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Takahashi K, Sasaki D, Iwamura T, Sakaue T, Okura T. "Loss of Bone Signal" on 99m Tc-Labeled Pyrophosphate Scintigraphy in a Patient With Wild-Type Transthyretin Amyloidosis. Clin Nucl Med 2024; 49:767-770. [PMID: 38651784 DOI: 10.1097/rlu.0000000000005236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
ABSTRACT 99m Tc-3,3-diphosphono-1,2-propanedicarboxylic acid (DPD) scintigraphy and 99m Tc-pyrophosphate (PYP) scintigraphy are highly sensitive modalities for imaging both myocardial and extracardiac amyloid transthyretin in patients with wild-type transthyretin (ATTRwt) amyloidosis. "Loss of bone signal" on planar imaging of 99m Tc-DPD scintigraphy, in which the tracer uptake in bone is obscured by marked tracer uptake in the overlying skeletal muscles, is reported. However, this phenomenon has not yet been documented on 99m Tc-PYP scintigraphy. We describe an 89-year-old woman with ATTRwt amyloidosis in whom "loss of bone signal" together with marked tracer uptake into the skeletal muscles was clearly demonstrated on 99m Tc-PYP scan.
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Affiliation(s)
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Takaaki Iwamura
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | | | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
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Takahashi K, Iwamura T, Hiratsuka Y, Sasaki D, Yamamura N, Ueda M, Morioka H, Yoshino M, Enomoto D, Uemura S, Okura T, Sakaue T, Ikeda S. A Gluteus Medius Muscle Biopsy to Confirm Amyloid Transthyretin Deposition in Wild-type Transthyretin Cardiac Amyloidosis: A Report of Two Cases. Intern Med 2024; 63:1575-1584. [PMID: 37899242 PMCID: PMC11189698 DOI: 10.2169/internalmedicine.2742-23] [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: 08/09/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
In patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), the uptake of the tracer on technetium-99m-labeled pyrophosphate (99mTc-PYP) scintigraphy, which indicates amyloid transthyretin (ATTR) per se, is often observed in skeletal muscles, such as the abdominal oblique and gluteal muscles. Among extracardiac biopsies for confirming ATTR deposition in ATTRwt-CA, a 99mTc-PYP imaging-based computed tomography (CT)-guided core needle biopsy of the internal oblique muscle has relatively high sensitivity. In some patients, the 99mTc-PYP uptake is more pronounced in the gluteal muscles than in oblique muscles. We herein report two cases of ATTRwt-CA in which a CT-guided biopsy of the gluteus medius muscle with 99mTc-PYP uptake confirmed the presence of ATTR deposits.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Takaaki Iwamura
- Department of Radiology, Yawatahama City General Hospital, Japan
| | | | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Mako Yoshino
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
- Department of Cardiology, Yawatahama City General Hospital, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Japan
- Department of Cardiology, Yawatahama City General Hospital, Japan
