Elsevier

Journal of Nuclear Cardiology

Volume 29, Issue 6, December 2022, Pages 3586-3589
Journal of Nuclear Cardiology

Images that Teach
Subacute myocardial infarction detected by technetium-99m-labeled somatostatin analog scintigraphy

https://doi.org/10.1007/s12350-021-02644-4Get rights and content

Abstract

Recently, the applicability of somatostatin receptor-targeted (SSTR-t) radiotracers for post-ischemic myocardial inflammation imaging has been shown using PET. Currently, there are no studies which demonstrate ability of SPECT and technetium-99m SSTR-t radiotracers to detect inflammation, which appears in response to acute myocardial infarction (AMI). A case of 51-year-old male with acute anterior myocardial infarction (AMI) with ST elevation has been presented. This patient on 7th day after AMI onset underwent SPECT/CT (by cardiac cadmium-zinc-telluride gamma-camera) with 99mTc-Tectrotide, cardiac MRI with gadolinium and, on 9th day after AMI, myocardial perfusion scintigraphy (MPS) at rest. Clear myocardial uptake of 99mTc-Tectrotide, predominantly in apical and intermediate anterior wall of left ventricle was detected. The uptake matched with areas of hypoperfusion (by SPECT) and myocardial injury (by MRI). This case demonstrated the applicability of technetium-99m-labeled SSTR-t radiotracers for post-infarction inflammation imaging. Currently assumed, that SSTR-t radiotracers reflect an increased number of activated macrophages infiltrating infarcted myocardium, which is not possible using any other imaging technique. Thus, potentially, SSTR scintigraphy may be useful for diagnosis and monitoring of myocardial post-infarction inflammation as well as for anti-inflammatory image-guide therapy assessment.

Introduction

Recently, the applicability of somatostatin receptor-targeted (SSTR-t) radiotracers for post-ischemic myocardial inflammation imaging has been shown using PET.1, 2, 3 Currently, there are no studies which demonstrate ability of SPECT and technetium-99m SSTR-t radiotracers to detect inflammation which appears in response to acute myocardial infarction (AMI).

Section snippets

Case Summary

A 51-year-old male with acute chest pain of 7 hours of duration was admitted to our hospital. He had QS in leads V1-V3 and ST elevation in leads V2-V3 in the electrocardiogram. Echocardiography showed hypokinesis of the apex, septum and anterior wall of the left ventricular (LV) and LV ejection of 44%. Troponin I level was elevated up to 3.81 ng·mL−1. Emergency invasive coronary angiography revealed acute occlusion of the mid segment of left anterior descending artery and atherosclerotic

Discussion

This case demonstrated the applicability of technetium-99m-labeled SSTR-t radiotracers for post-infarction inflammation imaging. Significant is that 99mTc-Tectrotide uptake area was matched with areas of hypoperfusion (by SPECT) and myocardial injury (by MRI). While cardiac MRI depicts myocardium damage or scarring and MPS shows zones of impaired blood flow, SSTR-t radiotracers, as currently assumed,1, 2, 3 reflect an increased number of activated macrophages infiltrating infarcted myocardium.

Disclosures

S.I. Sazonova, A.G. Syrkina, O.V. Mochula, Zh.Zh. Anashbaev, E.V. Popov and V.V. Ryabov declare that they have no conflict of interest.

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