1
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Ungericht M, Groaz V, Messner M, Schuetz T, Brunelli L, Zaruba MM, Lener D, Stocker E, Bauer A, Kroiss AS, Mayr A, Röcken C, Poelzl G. Correlation of 99mTc-DPD bone scintigraphy with histological amyloid load in patients with ATTR cardiac amyloidosis. Amyloid 2024; 31:22-31. [PMID: 37530216 DOI: 10.1080/13506129.2023.2239986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The significance of measuring 99mTc-labelled-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) in transthyretin (ATTR) cardiac amyloidosis has not been adequately studied. This single-centre observational study evaluated the correlation between 99mTc-DPD scintigraphy and histological amyloid load in endomyocardial biopsy (EMB). METHODS Twenty-eight patients with biopsy-proven ATTR amyloidosis and concomitantly available 99mTc-DPD scintigraphy were included. Visual Perugini scoring, and (semi-)quantitative analysis of cardiac 99mTc-DPD uptake by planar whole-body imaging and single photon emission computed tomography (SPECT/CT) using regions of interest (ROI) were performed. From this, heart-to-whole-body ratio (H/WB) and heart-to-contralateral-chest ratio (H/CL) were calculated. The histological amyloid load was quantified using two different staining methods. RESULTS Increased cardiac tracer uptake was documented in all patients (planar: ROImean 129 ± 37 cps; SPECT/CT: ROImean 369 ± 142 cps). Histological amyloid load (19 ± 13%) significantly correlated with Perugini score (r = 0.69, p < .001) as well as with cardiac 99mTc-DPD uptake (planar: r = 0.64, p < .001; H/WB: r = 0.50, p = .014; SPECT/CT: r = 0.53, p = .008; H/CL: r = 0.43, p = .037) (results are shown for correlations with Congo Red-staining). CONCLUSION In ATTR, cardiac 99mTc-DPD uptake significantly correlated with histological amyloid load in EMB. Further studies are needed to implement thresholds in cardiac 99mTc-DPD uptake measurements for risk stratification and guidance of therapy.
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Affiliation(s)
- Maria Ungericht
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Valeria Groaz
- Department of Emergency Medicine, Klinik Arlesheim, Arlesheim, Switzerland
| | - Moritz Messner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Schuetz
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luca Brunelli
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Lener
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Stocker
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - Gerhard Poelzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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2
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Ahluwalia N, Roshankar G, Draycott L, Jimenez-Zepeda V, Fine N, Chan D, Han D, Miller RJH. Diagnostic accuracy of bone scintigraphy imaging for transthyretin cardiac amyloidosis: systematic review and meta-analysis. J Nucl Cardiol 2023; 30:2464-2476. [PMID: 37226006 DOI: 10.1007/s12350-023-03297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Bone scintigraphy imaging is frequently used to investigate patients with suspected transthyretin cardiac amyloidosis (ATTR-CM). However, the reported accuracy for interpretation approaches has changed over time. We performed a systematic review and meta-analysis to determine the diagnostic accuracy of visual planar grading, heart-to-contralateral (HCL) ratio, and quantitative analysis of SPECT imaging and evaluate reasons for shifts in reported accuracy. METHODS We performed a systematic review to identify studies of the diagnostic accuracy of bone scintigraphy for ATTR-CM from 1990 until February 2023 using PUBMED and EMBASE. Studies were reviewed separately by two authors for inclusion and for risk of bias assessment. Summary receiver operating characteristic curves and operating points were determined with hierarchical modeling. RESULTS Out of a total of 428 identified studies, 119 were reviewed in detail and 23 were included in the final analysis. The studies included a total of 3954 patients, with ATTR-CM diagnosed in 1337 (39.6%) patients and prevalence ranging from 21 to 73%. Visual planar grading and quantitative analysis had higher diagnostic accuracy (.99) than HCL ratio (.96). Quantitative analysis of SPECT imaging had the highest specificity (97%) followed by planar visual grade (96%) and HCL ratio (93%). ATTR-CM prevalence accounted for some of the observed between study heterogeneity. CONCLUSIONS Bone scintigraphy imaging is highly accurate for identifying patients with ATTR-CM, with between study heterogeneity in part explained by differences in disease prevalence. We identified small differences in specificity, which may have important clinical implications when applied to low-risk screening populations.
