13 In the present study we investigated the clinical significance of PYP, BMIPP, 201 TlCl and T2-weighted inversion -recovery magnetic resonance imaging (MRI) for detecting the culprit lesions in patients with ACS. Katumi Matumoto, MD*; Youhei Yamakawa, MD*; Satosi Umemura, MD* Background 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--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. Methods and ResultsThe 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 w...

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Abnormal technetium-99m pyrophosphate images in unstable angina: Ischemia versus infarction?

Cited by 31 publications

References 20 publications

Contrast enhancement of myocardial infarction: dependence on necrosis and residual blood flow and the relationship to distribution of scintigraphic imaging agents.

Contrast enhancement of myocardial infarction: dependence on necrosis and residual blood flow and the relationship to distribution of scintigraphic imaging agents.

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

Diagnostic Use of T2-Weighted Inversion-Recovery Magnetic Resonance Imaging in Acute Coronary Syndromes Compared With 99mTc-Pyrophosphate, 123I-BMIPP and 201TlCl Single Photon Emission Computed Tomography

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