Document Detail

Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report.
Jump to Full Text
MedLine Citation:
PMID:  17967203     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Delayed-enhancement magnetic resonance imaging (DE-MRI) has been recently proposed as an alternative tool in identifying myocardial viability and transmural distribution of necrosis in the myocardium.
CASE PRESENTATION: We describe a case of a 71-year-old man admitted for ischemic-like chest pain in which DE-MRI and post-nitrate 99mTc-tetrofosmin myocardial scintigraphy equally contributed to the diagnosis of previous lateral myocardial infarction.
CONCLUSION: In this patient with coronary artery disease, the absence of uptake of tracer at myocardial scintigraphy appeared to be closely correlated to DE-MRI data. Cardiologists can use SPECT or DE-MRI to obtain similar information about myocardial viability.
Authors:
Mauro Feola; Gian Luca Rosso; Alberto Biggi; Stephane Chauvie; Giovanni Leonardi; Franca Margaria; Maurizio Grosso; Valeria Ferrero
Related Documents :
18827373 - Multifocal, persistent cardiac uptake of [18-f]-fluoro-deoxy-glucose detected by positr...
8774623 - Myocardial viability in cases with persistent perfusion defects on the dipyridamole tha...
7852663 - Acute vs. chronic eeg effects in maprotiline- and in clomipramine-treated depressive in...
Publication Detail:
Type:  Journal Article     Date:  2007-10-30
Journal Detail:
Title:  Journal of medical case reports     Volume:  1     ISSN:  1752-1947     ISO Abbreviation:  J Med Case Rep     Publication Date:  2007  
Date Detail:
Created Date:  2007-12-19     Completed Date:  2011-07-14     Revised Date:  2012-05-16    
Medline Journal Info:
Nlm Unique ID:  101293382     Medline TA:  J Med Case Rep     Country:  England    
Other Details:
Languages:  eng     Pagination:  120     Citation Subset:  -    
Affiliation:
Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Italy. m_feola@virgilio.it.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): J Med Case Reports
ISSN: 1752-1947
Publisher: BioMed Central
Article Information
Download PDF
Copyright © 2007 Feola et al; licensee BioMed Central Ltd.
open-access: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Day: 9 Month: 7 Year: 2007
Accepted Day: 30 Month: 10 Year: 2007
collection publication date: Year: 2007
Electronic publication date: Day: 30 Month: 10 Year: 2007
Volume: 1First Page: 120 Last Page: 120
ID: 2147020
Publisher Id: 1752-1947-1-120
PubMed Id: 17967203
DOI: 10.1186/1752-1947-1-120

Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report
Mauro Feola1 Email: m_feola@virgilio.it
Gian Luca Rosso1 Email: rossogl@tiscali.it
Alberto Biggi2 Email: biggi.a@ospedale.cuneo.it
Stephane Chauvie2 Email: chauvie.s@ospedale.cuneo.it
Giovanni Leonardi1 Email: leonardi.g@ospedale.cuneo.it
Franca Margaria1 Email: margaria.f@ospedale.cuneo.it
Maurizio Grosso3 Email: grosso.m@ospedale.cuneo.it
Valeria Ferrero4 Email: valeria.ferrero@hotmail.com
1Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Italy
2Nuclear Medicine Service, Ospedale Santa Croce-Carle Cuneo, Italy
3Radiology Service, Ospedale Santa Croce-Carle Cuneo, Italy
4Division of Cardiology Universita' di Verona Ospedale Borgo Trento Verona, Italy

Introduction

Delayed-enhancement magnetic resonance imaging (DE-MRI) is a highly accurate method for the non-invasive estimation of infarct size and location in acute or chronic myocardial infarction [1-3]. Cardiac MRI can also be used to detect the chronic consequence of myocardial infarction using its high degree of image definition [4]. It has recently been proposed as an alternative tool for the assessment of myocardial necrosis. Diagnostic methods for assessing myocardial viability, such as positron-emission tomography, single-photon-emission computed tomography (SPECT) and dobutamine echocardiography all have demonstrated limits in identifying the transmural extension of necrosis and/or viability of the ventricular wall [5-7].

Previous studies [1,8,9] have documented the comparable efficacy of myocardial SPECT (using either thallium 201 or 99mTc-tetrofosmin) and DE-MRI in the evaluation of the presence, location, and transmural extension of myocardial necrosis. Furthermore, DE-MRI is a diagnostic method that is characterized by superior spatial resolution and the absence of ionizing radiation.

In this case report we describe the case of a man with a previous lateral myocardial infarction, in which MRI showed a DE in the lateral wall according to the result of post-nitrate 99mTc-tetrofosmin imaging.


