Uptake of myocardial imaging agents by rejecting and nonrejecting cardiac transplants. A comparative clinical study of thallium-201, technetium-99m, and gallium-67.
To study the scintigraphic detectability of cardiac rejection, we performed 135 planar myocardial scans ([99mTc]pyrophosphate, 85; 201Tl, 36; 67Ga, 14) together with endomyocardial biopsies in ten patients for a (mean) 17-mo postoperative period. Specificity of each agent exceeded 89%. Technetium-99m pyrophosphate showed results that significantly correlated with the severity of rejection (p = 0.03), as shown by biopsy, but neither 201Tl nor 67Ga did so (p = 0.63 and 0.81, respectively). Technetium-99m pyrophosphate showed better diagnostic accuracy (85%) than 201Tl (69%) and 67Ga (64%). Technetium-99m pyrophosphate also showed higher negative predictive value (91%) than thallium (76%) and gallium (69%). Thus, a normal 99mTc pyrophosphate scan was usually associated with absence of cardiac rejection. However, all three agents showed unacceptably poor sensitivity (0% to 30%) and thus were not useful as a screening test for cardiac rejection, even when the same agent was used serially in imaging a given patient.
Yamamoto
S
S
Buffalo Veterans Administration Medical Center, New York.
Bergsland
J
J
Michalek
S M
SM
Carroll
M
M
Gona
J M
JM
Balu
D
D
Carr
E A
EA
D000328:Adult; D001706:Biopsy; D004699:Endocardium / Q000276:immunology / Q000473:pathology; D005260:Female; D005710:Gallium Radioisotopes; D006084:Graft Rejection; D006321:Heart / Q000000981:diagnostic imaging; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D011877:Radionuclide Imaging; D013667:Technetium; D013794:Thallium Radioisotopes
D005710:Gallium Radioisotopes; D013794:Thallium Radioisotopes; D013667:Technetium