Limited clinical diagnostic specificity of technetium-99m stannous pyrophosphate myocardial imaging in acute myocardial infarction

Ahmad, Masood; Dubiel, J; Logan, K.W.; Verdon, Thomas A.; Martin, Richard H.

doi:10.1016/s0002-9149(77)80010-6

Cited by 54 publications

(3 citation statements)

References 11 publications

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“…Recently, reports have suggested that myocardial accumulation of this radionuclide may occur without evidence of an acute myocardial infarction (1,10,13,17,20,24,28,31,35), and may be associated with left ventricular aneurysms (2,22). In our hospital one-third of the " mTc-polyphosphate bone scans were noted to have myocardial accumulation (16).…”

Section: Introductionmentioning

confidence: 99%

Correlation of <sup>99m</sup>Tc-Pyrophosphate Myocardial Accumulation with Left Ventricular Wall Motion Abnormalities

Ja¹,

Fd²,

Ew³

1980

Cardiology

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Reports have indicated that myocardial accumulation of ^99mTc-pyrophosphate occurs in the absence of a recent myocardial infarction. An attempt was made to determine if myocardial accumulation, in the absence of a recent infarction, may be associated with left ventricular wall motion abnormalities. 51 patients undergoing elective left ventriculography had ^99mTc-pyrophosphate cardiac scans 24–28 h prior to the procedure. 33 (33/51) patients had myocardial accumulation; all 33 had left ventricular wall motion abnormalities. Localized myocardial accumulation occurred in 21 (21/33) patients; 19 of the 21 had localized left ventricular wall motion abnormalities corresponding to the area of myocardial accumulation. 12 (12/33) patients had diffuse myocardial accumulation; 4 had diffuse left ventricular hypokinesis and 8 had localized myocardial dysfunction. 18 (18/51) patients had no myocardial accumulation of the radionuclide; 9 had normal wall motion in all areas and 9 had localized dysfunction. The data strongly suggest that myocardial accumulation of ^99mTc-pyrophosphate in the absence of a recent myocardial infarction is associated with a left ventricular wall motion abnormality.

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Section: Introductionmentioning

confidence: 99%

Correlation of <sup>99m</sup>Tc-Pyrophosphate Myocardial Accumulation with Left Ventricular Wall Motion Abnormalities

Ja¹,

Fd²,

Ew³

1980

Cardiology

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“…Since its introduction by Bonte and co-workers Parkey et al, 1974;McLaughlin et al, 1975), experience has been accumulating with the use of this agent and the sensitivity and specificity of the diagnostic technique. Its specificity has been found to be adversely influenced in a variety of settings in which positive scintiscans may be obtained in the known or inferred absence of acute myocardial infarction (Ahmad et al, 1975;Berman et al, 1975;Willerson et al, 1975;Abdulla et al, 1976;Ahmad et al, 1976;DiCola et al, 1976;Klein et al, 1976;Pugh et al, 1976;Ahmad et al, 1977;Prasquier et al, 1977;Righetti et al, 1977) (Table 1). It is uncertain whether positive images in unstable angina Abdulla et al, 1976), transient exercise-induced ischaemia (Berman et al, 1975), and direct current cardioversion (DiCola et al, 1976;Pugh et al, 1976) should be termed 'false positive' since there may be myocardial necrosis without reflection by the usual clinical (electrocardiographic or enzymatic) values.…”

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“…After coronary artery bypass surgery, scintiscans have been found to show areas with increased uptake at the site of the vent in the left ventricle created during surgery (Ahmad et al, 1975). Left ventricular aneurysms and dyskinetic areas have also been found to be associated with positive scintiscans without evidence of acute myocardial infarction (Ahmad et al, 1976(Ahmad et al, , 1977. Scintiscans which are positive in the presence of impaired renal function or after left mastectomy (Prasquier et al, 1977) may represent inadvertent blood pool scanning, with abnormal positivity being the result either of high levels of circulating tracer material or of diminution in shielding over the left thorax.…”

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Technetium-99m stannous pyrophosphate scintigraphy in patients with calcification within the cardiac silhouette.

Wald¹,

Sternberg²,

Huckell³

et al. 1978

Heart

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SUMMARY Technetium-99m stannous pyrophosphate scintiscanning was performed in 22 patients with radiographically detected calcification within the cardiac silhouette. All but one of these scintigrams showed a localised area of increased activity similar to that ordinarily seen in acute myocardial infarction. Scintiscans in 3 patients after removal of the calcified aortic valve reverted to negative. It was concluded that this technique for acute infarct detection may yield false positive results in the presence of cardiac calcification.

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Correlation of false negative myocardial infarct scintigraphy with postmortem studies

Codini

Hawkins

Turner

1981

Clinical Cardiology

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Summary:Negative myocardial infarct scintigrams with """'technetium stannous pyrophosphate (99mTc-PY P) were obtained in two patients with acute massive transmural infarct. Both patients died soon after scintigraphy. Because necropsy was performed within hours after death, we were able to correlate the distribution of the tracer within the acutely infarcted tissue with the myocardial scintigram. The clinical implication is that a single myocardial scintigram may be grossly inaccurate in detecting and quantifying infarct size. The scintigraphic findings should always be correlated with the electrocardiographic and enzymatic findings in evaluating patients with possible myocardial infarct. The sensitivity of 9')"'technetium stannous pyrophosphate (O')tllTc-PY P) cardiac imaging in the detection of acute myocardial infarct (AMI) varies from 86 to 100% in patients An 83-year-old male was admitted with the classical clinical findings of an A M I . The patient had a history of myocardial infarct 19 years prior to admission and exertional angina. An admission ECG and subsequent tracings revealed the characteristic evolution of an acute anterior infarct. The admission blood pressure was 130/70 mmHg; heart rate was 72 beats/min. Creatinine kinase was 180 IU/I and rose to 670 IU/I by 12 h (normal range, 25-145).On the second hospital day, 15 mCi of 99mTc-PYP were injected intravenously. A Searle Radiographics mobile scintillation camera equipped with a medium resolution collimator (LEAP-parallel hole) was used. The pulse height analyzer was centered on an energy corresponding to a 140-keV photopeak of 99mtechnetium with a 20% window.

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Limited clinical diagnostic specificity of technetium-99m stannous pyrophosphate myocardial imaging in acute myocardial infarction

Cited by 54 publications

References 11 publications

Correlation of <sup>99m</sup>Tc-Pyrophosphate Myocardial Accumulation with Left Ventricular Wall Motion Abnormalities

Correlation of <sup>99m</sup>Tc-Pyrophosphate Myocardial Accumulation with Left Ventricular Wall Motion Abnormalities

Technetium-99m stannous pyrophosphate scintigraphy in patients with calcification within the cardiac silhouette.

Correlation of false negative myocardial infarct scintigraphy with postmortem studies

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