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Affiliation(s)
- Nanki Ahluwalia
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Golnaz Roshankar
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Logan Draycott
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | | | - Nowell Fine
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Denise Chan
- Department of Nuclear Medicine, University of Calgary, Calgary, AB, Canada
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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3
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Sebastián Palacid F, Álvarez Mena N, Del Carmen Zambrano Infantino R, García Aragón M, Alonso Rodríguez M, Pérez López B, Gamazo Laherrán C, González Soto MJ, Ruano Pérez R. Absolute quantification of myocardial uptake of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). Rev Esp Med Nucl Imagen Mol 2023; 42:302-309. [PMID: 37105317 DOI: 10.1016/j.remnie.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). MATERIALS AND METHODS SPECT/CT was performed in 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades 2 and 3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. The Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients. RESULTS Statistically significant differences were observed in all the study variables, with the exception of bone SUVmax. The differences with the greatest statistical power were observed in the variables SUVmaxRV and the percentage of dose in both ventricles (p < 0.001). The cut-off point obtained for the variable SUVmaxLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC 0.966), while that of the variable SUVmaxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC 0.955). CONCLUSIONS The absolute quantification of myocardial uptake of 99mTc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows adequate classification of patients according to the Perugini visual grading scale.
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Affiliation(s)
| | - Noelia Álvarez Mena
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid. Spain
| | | | - María García Aragón
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid. Spain
| | | | - Berta Pérez López
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid. Spain
| | - Claudia Gamazo Laherrán
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid. Spain
| | | | - Ricardo Ruano Pérez
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid. Spain
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4
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Auer B, Kijewski MF, Dorbala S. Quantitative ATTR-cardiac amyloidosis SPECT/CT imaging: The time is now! J Nucl Cardiol 2023; 30:1246-1249. [PMID: 37138175 DOI: 10.1007/s12350-023-03278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Benjamin Auer
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Marie Foley Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- CV Imaging Program, Cardiovascular Division, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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5
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Gherghe M, Lazar AM, Sterea MC, Spiridon PM, Motas N, Gales LN, Coriu D, Badelita SN, Mutuleanu MD. Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis-A New Dimension of Molecular Imaging. J Cardiovasc Dev Dis 2023; 10:242. [PMID: 37367407 DOI: 10.3390/jcdd10060242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS Cardiac transthyretin amyloidosis (ATTR) represents the accumulation of misfolded transthyretin in the heart interstitium. Planar scintigraphy with bone-seeking tracers has long been established as one of the three main steps in the non-invasive diagnosis of ATTR, but lately, single-photon emission computed tomography (SPECT) has gained wide recognition for its abilities to exclude false positive results and offer a possibility for amyloid burden quantitation. We performed a systematic review of the existing literature to provide an overview of the available SPECT-based parameters and their diagnostic performances in the assessment of cardiac ATTR. Methods and Methods: Among the 43 papers initially identified, 27 articles were screened for eligibility and 10 met the inclusion criteria. We summarised the available literature based on radiotracer, SPECT acquisition protocol, analysed parameters and their correlation to planar semi-quantitative indices. RESULTS Ten articles provided accurate details about SPECT-derived parameters in cardiac ATTR and their diagnostic potential. Five studies performed phantom studies for accurate calibration of the gamma cameras. All papers described good correlation of quantitative parameters to the Perugini grading system. CONCLUSIONS Despite little published literature on quantitative SPECT in the assessment of cardiac ATTR, this method offers good prospects in the appraisal of cardiac amyloid burden and treatment monitoring.
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Affiliation(s)
- Mirela Gherghe
- Nuclear Medicine Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
- Carcinogenesis and Molecular Biology Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Maria-Carla Sterea
- Nuclear Medicine Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Paula Monica Spiridon
- Nuclear Medicine Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Natalia Motas
- Department of Thoracic Surgery, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Clinic of Thoracic Surgery, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Oncology Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
- Oncology Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Daniel Coriu
- Hematology Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Hematology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania
| | | | - Mario-Demian Mutuleanu
- Nuclear Medicine Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
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6
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Benz DC, Dorbala S, Pazhenkottil AP. Quantifying the burden of cardiac amyloid: The future is about numbers! J Nucl Cardiol 2023; 30:112-115. [PMID: 35672568 DOI: 10.1007/s12350-022-03011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Dominik C Benz
- Cardiac Imaging, Department of Cardiology and Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- CV Imaging Program, Cardiovascular Division, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- CV Imaging Program, Cardiovascular Division, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Aju P Pazhenkottil
- Cardiac Imaging, Department of Cardiology and Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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7
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Grossman GB. Quantitation in ATTR cardiac amyloidosis: the next step is almost there! J Nucl Cardiol 2023; 30:140-143. [PMID: 35854040 DOI: 10.1007/s12350-022-03044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Gabriel Blacher Grossman
- Moinhos de Vento Hospital, Ramiro Barcelos Street 910/201, Porto Alegre, CEP 90035-000, Brazil.
- Cardionuclear Clinic, Porto Alegre, Brazil.
