[Gallium-67 myocardial imaging for the detection of adriamycin cardiomyopathy].
To detect Adriamycin cardiomyopathy, radionuclide myocardial imagings with Tl-201, Tc-99m pyrophosphate, I-123 metaiodobenzylguanidine and Ga-67 were performed in a 49 year-old-woman receiving Adriamycin (a total dose of 230 mg/m2) for the treatment of breast cancer. This patient demonstrated symptoms of congestive heart failure 2 months after the last intravenous administration. At the period of performing the radionuclide studies, echocardiographic LV ejection fraction (EF) was 22%. Despite severe deterioration of cardiac function, Tl-201 SPECT demonstrated no defect and Tc-99m pyrophosphate (PYP) SPECT demonstrated no positive finding. I-123 metaiodobenzylguanidine (MIBG) scintigraphy demonstrated no regional defect. However, I-123 MIBG washout rate during 4 hours was markedly enhanced, probably reflecting abnormalities of norepinephrine kinetics due to the progression of heart failure. Compared to these pharmaceuticals, Ga-67 was diffusely accumulated in the heart. Then, 5 months after the first study, when LV EF improved to 30% and congestive symptoms disappeared probably owing to beta-blockade therapy, myocardial accumulation of Ga-67 markedly reduced. It has been reported that Ga-67 accumulates in malignant tumor cells and leukocytes. Since, in Adriamycin cardiomyopathy, myocardial accumulation of leukocytes with myocardial fibrotic changes have been histologically demonstrated, the results of Ga-67 scintigraphy may reflect the accumulation of leukocytes. Thus, this case indicates that Ga-67 scintigraphy is advantageous for detecting Adriamycin cardiomyopathy and may be more useful than Tl-201 and Tc-99m PYP scintigraphies.
First Department of Medicine, Osaka University Medical School.
T
T
Morozumi
Y
Y
Ishida
A
A
Tani
M
M
Inui
M
M
Hori
A
A
Kitabatake
T
T
Kamada
H
H
Kondo
T
T
Kozuka
K
K
Kimura
D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D005710:Gallium Radioisotopes; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000139:chemically induced / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging
D005710:Gallium Radioisotopes; D004317:Doxorubicin