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PubMed1983

Hand and wrist arthropathies of hemochromatosis and calcium pyrophosphate deposition disease: distinct radiographic features.

Radiographic features of hand and wrist involvement in 26 patients with hemochromatosis and in 26 patients with idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease were compared. Two radiologists independently examined the radiographs without knowledge of the specific group to which the patient belonged. The results of this study clearly establish that structural joint diseases in the two disorders are not identical. Characteristic findings allow the radiologist to favor one diagnosis over the other. These radiographic differences indicate that the arthropathy of hemochromatosis is related to factors additional to the presence of CPPD crystals, specifically, the more prevalent narrowing of the metacarpophalangeal joint spaces, including those in the fourth and fifth digits, peculiar hook-like osteophytes on the radial aspect of the metacarpal heads, and less prevalent separation of the scaphoid and the lunate.

Adult↗

PubMed1983

Amyloidosis of heart and liver: comparison of Tc-99m pyrophosphate and Tc-99m methylene diphosphonate for detection.

A prospective, comparative study was made of the efficacy of technetium-99m pyrophosphate (Tc PYP) and technetium-99m methylene diphosphonate (Tc MDP) in detecting soft-tissue amyloidosis. Tc PYP and Tc MDP scans were obtained within ten-day intervals in seven patients with histologically proven amyloidosis. Tc PYP was a better scanning agent for soft-tissue amyloidosis in all patients. Cardiac and hepatic involvement were proved by autopsy in one patient. Involvement of the heart was confirmed by echocardiography in five patients. The potential use of Tc PYP scanning as a screening test for soft-tissue amyloidosis is discussed.

Adult↗

PubMed1984

Vertebral involvement in calcium pyrophosphate dihydrate crystal deposition disease. Radiographic-pathological correlation.

The authors conducted a comprehensive radiographic and pathological investigation of more than 1,000 postmortem spinal specimens and documented many examples of calcium pyrophosphate dihydrate crystal deposition disease (CPPD/CDD) in a variety of vertebral structures, including not only the intervertebral disk but also the apophyseal and sacroiliac joints, posterior longitudinal ligament, interspinous and supraspinous ligaments, ligamentum flavum, interosseous sacroiliac ligament, transverse atlas ligament, and posterior median atlanto-axial joint. Such crystal accumulation supports previous reports of abnormal calcification and structural damage on radiographs of the axial skeleton in patients with CPPD/CDD and may explain not only the associated spinal symptoms and signs but also spinal stenosis, spondylolisthesis, and atlanto-axial subluxation.

Calcinosis↗

PubMed1990

Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease.

Scapholunate advanced collapse (SLAC) is a pattern of wrist malalignment that has been attributed to posttraumatic or spontaneous osteoarthritis of the wrist. Its features, however, also have been observed in patients with idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. To determine the frequency and characteristics of SLAC in this disease, the authors reviewed wrist radiographs in 168 well-documented cases of this disorder. Forty-four of the cases (26%) revealed wrist abnormalities typical of SLAC. Associated findings included bilateral involvement (63%); calcification in or near the triangular fibrocartilage (70%); scapholunate widening or dissociation (70%); and arthropathies of the trapezioscaphoid (57%), metacarpophalangeal (second through fifth) (52%), first carpometacarpal (40%), and radiolunate (14%) joints. Results strongly suggest that CPPD crystal deposition disease is one of the major causes of SLAC. Furthermore, radiolunate arthropathy was found in 14% of the patients with SLAC and CPPD crystal deposition disease, which is different from other observations.

Aged↗

PubMed1995

High-voltage electric injury: assessment of muscle viability with MR imaging and Tc-99m pyrophosphate scintigraphy.

PURPOSE: To evaluate use of magnetic resonance (MR) imaging and technetium-99m pyrophosphate (PYP) scintigraphy in preoperative assessment of muscle viability after high-voltage electric injury. MATERIALS AND METHODS: Twelve injured limbs were studied. Immediate, equilibrium, and delayed Tc-99m PYP scintigrams and gadolinium-enhanced and unenhanced MR images were obtained. Imaging results were compared with clinical findings. RESULTS: Scintigraphy demonstrated nonperfusion in four limbs that were subsequently amputated, but MR imaging had poor sensitivity in nonperfused regions owing to lack of edema. Tc-99m PYP uptake increased at transition zones between normal and nonperfused regions. MR imaging allowed further characterization of these zones by demonstrating edema as enhancing (perfused) or nonenhancing (nonperfused). In all nonamputated limbs, edema showed enhancement. CONCLUSION: In high-voltage electric injury, gadolinium-enhanced MR imaging appears able to demonstrate zones of potential viability within radionuclide-avid tissue but has poor perfusion sensitivity when used alone.

Amputation, Surgical↗

PubMed2000

Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients.