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Takahashi K, Hiratsuka Y, Iwamura T, Sasaki D, Yamamura N, Kitazawa S, Ueda M, Morioka H, Okura T, Enomoto D, Uemura S, Kono T, Sakaue T, Ikeda S. Technetium-99m-pyrophosphate imaging-based computed tomography-guided core-needle biopsy of internal oblique muscle in wild-type transthyretin cardiac amyloidosis. Amyloid 2024; 31:12-21. [PMID: 37486102 DOI: 10.1080/13506129.2023.2235881] [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: 12/28/2022] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Technetium-99m-pyrophosphate (99mTc-PYP) uptake in the internal oblique muscle (IOM), which is often observed in patients with wild-type transthyretin cardiac amyloidosis (ATTR-CA), indicates amyloid transthyretin (ATTR) deposition. OBJECTIVE This study aimed to assess the safety and efficacy of 99mTc-PYP imaging-based computed tomography (CT)-guided core-needle biopsy of the IOM as a new extracardiac screening biopsy for confirming the presence of ATTR deposits. METHODS Patients with suspected ATTR-CA in whom myocardial tracer uptake was detected on chest- and abdomen-centered images of 99mTc-PYP scintigraphy underwent CT-guided core-needle biopsy at the site with the highest tracer uptake in the IOM between September 2021 and November 2022. RESULTS All 18 consecutive patients (mean age, 86.3 years ± 6.5; 61.1% male) enrolled in the study showed 99mTc-PYP uptake into the IOM. Adequate tissue samples were obtained from all patients except one without serious complications. Immunohistochemical analysis confirmed ATTR deposits in 16/18 (88.9%) patients. In the remaining two patients, ATTR deposits were observed via endomyocardial biopsy. All patients were diagnosed with wild-type ATTR-CA based on transthyretin gene sequence testing results. CONCLUSION In wild-type ATTR-CA, 99mTc-PYP imaging-based CT-guided core-needle biopsy of the IOM could be used as an extracardiac screening biopsy to confirm the presence of ATTR deposits.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | | | - Takaaki Iwamura
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Taizo Kono
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
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Slart RHJA, Chen W, Tubben A, Tingen HSA, Davies DR, Grogan M, Wechalekar AD, Kittleson MM, Thomson LEJ, Slomka PJ, Wechalekar K, Chareonthaitawee P. Emerging Role of Scintigraphy Using Bone-Seeking Tracers for Diagnosis of Cardiac Amyloidosis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329347. [PMID: 37315017 DOI: 10.2214/ajr.23.29347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Amyloidoses are a complex group of clinical diseases that result from progressive organ dysfunction due to extracellular protein misfolding and deposition. The two most common types of cardiac amyloidosis are transthyretin amyloidosis (ATTR) and light-chain (AL) amyloidosis. Diagnosis of ATTR cardiomyopathy (ATTR-CM) is challenging owing to its phenotypic similarity to other more common cardiac conditions, the perceived rarity of the disease, and unfamiliarity with its diagnostic algorithms; endomyocardial biopsy was historically required for diagnosis. However, myocardial scintigraphy using bone-seeking tracers has shown high accuracy for detection of ATTR-CM and has become a key noninvasive diagnostic test for the condition, receiving support from professional society guidelines and transforming prior diagnostic paradigms. This AJR Expert Panel Narrative Review describes the role of myocardial scintigraphy using bone-seeking tracers in the diagnosis of ATTR-CM. The article summarizes available tracers, acquisition techniques, interpretation and reporting considerations, diagnostic pitfalls, and gaps in the current literature. The critical need for monoclonal testing of patients with positive scintigraphy results to differentiate ATTR-CM from AL cardiac amyloidosis is highlighted. Recent updates in guideline recommendations that emphasize the importance of a qualitative visual assessment are also discussed.
