Hubalewska Alicja, Dudek Dariusz, Dubiel Jacek, Płaczkiewicz-Jankowska Ewa, Huszno Bohdan, Staszczak Anna, Frasik Wiesław
Nuclear Medicine Unit, Department of Endocrinology, Institute of Cardiology, Collegium Medicum, Jagiellonian University, Karkow, Poland.
Nucl Med Rev Cent East Eur. 2004;7(2):165-9.
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.
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.
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.
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.
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.
心肌炎最常见的病因是柯萨奇B病毒、流感病毒和埃可病毒。它通常具有自限性，最终可完全康复，但在一些患者中，感染会导致充血性心肌病。使用临床标准、实验室检查、心电图和超声心动图来识别心肌炎患者很困难，目前需要进行心肌活检来确诊。该检查的并发症风险、取样误差和费用凸显了对无创但敏感的成像方法的需求。到目前为止，已有几种放射性药物用于确认炎症：67Ga、（99m）Tc-纳米胶体和111In-白细胞。用放射性标记的自体白细胞（WBC）进行闪烁扫描被认为是识别炎症来源的一种非常有用的方法，但操作困难且耗时。
我们研究的目的是调查用（99m）Tc-抗粒细胞BW 250/183抗体进行闪烁扫描是否是评估心脏局灶性和弥漫性炎症的一种有价值的诊断方法，因此是否可用于急性心肌炎的筛查。
对14名年龄在25至60岁之间的受试者（11名男性和3名女性）进行了二维闪烁扫描和使用（99m）Tc-抗粒细胞抗体（740 MBq）的心脏SPECT成像，这些受试者心肌活检呈阳性，证实心肌存在炎症过程。静脉注射示踪剂后，在最初的60分钟内进行了1分钟的平面扫描系列。在1、2、4和24小时进行延迟静态扫描。
闪烁扫描显示13例患者心脏区域有示踪剂摄取，证实存在活动性炎症过程。在首次研究3至5个月后进行了随访闪烁扫描，此时对照心肌活检为阴性。研究结果显示，心脏有炎症过程的患者心肌活检结果与闪烁扫描结果一致。
使用（99m）Tc-抗粒细胞进行闪烁扫描似乎是评估疑似心肌炎患者的一种有用的诊断方法，但需要进一步研究以确定其敏感性和特异性。
