New approach to interpretation of technetium-99m pyrophosphate scintigraphy in detection of acute myocardial infarction. Clinical assessment of diagnostic accuracy

Daniel S. Berman, Ezra A Amsterdam, Horace H. Hines, Antone F. Salel, Gerald J. Bailey, Gerald L Denardo, Dean T. Mason

Research output: Contribution to journalArticle

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Abstract

A modified classification for interpreting technetium-99m pyrophosphate scintigrams defines the 2+ diffuse pattern of tracer uptake as equivocal rather than positive for acute myocardial infarction. Results of scintigraphy using this classification were compared with results of standard diagnostic tests for myocardial infarction in 235 patients admitted to a coronary care unit with acute chest pain. Of 81 patients with acute transmural infarction by standard clinical, electrocardiographic and serum enzyme criteria, 76 had a positive, 5 an equivocal and none a negative scintigram. Of 18 with acute nontransmural infarction by standard criteria, 7 had a positive, 9 an equivocal and 2 a negative scintigram. Thus it was uncommon for a patient with acute myocardial infarction, transmural or nontransmural, to have a definitely negative technetium-99m pyrophosphate study. Ten patients had equivocal evidence of infarction by standard criteria. Of the remaining 126 patients with no evidence of acute myocardial infarction by standard criteria, 87 had a negative, 35 an equivocal and 4 a definitely positive scintigram. Thus the definitely positive scintigraphic pattern was relatively highly specific for acute myocardial infarction. If the 2+ pattern had been considered positive, the specificity of the technique would have been greatly decreased. Computer processing strengthened observer certainty of the visual impression but changed the scintigraphic evaluation in only eight cases. Thus, use of an equivocal pattern renders technetium-99m pyrophosphate imaging both an extremely sensitive and specific method for detecting acute myocardial infarction.

Original languageEnglish (US)
Pages (from-to)341-346
Number of pages6
JournalThe American journal of cardiology
Volume39
Issue number3
DOIs
StatePublished - 1977

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Technetium
Radionuclide Imaging
Myocardial Infarction
Infarction
Coronary Care Units
Acute Pain
Chest Pain
Routine Diagnostic Tests
diphosphoric acid
Enzymes
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

New approach to interpretation of technetium-99m pyrophosphate scintigraphy in detection of acute myocardial infarction. Clinical assessment of diagnostic accuracy. / Berman, Daniel S.; Amsterdam, Ezra A; Hines, Horace H.; Salel, Antone F.; Bailey, Gerald J.; Denardo, Gerald L; Mason, Dean T.

In: The American journal of cardiology, Vol. 39, No. 3, 1977, p. 341-346.

Research output: Contribution to journalArticle

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abstract = "A modified classification for interpreting technetium-99m pyrophosphate scintigrams defines the 2+ diffuse pattern of tracer uptake as equivocal rather than positive for acute myocardial infarction. Results of scintigraphy using this classification were compared with results of standard diagnostic tests for myocardial infarction in 235 patients admitted to a coronary care unit with acute chest pain. Of 81 patients with acute transmural infarction by standard clinical, electrocardiographic and serum enzyme criteria, 76 had a positive, 5 an equivocal and none a negative scintigram. Of 18 with acute nontransmural infarction by standard criteria, 7 had a positive, 9 an equivocal and 2 a negative scintigram. Thus it was uncommon for a patient with acute myocardial infarction, transmural or nontransmural, to have a definitely negative technetium-99m pyrophosphate study. Ten patients had equivocal evidence of infarction by standard criteria. Of the remaining 126 patients with no evidence of acute myocardial infarction by standard criteria, 87 had a negative, 35 an equivocal and 4 a definitely positive scintigram. Thus the definitely positive scintigraphic pattern was relatively highly specific for acute myocardial infarction. If the 2+ pattern had been considered positive, the specificity of the technique would have been greatly decreased. Computer processing strengthened observer certainty of the visual impression but changed the scintigraphic evaluation in only eight cases. Thus, use of an equivocal pattern renders technetium-99m pyrophosphate imaging both an extremely sensitive and specific method for detecting acute myocardial infarction.",
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