Combined thallium 201/technetium 99m-labeled pyrophosphate tomography for identification of the 'culprit' vessel in acute myocardial infarction
| Autor: | Wolfgang Kasper, Ernst Moser, Carl Schümichen, A M Zeiher, Thomas Krause, Michael Schwehn |
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| Rok vydání: | 1996 |
| Předmět: |
Male
medicine.medical_specialty Technetium Tc 99m Pyrophosphate Myocardial Infarction Infarction Anterior Descending Coronary Artery Sensitivity and Specificity Culprit Predictive Value of Tests medicine.artery Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies cardiovascular diseases Myocardial infarction Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Heart Middle Aged medicine.disease Coronary Vessels Coronary arteries Thallium Radioisotopes medicine.anatomical_structure Right coronary artery Angiography Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Journal of Nuclear Cardiology. 3:105-113 |
| ISSN: | 1071-3581 |
| DOI: | 10.1016/s1071-3581(96)90002-1 |
| Popis: | Background . Many previous investigations have used the presence of transient ischemic 201 Tl perfusion defect to localize coronary artery stenosis. This study reports the results of 201 Tl tomography alone and combined 201 Tl/ 99m Tc-labeled pyrophosphate ( 99m Tc PYP) tomography employed to identify the infarct-related vessel in patients with acute myocardial infarction (AMI). Methods and Results . All short-axis images were evaluated by dividing each left ventricular slice into eight equal sectors. In addition, for combined 201 Tl/ 99m Tc PYP tomography, two sectors were added to evaluate involvement of the right ventricle. In a preevaluation phase of the study, the sectors were assigned to the supplying coronary arteries in 75 patients with single chronic myocardial infarction related to the left anterior descending coronary artery (LAD), left circumflex artery (LCX), or right coronary artery (RCA). In this pilot phase, 201 Tl tomograms were reviewed in conjunction with the angiographic data. This assignment was then tested prospectively in 117 patients with AMI. As confirmed by angiography, the AMI was related to the LAC, LCX, and RCA in 54, 17, and 46 patients, respectively. Sensitivity and specificity for 99m Tc PYP accumulation on combined 201 Tl/ 99m Tc PYP tomography were 98% a nd 100% for the LAD, 88% and 99% for the LCX, and 98% and 96% for the RCA, respectively. For 201 Tl tomography, sensitivity and specificity for identification of the culprit vessel were 94% and 89% for the LAD, 82% and 91% for the LCX, and 72% and 96% for the RCA, respectively. Conclusion . This prospective study demonstrates that combined 201 Tl/ 99m Tc PYP tomography is highly accurate for identification of the infarct-related artery in AMI, even in patients with multivessel disease. Positive contrast visualization of myocardial necrosis in both the left and right ventricle allows for reliable differentiation between AMI related to the LCX or RCA territory. In comparison, for 201 Tl tomography the sensitivity to detect the culprit vessel, particularly the LCX and RCA, appears to be lower than for 201 Tl/ 99m Tc PYP imaging, particularly in patients with prior infarction or right dominant coronary artery. |
| Databáze: | OpenAIRE |
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