PURPOSE: To investigate the histopathologic anatomy of calcium pyrophosphate dihydrate (CPPD) crystal deposition in and around the atlantoaxial joint and the association between CPPD crystal deposition and subchondral cysts, erosions, and fracture involving the odontoid process of the axis. MATERIALS AND METHODS: One adult cadaver demonstrating calcification in the retro-odontoid area at computed tomography (CT) was selected for further radiography, CT, and magnetic resonance (MR) imaging at the C1-2 level. Anatomic sectioning and histologic evaluations were performed in the specimen. For clinical study, radiographs (n = 5), CT scans (n = 8), and MR images (n = 6) in nine patients (mean age, 74.4 years) with odontoid process fractures and CPPD crystal deposits in and around the atlantoaxial joint were reviewed. RESULTS: In the cadaveric specimen, radiography and CT demonstrated calcifications in the transverse ligament; histologic evaluation confirmed that these calcifications were CPPD crystal deposits. In all nine patients, radiography (n = 5) and CT (n = 8) also showed calcification in areas adjacent to the odontoid process, which included the transverse ligament. T1- and T2-weighted MR imaging showed a retro-odontoid mass of low signal intensity that compressed the cervical cord in six patients. CT, MR imaging, or both demonstrated subchondral cysts, osseous erosions, or a type 2 odontoid fracture in all patients. CONCLUSION: CPPD crystal deposition disease involving the C1-C2 articulation can be a clinically important entity that may place affected patients at increased risk of pathologic fracture of the odontoid process.

Aged↗

PubMedDate not supplied

Evaluation of the severity of traumatic rhabdomyolysis using technetium-99m pyrophosphate scintigraphy.

A quantitative scoring method was designed to assess the extent of muscle damage. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy was performed for 9 patients experiencing crush injury in the Chichi (Taiwan) earthquake. The magnitude of muscle uptake of 99mTc-PYP was graded as follows: grade 0, less than bone radioactivity (BRA); grade 1, equal to BRA; grade 2, higher than BRA; or grade 3, greatly higher than BRA. The area of muscle injury was estimated according to the rule of nines. The sum of the muscle injury size multiplied by its corresponding grading was defined as the anterior or posterior score according to the anterior or posterior images. Each image was interpreted by two physicians and average anterior and posterior scores were calculated. The muscle score was defined as the geometric mean of the average anterior and posterior scores. Significant correlations were obtained between the muscle score and duration of time trapped (r = 0.868, p < 0.01), peak serum creatine kinase level (r = 0.866, p < 0.01), peak serum phosphorus level (r = 0.877, p < 0.01) and number of hospital days (r = 0.875, p < 0.01). A negative correlation between the muscle score and blood pH (r = -0.706, p < 0.01) was also observed. We concluded that this scoring method may be used as an adjunct for evaluating the locations of trauma and the severity of crush syndrome, and for predicting the duration of hospital stay.

Adolescent↗

PubMed1988

Experimental hemarthrosis in dogs: progressive synovitis monitored with technetium-99m pyrophosphate joint imaging.

We examined the time course of the development of hemorrhagic synovitis in response to repeated autologous blood injections into knee joints in mature dogs and the possible usefulness of joint imaging with technetium-99m pyrophosphate (Tc99m-PYP) in monitoring the early response of synovium to blood. Experimental hemarthrosis was induced in dogs by twice weekly injection of autologous blood into the knee joints. Sequential examination of the synovium at monthly intervals over a period of 12 weeks revealed early inflammatory cell infiltration and capillary neovascularization with eventual replacement of the normal fatty synovium by dense fibrous tissue. Serial Tc99m-PYP joint images demonstrated a progressive increase in isotope accumulation in the knees during the course of the study. Further isotope accumulation was observed after CO2 laser synovectomy. During the 24-week course of the entire study, no changes in joint cartilage or bone were observed by gross inspection or radiologic and light-microscopic examination. The findings indicate that the progressive proliferative, inflammatory, fibrotic changes in joint synovium associated with experimental hemarthrosis in dogs may be noninvasively and semiquantitatively assessed with the use of Tc99m-PYP scintigraphy. Evidence is also presented that the intensity of Tc99m-PYP joint accumulation (immediate static images) may not readily reflect synovial vascularity or synovial tissue mass.

Animals↗

PubMedDate not supplied

Effect of methotrexate on the intracellular phosphoribosyl pyrophosphate level and glucose transport of Ehrlich ascites tumor cells in vitro.

Methotrexate (MTX) suppressed the growth of Ehrlich ascites tumor (EAT) cells in vitro. The intracellular level of phosphoribosyl 5-pyrophosphate (PRPP) of EAT cells increased in a dose-dependent manner in response to MTX treatment. At the same time, the rate of glucose transport was lowered. Hypoxanthine reversed both these effects of MTX and partially rescued EAT cell growth. Under all conditions tested, changes in rate of glucose transport were shown to be the result of alterations in the number of glucose transporter (Vmax) rather than ligand affinity (Km). The dual action of MTX as a chemotherapeutic agent is discussed in this light.