Case presentation

A 71-year-old man was admitted for ischemic-like chest pain occurring 10 days prior to the hospital admission. The ECG showed ST-T segment elevation without a q wave in the infero-lateral leads (figure 1) that could identify either myocardial infarction changes or pericarditis. A persistent release of cardiac markers was registered (troponin I 1.05 μg/l [normal value< 0.6 μg/l]) together with a slight increase in inflammatory markers and white blood cells. The clinical presentation, the ECG pattern and the laboratory data were not sufficient to rule out a diagnosis of pericarditis. Transthoracic echocardiography was not diagnostic. The patient underwent two 99mTc-tetrofosmin myocardial SPECTs on different days: the first at rest and the second after the use of nitroglycerine (0.005 mg/kg per os). The left ventricular ejection fraction (LVEF) was calculated using a previously validated and commercially available automated software (quantitative gated SPECT, QGS, Cedars-Sinai Medical Center, Los Angeles, CA [10]). The oral post-nitrate images clearly demonstrated an absence of uptake of 99mTc-tetrofosmin in the lateral and infero-lateral wall (figure 2); the LVEF was 31%. This absence of tracer uptake after the nitrate administration clearly indicated the presence of non-viable myocardium [11]. The same patient underwent cardiac MRI using a clinical 1.5-T Gyroscan ACS-NT MRI scanner (Philips Medical System, Eindhoven, The Netherlands). The scan was analysed according to: a) the left ventricular function (sequences balanced-echo cine MRI) and b) the presence of scar tissue with delayed-enhancement (DE) images. Delayed sequences were obtained approximately 12 minutes after intravenous injection of 0.2 mmol/kg gadolinium diethyltriaminepentaacetic acid (Gd-DTPA) using a fast field echo sequence (slice thickness 8 mm, FOV 360 mm, flip angle 15°, TE 1.3 ms, TR 4.1 ms). Delayed enhancement images were displayed with a grey scale to optimally show normal myocardium (dark) and the region of delayed-enhancement myocardium (bright). The akinesia of the infero-apical left ventricular segment and the diskinesia of the lateral wall emerged (figure 3). The LVEF was calculated as 36%; a bilateral pleural effusion was also present. The DE distribution was transmural with a dilatation of the lateral wall that appeared like an aneurysm. Necrotic myocardium usually accumulates and retains gadolinium-based contrast material for 10 or more minutes after the agent has been administered [12]. Considering the results of myocardial SPECT and MRI together, coronary angiography was performed on the fourth day and occlusion of left circumflex coronary artery was identified. As a result of the clinical and image data, medical therapy was continued.


Discussion

The DE MRI technique has quickly been found to have potential utility as an important clinical method of evaluating cardiac viability in ischemic myocardium [3,12]. In this case report the severity of the perfusion defect identified at myocardial SPECT after nitrate assumption closely correlated to the transmural distribution of DE-MRI. In 21 patients with severe ischemic left ventricular dysfunction, Giorgetti et al [8] demonstrated a clear correlation between the extension of 99mTc-tetrofosmin myocardial SPECT uptake injected during nitrate infusion and the distribution of necrosis at DE-MRI. The infusion of nitrate significantly increased the tracer uptake at SPECT scan in DE-MRI viable segments, improving the diagnostic accuracy in the detection of myocardial viability. In our patient we obtained the same information after sublingual nitrate administration before the tracer injection: this convenient method of drug administration is faster and might help in a clinical setting. Evidence of persistent viability after myocardial infarction not treated with reperfusion procedures should always be investigated. In fact, the OAT study did not demonstrated any clinical utility of percutaneous revascularization in stable patients with persistent total occlusion of the infarct-related artery [13].


Conclusion

In conclusion, the oral postnitrate 99mTc-tetrofosmin myocardial SPECT has been confirmed to be closely correlated with DE-MRI images indicating their comparable value to estimate myocardial viability. In patients with coronary artery disease, clinicians might obtain similar information about myocardial viability using either myocardial SPECT or DE-MRI.


Consent

We wish to acknowledge that the patient provided written consent for publication of this case report and these images.


Competing interests

The author(s) declare that they have no competing interests.


Authors' contributions

MF and GLR collected data and drafted the manuscript. AB and SC analysed the SPECT scan. GL and FM performed the cardiac MRI. MG and VF proofed the final version of the manuscript. All authors read and approved the final manuscript.


