Pathophysiologic considerations and clinicopathological correlates of technetium-99m stannous pyrophosphate myocardial scintigraphy

Willerson, James T.; Parkey, Robert W.; Bonte, Frederick J.; Lewis, Samuel E.; Corbett, James C.; Buja, L. Maximilian

doi:10.1016/s0001-2998(80)80029-8

Cited by 54 publications

(21 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, when 99mTc-PPi is injected 90 min after reflow, its uptake is limited to severely and apparently irreversibly damaged cells within the infarct area. Recent evidence has implicated calcium overload as a major factor contributing to reperfusion injury.22 Also, calcium antagonists, when given early after occlusion, can be protective and extend the time period for preservation of ventricular function during experimental temporary coronary occlusion.23 24 We hypothesize that a significant change in calcium concentration occurs within severely ischemic cells between 10 A potential limitation of the present study is the simple edge-detection algorithm used in imaging in vitro and in vivo. SPECT imaging has more limited spatial resolution than the planar imaging in vitro used in protocol 1.…”

Section: Resultsmentioning

confidence: 97%

“…Group C dogs served as their own controls, and the infarct sizes determined by SPECT were larger in all five dogs when 99mTc-PPi was injected 10 figure 3, A). The relationship between 99mTc-PPi uptake and regional MBF was similar for group B dogs ( figure 3, B), with an inverse exponential relationship (r = -.82).…”

Section: Resultsmentioning

confidence: 99%

“…Three protocols were used in this study: (1) 3 hr of temporary coronary artery occlusion followed by 2 hr of reflow, with 99mTc-Ppi injected 10 min after reflow and postmortem imaging in vitro 2 hr after reflow (group A), (2) 3 hr of temporary coronary artery occlusion followed by 2 hr of reflow, with 99mTc-PPi injected 90 min after reflow and postmortem imaging in vitro 2 hr after reflow (group B), and (3) 3 hr of temporary occlusion followed by reflow, with 99mTc-PPi injected 10 Determination of infarct size with TTC. The cardiac slices were fixed in phosphate-buffered formalin and 35 mm color photographs were taken of both sides of each slice.…”

Section: Methodsmentioning

confidence: 99%

“…[7][8][9] Previously, we have found localization with 99mTc-PPi to be relatively specific for irreversibly injured myocardium after permanent coronary artery occlusion. 10 uptake by severely injured but viable myocardium. 13 Therefore, this study tested the hypothesis that 99mTc.-PPi accurately localizes and estimates the extent of irreversibly damaged myocardium associated with temporary coronary artery occlusion followed by reperfusion.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate.

et al. 1987

View full text Add to dashboard Cite

Previously, technetium-99m-stannous pyrophosphate (99mTc-PPi) has been used to localize and estimate the size of myocardial infarcts in animals after permanent coronary artery occlusion. This study tested the hypothesis that 99mTc-PPi accurately sizes myocardial infarctions produced by temporary coronary artery occlusion and reflow in dogs. Three groups of dogs were studied: group A underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 10 min after reflow (n = 10); group B underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 90 min after reflow (n = 11); and group C underwent 3 hr of occlusion followed by reflow with 99mTc-PPi injected at 10 min and again at 48 hr after reflow (n = 5). Myocardial slices from group A and B dogs were imaged in vitro. Group C dogs were imaged with single photon-emission computed tomography (SPECT) in vivo, and myocardial slices were imaged in vitro at the conclusion of the study. The extent of myocardial infarction was defined with triphenyltetrazolium chloride (TTC) staining, and coronary blood flow was estimated with radioactive microspheres. In addition, transmural myocardial tissue samples were taken from the center of the myocardial infarction, the lateral portion of the myocardial infarction, the normal myocardium adjacent to the lateral aspect of the infarcts, and from the normal myocardium and counted for 99mTc-PPi activity. A significant correlation was found between infarct size determined by areas of increased 99mTc-PPi uptake and that estimated from TTC staining for both group A (r = .89) and group B animals (r = .98). However, the intercepts and slopes relating estimates of infarct size from 99mTc-PPi uptake and TTC staining indicated that 99mTc-PPi overestimated size of infarction when injected early after reflow (group A), especially that of small infarcts (.5 g). Results in group C dogs confirmed that, in the same dogs, estimates of infarct size were smaller when 99mTc-PPi was injected relatively late as compared with early after reperfusion. Thus, 99mTc-PPi injected 90 min or later after reperfusion provides an excellent means to identify and size myocardial infarcts produced by temporary coronary artery occlusion and reflow in this canine preparation. 99mTc-PPi uptake early, but not late, after reperfusion probably occurs in some myocardial cells that are severely injured but viable after reperfusion, and possibly in cells with excess cytosolic calcium that recover with longer periods of reperfusion. Circulation 75, No. 3, 611-617, 1987. REPERFUSION early after acute myocardial infarction is presently being evaluated as a potential means to reduce infarct size and mortality, and preserve regional ventricular function.' Evaluation of reperfu-

show abstract

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate.

