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Screening for acute myocarditis--is scintigraphy with (99m)Tc-Anti-Granulocyte BW 250/183 an answer?
Alicja Hubalewska1, Dariusz Dudek, Jacek Dubiel
1Nuclear Medicine Unit, Department of Endocrinology, Institute of Cardiology, Collegium Medicum, Jagiellonian University, Karkow, Poland. alahuh@endo.cm-uj.krakow.pl
Insights
This study shows (99m)Tc-Anti-Granulocyte scintigraphy is a promising tool for diagnosing myocarditis. It effectively identifies heart inflammation, offering a potential non-invasive alternative to myocardial biopsy for acute myocarditis screening.
Area of Science:
- Cardiology
- Nuclear Medicine
- Immunology
Background:
- Myocarditis, often viral, can lead to serious heart conditions like cardiomyopathy.
- Current diagnosis relies on invasive myocardial biopsy, with limitations in sensitivity and cost.
- Existing non-invasive imaging methods for inflammation lack optimal performance.
Purpose of the Study:
- To evaluate the diagnostic value of technetium-99m labeled Anti-Granulocyte antibody scintigraphy for acute myocarditis.
- To assess its utility in detecting focal and diffuse myocardial inflammation.
- To determine its potential as a screening tool for acute myocarditis.
Main Methods:
- 14 patients with confirmed myocarditis via biopsy underwent planar and SPECT scintigraphy using (99m)Tc-Anti-Granulocyte antibody.
- Tracer uptake was assessed within 60 minutes post-injection and via delayed scans at 1, 2, 4, and 24 hours.
- Follow-up studies included repeat biopsy and scintigraphy after 3-5 months.
Main Results:
- Scintigraphy detected tracer uptake in the heart in 13 out of 14 patients, indicating active inflammation.
- Results showed good concordance between scintigraphy and myocardial biopsy findings in patients with cardiac inflammation.
- Follow-up studies demonstrated resolution of inflammation.
Conclusions:
- (99m)Tc-Anti-Granulocyte scintigraphy appears to be a valuable method for diagnosing suspected myocarditis.
- The technique shows potential for evaluating focal and diffuse myocardial inflammation.
- Further research is required to confirm its sensitivity and specificity for acute myocarditis.
Background:
Myocarditis is most often caused by Coxackie B virus, influenza viruses, and echoviruses. It is usually self-restricting and ending in full recovery, but in some patients the infection leads to congestive cardiomyopathy. It is difficult to identify patients with myocarditis using clinical criteria, laboratory tests, ECG and ultrasonography, and currently a myocardial biopsy is required to establish the diagnosis. The risk of complications, sampling error and costs of this procedure underline the need of non-invasive but sensitive methods of imaging. Several radiopharmaceuticals have been used so far to confirm inflammation: 67Ga, (99m)Tc-nanocolloids and 111In-leucocytes. Scintigraphy with radiolabeled autologous white blood cells (WBCs) is considered a very useful method in identifying sources of inflammation but is difficult to perform and time-consuming.
Aims:
The aim of our study was to investigate whether scintigraphy with (99m)Tc-Anti-Granulocyte BW 250/183 antibody is a valuable diagnostic method in evaluating focal and diffuse inflammation of the heart and could therefore be suggested for use in screening for acute myocarditis.
Material And Methods:
A two dimensional scintigraphy and SPECT mode of heart imaging with the use of (99m)Tc-Anti-Granulocyte antibody (740 MBq) was performed on 14 subjects (11 males and 3 females) aged 25-60 years with a positive myocardial biopsy confirming an inflammatory process in the myocardium. After i.v. administration of the tracer a 1 minute series of planar scans was performed within the first 60 minutes. Delayed static scans were performed at 1, 2, 4 and 24 hours.
Results:
The scintigraphic scans revealed the uptake of the tracer in the heart area in 13 patients, confirming active inflammatory process. Follow-up scintigraphy was performed 3-5 months after the first study, when the control myocardial biopsy was negative. The results of the study showed the concordance between myocardial biopsy and scintigraphy results in patients with an inflammatory process in the heart.
Conclusions:
Scintigraphy with the use of (99m)Tc-Anti-Granulocyte seems to be a useful diagnostic method in evaluating patients with suspected myocarditis, but further studies are needed to establish its sensitivity and specificity.
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