Animals↗

PubMed1981

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

We evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +/- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p less than 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p less than 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients.

Acute Disease↗

PubMed1984

99mTc-pyrophosphate imaging in patients with acute myocardial infarction: comparison of planar imaging with single-photon tomography with and without blood pool overlay.

To test the hypothesis that single-photon emission computed tomography (SPECT) of 99mTc-pyrophosphate (99mTc-PPi) with and without the overlay of tomographic blood pool scintigrams might detect small infarcts not identified by planar imaging, 52 patients were studied 3.2 +/- 2.0(SD) days after hospital admission for suspected acute myocardial infarction. Patients were chosen prospectively for tomographic study primarily, but not exclusively, because planar four-view imaging with 99mTc-PPi was either negative or equivocal. SPECT was performed with a commercial rotating detector system immediately after planar imaging on one occasion. Corresponding 99mTc-PPi and blood pool sections were mapped into opposite halves of a bichromic color table and displayed as an overlay. Planar images, SPECT and SPECT with blood pool overlay were interpreted separately and in random order without knowledge of clinical data. Seventeen patients had transmural infarcts (four anterior, 13 inferior), 19 had nontransmural infarcts, and 16 patients did not have acute myocardial infarction. The sensitivity of SPECT with blood pool overlay was significantly better than planar imaging for the entire group with myocardial infarction (97% vs 78%; p less than .025); this was primarily due to increased sensitivity in the detection of nontransmural myocardial infarction (95% vs 67%; p less than .05), although in one additional patient inferior transmural myocardial infarction was also detected by the SPECT overlay technique. The specificities of the SPECT overlay technique and planar imaging were not significantly different; however, receiver operating characteristic analysis showed enhanced observer confidence with the tomographic method. SPECT without overlay was intermediate in sensitivity and specificity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Quantification of myocardial infarction: a comparison of single photon-emission computed tomography with pyrophosphate to serial plasma MB-creatine kinase measurements.

Single photon-emission computed tomography (SPECT) with 99mTc-pyrophosphate (PPi) has been shown to estimate size of myocardial infarction accurately in animals. We tested the hypothesis that SPECT with 99mTc-PPi and blood pool subtraction can provide prompt and accurate estimates of size of myocardial infarction in patients. SPECT estimates are potentially available early after the onset of infarction and should correlate with estimates of infarct size calculated from serial measurements of plasma MB-creatine kinase (CK) activity. Thirty-three patients with acute myocardial infarction and 16 control patients without acute myocardial infarction were studied. Eleven of the patients had transmural anterior myocardial infarction, 16 had transmural inferior myocardial infarction, and six had nontransmural myocardial infarction. SPECT was performed with a commercially available rotating gamma camera. Identical projection images of the distribution of 99mTc-PPi and the ungated cardiac blood pool were acquired sequentially over 180 degrees. Reconstructed sections were color coded and superimposed for purposes of localization of infarct. Areas of increased PPi uptake within myocardial infarcts were thresholded at 65% of peak activity. The blood pool was thresholded at 50% and subtracted to determine the endocardial border for the left ventricle. Myocardial infarcts ranged in size from 1 to 126 gram equivalents (geq) MB-CK. The correlation of MB-CK estimates of size of infarct with size determined by SPECT (both in geq) was good (r = .89 with a regression line of y = 13.1 + 1.5x).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate.

Previously, technetium-99m-stannous pyrophosphate (99mTc-PPi) has been used to localize and estimate the size of myocardial infarcts in animals after permanent coronary artery occlusion. This study tested the hypothesis that 99mTc-PPi accurately sizes myocardial infarctions produced by temporary coronary artery occlusion and reflow in dogs. Three groups of dogs were studied: group A underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 10 min after reflow (n = 10); group B underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 90 min after reflow (n = 11); and group C underwent 3 hr of occlusion followed by reflow with 99mTc-PPi injected at 10 min and again at 48 hr after reflow (n = 5). Myocardial slices from group A and B dogs were imaged in vitro. Group C dogs were imaged with single photon-emission computed tomography (SPECT) in vivo, and myocardial slices were imaged in vitro at the conclusion of the study. The extent of myocardial infarction was defined with triphenyltetrazolium chloride (TTC) staining, and coronary blood flow was estimated with radioactive microspheres. In addition, transmural myocardial tissue samples were taken from the center of the myocardial infarction, the lateral portion of the myocardial infarction, the normal myocardium adjacent to the lateral aspect of the infarcts, and from the normal myocardium and counted for 99mTc-PPi activity. A significant correlation was found between infarct size determined by areas of increased 99mTc-PPi uptake and that estimated from TTC staining for both group A (r = .89) and group B animals (r = .98).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Changes in erythrocyte transketolase activity and the thiamine pyrophosphate effect during storage of blood.