et al. 1987

View full text Add to dashboard Cite

show abstract

“…The Tc-99m PYP myocardial scintigrams were graded according to a standard protocol without knowledge of the treatment group on a scale of 0-4+, with grades 2-4+ considered positive and 0-1+ negative. 8 With the dog anesthetized and on the respirator, the final microsphere injection was performed. The saline or EHDP infusion was discontinued, and the dog was sacrificed 24-25 hours after LAD occlusion with a large dose (more than 60 mg/kg) of i.v.…”

Section: Protocolmentioning

confidence: 99%

Effect of EHDP on calcium accumulation and technetium-99m pyrophosphate uptake in experimental myocardial infarction.

et al. 1981

View full text Add to dashboard Cite

show abstract

Skeletal muscle uptake of Tc 99m pyrophosphate in amyloidosis

et al. 1982

View full text Add to dashboard Cite

In a patient with amyloidosis involving the heart, kidneys, and skeletal muscles, a Tc 99m pyrophosphate "bone" scan demonstrated intense uptake of tracer by the skeletal muscles; but not by the heart or kidneys. Using the alizarin red stain, prominent calcium deposits were detected histologically in association with the skeletal muscle amyloid. These findings suggest that certain amyloid deposits will take up Tc 99m pyrophosphate, but only if sufficient amounts of calcium are associated with the amyloid. Keg words: arnyloidosis, radionuclide imaging INTRODUCTIONAmyloidosis, the deposition within various organs of a distinctive fibrillar protein, is associated with a number of disease processes. When amyloidosis is associated with a plasma cell dyscrasia, monoclonal immunoglobulin light chains become deposited in the form of amyloid within various organs [I]. The heart, alimentary tract, kidneys, and liver are frequently affected and death usually occurs from cardiac involvement [2]. Patients with this syndrome have increased numbers of plasma cells in the bone marrow, and monoclonal light chains are demonstrable in the serum or urine [3,4]. When amyloid involves the thyroid, liver, or spleen, appropriate radionuclide scans may demonstrate organomegaly or decreased tracer uptake (51. A number of brief reports have described the uptake of various bone seeking tracers by amyloid deposits in the heart [6-81, skeletal muscles [8,9], skin [lo], liver [I I], and periarticular tissues [12]. It has been suggested that this phenomenon is due to amyloid calcification, and in two reports [7,8] calcium was demonstrated in amyloid by light microscopy [7,8] or electron microscopy [8]. However, it was not confirmed that those amyloid deposits not taking up tracer were also noncalcified.In this communication, we report a case of amyloidosis associated with a plasma cell dyscrasia in which there was histologically proven involvement of heart, kidneys, CASE REPORTA 69-year-old man was admitted to the hospital with congestive cardiac failure.There was no macroglossia, hepatosplenomegaly, purpura, or orthostatic hypotension.The hemoglobin was 11.4 gm%, WBC 6300/mm3, and the platelet count 244,000/mm3. Serum creatinine was 1.6 mg% (normal 0.8-1.2), BUN 272 mg% (normal 8-20), and creatinine clearance 35 ml/min. Serum electrophoresis was normal, but immunoelectrophoresis showed an M band of lambda chains. The Ig G was 563 mg% (normal 560-1512), IgA 60 mg% (normal 104-448), and IgM was 33 mg% (normal 66-352). The patient was excreting in his urine 1000 mg/24 hr. of lambda light chains. There were 23.8% plasma cells in the bone marrow and many appeared atypical. The serum creatinine phosphokinase activity was 309 IU per litre (normal 36-188), and was predominantly the MM isoenzyme. The prothrombin time and partial thromboplastin time were normal. Coagulation factor IX was 93%, and factor X was 64% (normal ranges 50-150%).The chest x-ray demonstrated cardiomegaly and congestive cardiac failure. The electrocardiogram revealed varying atri...

show abstract

Pathophysiologic considerations and clinicopathological correlates of technetium-99m stannous pyrophosphate myocardial scintigraphy

Cited by 54 publications

References 37 publications

Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate.

Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate.

Effect of EHDP on calcium accumulation and technetium-99m pyrophosphate uptake in experimental myocardial infarction.

Skeletal muscle uptake of Tc 99m pyrophosphate in amyloidosis

Contact Info

Product

Resources

About