References
Slomka PJ,Fieno D,Thomson L,Friedman JD,Hayes SW,Germano G,Berman DS. Automatic detection and size quantification of infarcts by myocardial perfusion SPECT: clinical validation by delayed-enhancement MRIJ Nucl Med 2005;46:728–735. [pmid: 15872343]
Bondarenko O,Beek AM,Hofman MB,Kuhl HP,Twisk JW,van Dockum WG,Visser CA,van Rossum AC. Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMRJ Cardiovasc Magn Reson 2005;7:481–485. [pmid: 15881532] [doi: 10.1081/JCMR-200053623]
Kim RJ,Wu E,Rafael A,Chen EL,Parker MA,Simoneti D,Klocke FJ,Bonow RO,Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunctionN Engl J Med 2000;343:1445–1453. [pmid: 11078769] [doi: 10.1056/NEJM200011163432003]
Varvarigos N,Koletis E,Zafiropoulos A,Papaioannou H,Migdalis I. A case of left ventricular pseudoaneurysm with long survival and congestive heart failure as first presentation. Case report and review of the literatureMed Sci Monit 2005;11:CS69–CS73. [pmid: 16258404]
Chareonthaitawee P,Gersh BJ,Araoz PA,Gibbons RJ. Revascularization in severe left ventricular dysfunction. The role of viability testJ Am Coll Cardiol 2005;46:567–574. [pmid: 16098417] [doi: 10.1016/j.jacc.2005.03.072]
Arnese M,Cornel JH,Salustri A,Haat A,Elhendy A,Reijs AE,Tenkate FJ,Keane D,Balk AH,Rollandt JR,Fioretti PM. Prediction of improvement of regional left ventricular function after surgical revascularization: a comparison of low-dose dobutamine echocardiography with 201Tl single-photon emission computed tomographyCirculation 1995;91:2748–2752. [pmid: 7758180]
Perrone-Filardi P,Pace L,Prastaro M,Squame F,Betocchi S,Soricelli A,Piscione F,Indolfi C,Crisci t,Salvatore M,Chiariello M. Assessment of myocardial viability in patients with chronic coronary artery disease. Rest-4-hour-24-hour 201Tl tomography versus dobutamine echocardiographyCirculation 1996;94:2712–2719. [pmid: 8941094]
Giorgetti A,Pingitore A,Favilli B,Kusch A,Lombardi M,Marzullo P. Baseline/post-nitrate tetrofosmin SPECT for myocardial viability assessment in patients with postischemic severe left ventricular dysfunction: new evidence from MRIJ Nucl Med 2005;46:1285–1293. [pmid: 16085584]
Lund GK,Stork A,Saeed M,Bansmann MP,Gerken JH,Muller V,Mester J,Higgins CB. Acute myocardial infarction : evaluation with first-pass enhancement and delayed enhancement MR imaging compared with 201Tl SPECT imagingRadiology 2004;232:49–57. [pmid: 15166320] [doi: 10.1148/radiol.2321031127]
Germano G,Kiat H,Kavanagh PB,Moriel m,Mazzanti M,Su HT,Vantrain KF,Berman DS. Automatic quantification of ejection fraction from gated myocardial perfusion SPECTJ Nucl Med 1995;36:2138–2147. [pmid: 7472611]
Maurea S,Cuocolo A,Soricelli A,castelli L,Nappi A,Squame F,Imbriaco M,Trimarco B,Salvatore M. Enhanced detection of viable myocardium by technetium-99m-MIBI imaging after nitrate administration in chronic coronary artery diseaseJ Nucl Med 1995;36:1945–1952. [pmid: 7472580]
Laissy JP,Hyafil F,Feldman LJ,Siliard JM,Schouman-Claeys E,steg PG,Faraggi M. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imagingRadiology 2005;237:75–82. [pmid: 16126925] [doi: 10.1148/radiol.2371041322]
Hochman JS,Lamas GA,Buller CE,Dzavik V,Reynolds HR,Abramsky SJ,Forman S,Ruzyllo W,Maggioni AP,White H,Sadowsky Z,Carvalho AC,Rankin JM,Ronkin JP,Steg PG,Mascette AM,Sopko G,Pfisterer ME,Leor j,Friedrich V,Mark DB,Knatternd GL,Occluded Artery Trial InvestigatorsCoronary intervention for persistent occlusion after myocardial infarctionN Engl J Med 2006;355:2395–2407. [pmid: 17105759] [doi: 10.1056/NEJMoa066139]

Figures

[Figure ID: F1]
Figure 1 

The 12-lead electrocardiogram showed persistent ST-T segment elevation in the infero-lateral leads, supraventricular premature complexes and incomplete right bundle branch block. This ECG may identify either a non-q myocardial infarction or pericarditis.



[Figure ID: F2]
Figure 2 

Post-nitrate myocardial (left images) and rest (right images) 99mTc-tetrofosmin SPECT showing absent uptake of tracer in lateral and infero-lateral wall. The nitrate administration did not significantly change the perfusion pattern.



[Figure ID: F3]
Figure 3 

Cardiac MRI after gadolinium injection demonstrated a transmural area of DE in the lateral wall of the left ventricle. A bilateral pleural effusion was also evident.



Article Categories:
  • Case Report


Previous Document:  Fulminant Clostridium Septicum myonecrosis in well controlled diabetes: a case report.
Next Document:  Posterior nasal septal abscess in a healthy adult patient.