Whole blood and washed erythrocytes from nutritionally normal and abnormal elderly patients were stored at room temperature, 4 degrees C and -20 degrees C for up to 14 days. In both groups, and under all storage conditions, the erythrocyte transketolase (ETK) activity and the thiamine pyrophosphate (TPP) effect decreased with time of storage. The ETK activity for specimens stored at -20 degrees C decreased significantly by day 14 (P less than 0.05). The TPP effect in specimens stored at -20 degrees C decreased significantly in the nutritionally abnormal group at 4 days (P less than 0.05) and in the nutritionally normal group by day 14 (P less than 0.05). These significant changes in ETK activity and TPP effect with storage can lead to misleading interpretation of thiamine nutritional status.

Aged↗

PubMed1982

Myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate compared with morphologic findings in daunorubicin treated rabbits.

In long-term daunorubicin treated rabbits increased myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate of a varying degree were recorded, visible at gamma camera examination in more than half of the animals. Chronic cardiomyopathy morphologically and topographically different from the ischemic myocardial injury was demonstrated in most animals at light microscopic examination. The myocardial abnormalities were classified in qualitative and quantitative scores and compared with the degree of isotope accumulation. The rabbits receiving a large single dose of daunorubicin had slightly increased isotope accumulation in the myocardium but no histopathologic changes.

Animals↗

PubMed1984

Calcium pyrophosphate deposition in nonhuman primates.

Naturally occurring deposition of calcium pyrophosphate has been identified in six rhesus monkeys following acute episodes of trauma and various septicemias. Scanning electron microscopy with energy-dispersive X-ray analytical system and single crystal electron diffraction studies were used to identify the crystals within the articular cartilage. The osteoarthritis grading system was used to determine the degree of cartilage degenerative changes.

Animals↗

PubMed2004

Diagnostic use of T2-weighted inversion-recovery magnetic resonance imaging in acute coronary syndromes compared with 99mTc-Pyrophosphate, 123I-BMIPP and 201TlCl single photon emission computed tomography.

BACKGROUND: The incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by a new imaging modality. In the present study, the clinical significance of (99m)Tc-pyrophosphate (PYP), (123)I-beta-methyl-p-iodephenyl-pentadecanoic acid (BMIPP), (201)TlCl scintigraphy (imaging) and T2-weighted inversion-recovery magnetic resonance imaging (MRI) for the detection of culprit lesion in patients with acute coronary syndromes (ACS) was compared. METHODS AND RESULTS: The study group comprised 18 patients with ACS: 12 patients with acute myocardial infarction (AMI) (11 males; mean age, 63+/-11 years) and 6 patients with unstable angina (UA) (3 males, mean age, 67+/-5 years). Of the 12 patients with AMI, 10 underwent (201)TlCl and PYP single photon emission computed tomography (SPECT) studies as a dual-energy acquisition ((201)TlCl/PYP) and 8 underwent (201)TlCl SPECT within 1 week of the BMIPP study. All 18 patients underwent BMIPP SPECT and MRI. The MRI pulse sequence was black blood turbo short-inversion-time inversion recovery (STIR) (breath-hold T2-weighted studies). The T2-weighted inversion-recovery MRI showed higher sensitivity and negative predictive value than PYP and (201)TlCl, and higher specificity and positive predictive value than BMIPP and (201)TlCl. The area under the receiver-operating characteristic curve for PYP, BMIPP, (201)TlCl and MRI was 0.787, 0.725, 0.731 and 0.878, respectively. The difference between the areas of MRI and BMIPP was significant (p<0.05). CONCLUSION: Accurate detection of culprit lesion is improved by using MRI rather than BMIPP, particularly for patients with ACS.

Acute Disease↗

PubMed1982

Technetium-99m pyrophosphate uptake in spontaneously occurring perimyocardial lesions in an inbred strain of DBA/2 mice.

The spontaneous occurrence of perimyocardial calcification localized in the right ventricle has been reported in an inbred strain of DBA/2 mice. In this paper we examined the correlation between the myocardial uptake ratio of technetium-99m pyrophosphate (99mTc-PYP) and pathological findings in these mice ranging in age from one to 12 months and became lower with age, while calcification and fibrosis in the perimyocardium of the right ventricle became more prominent in aged mice. This may be due to an insidious onset of degeneration with calcification and fibrosis in spontaneously occurring perimyocardial lesions in these mice. Persistent abnormal uptake of 99mTc-PYP observed in the present study suggests the usefulness of such scintigrams in the diagnosis of chronic perimyocardial disease.

Animals↗