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8
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Avalon JC, Fuqua J, Deskins S, Miller T, Conte J, Martin D, Marano G, Yanamala N, Mills J, Bianco C, Patel B, Seetharam K, Raylman R, Sengupta PP, Hamirani YS. Quantitative single photon emission computed tomography derived standardized uptake values on 99mTc-PYP scan in patients with suspected ATTR cardiac amyloidosis. J Nucl Cardiol 2023; 30:127-139. [PMID: 35655113 DOI: 10.1007/s12350-022-02988-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/02/2022] [Indexed: 01/15/2023]
Abstract
Technetium-99 pyrophosphate scintigraphy (99mTc-PYP) provides qualitative and semiquantitative diagnosis of ATTR cardiac amyloidosis (ATTR-CA) using the Perugini scoring system and heart/contralateral heart ratio (H/CL) on planar imaging. Standardized uptake values (SUV) with quantitative single photon emission computed tomography (xSPECT/CT) can offer superior diagnostic accuracy and quantification through precise myocardial contouring that enhances assessment of ATTR-CA burden. We examined the correlation of xSPECT/CT SUVs with Perugini score and H/CL ratio. We also assessed SUV correlation with cardiac magnetic resonance (CMR), echocardiographic, and baseline clinical characteristics. Retrospective review of 78 patients with suspected ATTR-CA that underwent 99mTc-PYP scintigraphy with xSPECT/CT. Patients were grouped off Perugini score (Grade 0-1 and Grade 2-3), H/CL ratio (≥ 1.5 and < 1.5). Two cohorts were also created: myocardium SUVmax > 1.88 and ≤ 1.88 at 1-hour based off an AUC curve with 1.88 showing the greatest sensitivity and specificity. Cardiac SUV retention index was calculated as [SUVmax myocardium/SUVmax vertebrae] × SUVmax paraspinal muscle. Primary outcome was myocardium SUVmax at 1-hour correlation with Perugini grades, H/CL ratio, CMR, and echocardiographic data. Higher Perugini Grades corresponded with higher myocardium SUVmax values, especially when comparing Perugini Grade 3 to Grade 2 and 1 (3.03 ± 2.1 vs 0.59 ± 0.97 and 0.09 ± 0.2, P < 0.001). Additionally, patients with H/CL ≥ 1.5 had significantly higher myocardium SUVmax compared to patients with H/CL ≤ 1.5 (2.92 ± 2.18 vs 0.35 ± 0.60, P < 0.01). Myocardium SUVmax at 1-hour strongly correlated with ECV (r = 0.91, P = 0.001), pre-contrast T1 map values (r = 0.66, P = 0.037), and left ventricle mass index (r = 0.80, P = 0.002) on CMR. SUVs derived from 99mTc-PYP scintigraphy with xSPECT/CT provides a discriminatory and quantitative method to diagnose and assess ATTR-CA burden. These findings strongly correlate with CMR.
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Affiliation(s)
| | - Jacob Fuqua
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Seth Deskins
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Tyler Miller
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Justin Conte
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Daniel Martin
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Gary Marano
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Naveena Yanamala
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - James Mills
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Christopher Bianco
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Brijesh Patel
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Karthik Seetharam
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Raymond Raylman
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Partho P Sengupta
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, 125 Patterson St, New Brunswick, NJ, 08901, USA
| | - Yasmin S Hamirani
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA.
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9
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Radiolabeled Thioflavin-T Derivative PET Imaging for the Assessment of Cardiac Amyloidosis. Curr Cardiol Rep 2022; 24:1883-1891. [PMID: 36378483 DOI: 10.1007/s11886-022-01811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Cardiac amyloidosis (CA) is an often under-recognized cause of heart failure with preserved ejection fraction. The goal of the current paper was to review imaging modalities available for detecting cardiac amyloidosis. We wished to determine what modalities are available for the diagnosis of cardiac amyloidosis and what modalities could be utilized in the future. RECENT FINDINGS Early and delayed planar imaging of the chest currently plays a central role in the workup and diagnosis of CA. However, novel positron emission tomography (PET) tracers could play a large role in CA imaging in the future. There is an increasing body of literature supporting the use of targeted amyloid-binding PET radiotracers such as 11C-Pittsburgh compound B (11C-PIB), 18F-florbetapir, -flutemetamol, and -florbetaben for the detection of cardiac amyloid. While planar imaging currently plays a large role in the workup of CA, PET imaging could play an increasing important role in the future. The quantitative abilities of novel PET tracers could theoretically allow for the serial monitoring of patients and detection of response to therapy, and the sensitive nature of the tracers could allow for even earlier disease detection. Further work with large randomized controlled trial data is needed in the development and validation of PET tracers for cardiac amyloid and represents an exciting development within the realm of nuclear cardiology.
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10
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Salvalaggio A, Cipriani A, Righetto S, Artioli P, Sinigiani G, De Michieli L, Cason M, Pilichou K, Cecchin D, Briani C. Incidental cardiac uptake of 99mTc-diphosphonates is predictive of poor outcome: data from 9616 bone scintigraphies. J Nucl Cardiol 2022; 29:3419-3425. [PMID: 35437680 DOI: 10.1007/s12350-022-02961-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/27/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bone scintigraphy (BS) is highly diagnostic for amyloid transthyretin (ATTR) cardiomyopathy. Prevalence and prognostic value of BS cardiac uptake is not well established. Our aim was to assess the prevalence of subclinical cardiac ATTR amyloidosis in patients undergoing [99mTc]MDP/DPD scintigraphy and to define their phenotype and prognosis. METHODS AND RESULTS BS scans performed for any clinical indications from 2009 to 2020 were reviewed. Patients were stratified according to Perugini visual score of cardiac uptake. Follow-up data were collected. Among 9616 BS scans, 0.7% (n = 67) showed cardiac uptake. In 47 (70%) patients, Perugini score was 1 and in 20 (30%) patients uptake was ≥ 2, suggesting cardiac ATTR amyloidosis. Forty subjects (61%) died during the follow-up (mean 47 ± 30 months). Compared with patients with Perugini score 1, those Perugini score ≥ 2 showed increased death rate (P = .018). Two (2/67) subjects were investigated for TTR gene mutations resulting negative. CONCLUSIONS In patients undergoing BS for different clinical indications, cardiac uptake suggesting cardiac ATTR amyloidosis is a rare, but still neglected finding, thus preventing possible diagnosis of ATTR cardiomyopathy. Importantly, cardiac uptake negatively affects the survival. Physicians should be aware of this rare, but crucial finding for timely diagnosis and treatment.
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Affiliation(s)
- A Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - A Cipriani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - S Righetto
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - P Artioli
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - G Sinigiani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - L De Michieli
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - M Cason
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - K Pilichou
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - D Cecchin
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - C Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
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11
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Miller RJH, Fine N. Quantifying is believing: Techniques for evaluating transthyretin cardiac amyloidosis burden for expanded clinical applications. J Nucl Cardiol 2022; 29:3111-3114. [PMID: 34921352 DOI: 10.1007/s12350-021-02880-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Robert J H Miller
- Libin Cardiovascular Institute and Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
| | - Nowell Fine
- Libin Cardiovascular Institute and Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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12
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Bae S, Gil J, Paeng JC, Park EA, Lee SP, Choi H, Kang KW, Cheon GJ, Lee DS. Reliability and feasibility of visual grading systems and quantitative indexes on [ 99mTc]Tc-DPD imaging for cardiac amyloidosis. Sci Rep 2022; 12:17271. [PMID: 36241893 PMCID: PMC9568548 DOI: 10.1038/s41598-022-21603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/29/2022] [Indexed: 01/06/2023] Open
Abstract
We aimed to evaluate the reliability and feasibility of visual grading systems and various quantitative indexes of [99mTc]Tc-DPD imaging for cardiac amyloidosis (CA). Patients who underwent [99mTc]Tc-DPD imaging with suspicion of CA were enrolled. On the planar image, myocardial uptake was visually graded using Perugini's and Dorbala's methods (PS and DS). As [99mTc]Tc-DPD indexes, heart-to-whole body ratio (H/WB) and heart-to-contralateral lung ratio (H/CL) were measured on planar image. SUVmax, SUVmean, total myocardial uptake (TMU), and C-index were measured on SPECT/CT. Inter-observer agreement of the indexes and their association with visual grading and clinical factors were evaluated. A total of 152 [99mTc]Tc-DPD images, of which 18 were positive, were analyzed. Inter-observer agreement was high for both DS (κ = 0.95) and PS (κ = 0.96). However, DS showed a higher correlation with quantitative indexes than PS. Inter-observer agreement was also high for SPECT/CT indexes, particularly SUVmax. SUVmax was significantly different between different DS groups (P = 0.014-0.036), and showed excellent correlations with H/WB and H/CL (r = 0.898 and 0.910). SUVmax also showed significant differences between normal, AL, and ATTR pathology (P = 0.022-0.037), and a significant correlation with extracellular volume on cardiac MRI (r = 0.772, P < 0.001). DS is a visual grading system for CA that is more significantly matched with quantitative indexes than PS. SUVmax is a reliable quantitative index on SPECT/CT, with a high inter-observer agreement, correlations with the visual grade, and potential association with cardiac MRI findings.
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Affiliation(s)
- Sungwoo Bae
- grid.31501.360000 0004 0470 5905Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Joonhyung Gil
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Chul Paeng
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Eun-Ah Park
- grid.412484.f0000 0001 0302 820XDepartment of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Pyo Lee
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hongyoon Choi
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Keon Wook Kang
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Dong Soo Lee
- grid.31501.360000 0004 0470 5905Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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