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Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report.

Feola M, Rosso GL, Biggi A, Chauvie S, Leonardi G, Margaria F, Grosso M, Ferrero V - J Med Case Rep (2007)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Italy. m_feola@virgilio.it.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

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.
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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.

Mentions: 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.


Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report.

Feola M, Rosso GL, Biggi A, Chauvie S, Leonardi G, Margaria F, Grosso M, Ferrero V - J Med Case Rep (2007)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2147020&req=5

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.
Mentions: 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.

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Italy. m_feola@virgilio.it.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus