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Scully PR, Morris E, Patel KP, Treibel TA, Burniston M, Klotz E, Newton JD, Sabharwal N, Kelion A, Manisty C, Kennon S, Ozkor M, Mullen M, Hartman N, Elliott PM, Pugliese F, Hawkins PN, Moon JC, Menezes LJ. DPD Quantification in Cardiac Amyloidosis: A Novel Imaging Biomarker. JACC Cardiovasc Imaging 2020; 13:1353-1363. [PMID: 32498921 PMCID: PMC7264710 DOI: 10.1016/j.jcmg.2020.03.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess whether single-photon emission computed tomography (SPECT/CT) quantification of bone scintigraphy would improve diagnostic accuracy and offer a means of quantifying amyloid burden. BACKGROUND Transthyretin-related cardiac amyloidosis is common and can be diagnosed noninvasively using bone scintigraphy; interpretation, however, relies on planar images. SPECT/CT imaging offers 3-dimensional visualization. METHODS This was a single-center, retrospective analysis of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scans reported using the Perugini grading system (0 = negative; 1 to 3 = increasingly positive). Conventional planar quantification techniques (heart/contralateral lung, and heart/whole-body retention ratios) were performed. Heart, adjacent vertebra, paraspinal muscle and liver peak standardized uptake values (SUVpeak) were recorded from SPECT/CT acquisitions. An SUV retention index was also calculated: (cardiac SUVpeak/vertebral SUVpeak) × paraspinal muscle SUVpeak. In a subgroup of patients, SPECT/CT quantification was compared with myocardial extracellular volume quantification by CT imaging (ECVCT). RESULTS A total of 100 DPD scans were analyzed (patient age 84 ± 9 years; 52% male): 40 were Perugini grade 0, 12 were grade 1, 41 were grade 2, and 7 were grade 3. Cardiac SUVpeak increased from grade 0 to grade 2; however, it plateaued between grades 2 and 3 (p < 0.001). Paraspinal muscle SUVpeak increased with grade (p < 0.001), whereas vertebral SUVpeak decreased (p < 0.001). The composite parameter of SUV retention index overcame the plateauing of the cardiac SUVpeak and increased across all grades (p < 0.001). Cardiac SUVpeak correlated well (r2 = 0.73; p < 0.001) with ECVCT. Both the cardiac SUVpeak and SUV retention index had excellent diagnostic accuracy (area under the curve [AUC]: 0.999). The heart to contralateral lung ratio performed the best of the planar quantification techniques (AUC: 0.987). CONCLUSIONS SPECT/CT quantification in DPD scintigraphy is possible and outperforms planar quantification techniques. Differentiation of Perugini grade 2 or 3 is confounded by soft tissue uptake, which can be overcome by a composite SUV retention index. This index can help in the diagnosis of cardiac amyloidosis and may offer a means of monitoring response to therapy.
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Affiliation(s)
- Paul R Scully
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Elizabeth Morris
- Clinical Physics, St. Bartholomew's Hospital, London, United Kingdom
| | - Kush P Patel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Thomas A Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Maria Burniston
- Clinical Physics, St. Bartholomew's Hospital, London, United Kingdom
| | | | - James D Newton
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Nikant Sabharwal
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew Kelion
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Muhiddin Ozkor
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Neil Hartman
- Nuclear Medicine, Abertawe Bro Morgannwg University HB, Swansea, United Kingdom
| | - Perry M Elliott
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Leon J Menezes
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Nuclear Medicine, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.
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Hyafil F, Jaber WA, Neglia D. Highlights of the 14th International Conference on Nuclear Cardiology and Cardiac Computed Tomography. Eur Heart J Cardiovasc Imaging 2020; 21:1-9. [PMID: 31665263 DOI: 10.1093/ehjci/jez223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/12/2022] Open
Abstract
The 14th International Conference on Nuclear Cardiology and Cardiac Computed Tomography was held from 12 May to 14 May 2019 in Lisbon, Portugal. In this article, the three Congress Programme Committee Chairs summarize selected highlights of the presented abstracts and lectures.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University Diderot, 46 rue Henri Huchard, F Paris, France.,Laboratory for Vascular Translational Science, INSERM, U-1148, DHU FIRE, University Diderot, 46 rue Henri Huchard, F Paris, France
| | - Wael A Jaber
- Heart and Vascular Institute, 9500 Euclid Avenue J1-5, Cleveland, OH, USA
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, Cardiovascular Department, CNR Institute of Clinical Physiology, Via G. Moruzzi 1, Pisa, Italy
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