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Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alwin Tubben
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrea S A Tingen
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
| | - Daniel R Davies
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, United Kingdom
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Piotr J Slomka
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA
- Department of Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA
| | - Kshama Wechalekar
- Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, Part of the Guy's and St Thomas' Foundation Trust Hospitals, London, United Kingdom
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Takahashi K, Iwamura T, Hiratsuka Y, Sasaki D, Yamamura N, Ueda M, Yoshino M, Enomoto D, Morioka H, Uemura S, Okura T, Sakaue T, Ikeda S. Iatrogenic intramuscular hematoma of the oblique muscles as a complication of technetium-99m-labeled pyrophosphate imaging-based computed tomography-guided core-needle biopsy in a patient with wild-type transthyretin cardiac amyloidosis. Radiol Case Rep 2024; 19:330-340. [PMID: 38028290 PMCID: PMC10661599 DOI: 10.1016/j.radcr.2023.09.107] [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: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 12/01/2023] Open
Abstract
Technetium-99m-labeled pyrophosphate imaging-based computed tomography-guided core-needle biopsy of the internal oblique muscle with tracer uptake is a safe and sensitive extracardiac screening biopsy. It can provide histopathological confirmation of the deposition of amyloid transthyretin in patients with wild-type transthyretin cardiac amyloidosis. This case report presents the case of a 73-year-old man receiving triple anti-thrombotic therapy for atrial flutter and coronary stenting who underwent this biopsy to confirm the diagnosis of transthyretin cardiac amyloidosis. The biopsy needle reached the internal oblique muscle via the external oblique muscle between the skin and the target. A type 1 intramuscular hematoma involving these muscles developed subsequently; however, manual compression hemostasis prevented further increase in size. Since this biopsy often targets elderly patients receiving anti-thrombotic therapy who are at high risk of bleeding owing to multimorbidity and polypharmacy, efforts should be made to reduce the frequency of complications, particularly bleeding, which can lead to the development of intramuscular hematoma.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Takaaki Iwamura
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | | | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Mako Yoshino
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime 796-8502, Japan
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Khor YM, Dorbala S. Extra-cardiac uptake on technetium-99m pyrophosphate (Tc-99m PYP) scan: not just a matter of the heart. J Nucl Cardiol 2023; 30:2540-2543. [PMID: 37468745 DOI: 10.1007/s12350-023-03341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, 16 College Road, Block 2 Basement 1, Singapore, Singapore.
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Takahashi K, Morioka H, Sasaki D, Yamamura N, Kitazawa S, Ueda M, Sakaue T, Enomoto D, Uemura S, Okura T, Ikeda S. Two autopsy cases of wild-type transthyretin cardiac amyloidosis who died 10 days after technetium-99m-pyrophosphate scintigraphy. J Nucl Cardiol 2023; 30:2215-2221. [PMID: 36352088 DOI: 10.1007/s12350-022-03128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan.
| | - Hiroe Morioka
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Yawatahama, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Yawatahama, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan
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AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: single photon emission computed tomography. J Nucl Cardiol 2023; 30:452-478. [PMID: 36797458 DOI: 10.1007/s12350-023-03216-4] [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: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
In this review, we will summarize a selection of articles on single-photon emission computed tomography published in the Journal of Nuclear Cardiology in 2022. The aim of this review is to concisely recap major advancements in the field to provide the reader a glimpse of the research published in the journal over the last year. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including in prognosis, non-perfusion variables, attenuation compensation, machine learning and camera design. It will also review nuclear imaging advances in amyloidosis, left ventricular mechanical dyssynchrony, cardiac innervation, and lung perfusion. We encourage interested readers to go back to the original articles, and editorials, for a comprehensive read as necessary but hope that this yearly review will be helpful in reminding readers of articles they have seen and attracting their attentions to ones they have missed.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, GSB 446, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Wollenweber T, Kretschmer-Chott E, Wurm R, Rasul S, Kulterer O, Rettl R, Duca F, Bonderman D, Sühs KW, Hacker M, Traub-Weidinger T. Does [99mTc]-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) soft tissue uptake allow the identification of patients with the diagnosis of cardiac transthyretin-related (ATTR) amyloidosis with higher risk for polyneuropathy? J Nucl Cardiol 2023; 30:357-367. [PMID: 35817943 PMCID: PMC9984356 DOI: 10.1007/s12350-022-02986-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND With the introduction of several drugs for the therapy of transthyretin-related amyloidosis (ATTR) which slow down the disease, early detection of polyneuropathy (PNP) is becoming increasingly of interest. [99mTc]-3,3-Diphosphono-1,2-Propanodicarboxylic Acid (DPD) bone scintigraphy, which is used for the diagnosis of cardiac (c)ATTR, can possibly make an important contribution in the identification of patients at risk for PNP. METHODS Fifty patients with cATTR, who underwent both planar whole-body DPD scintigraphy and nerve conduction studies (NCS) were retrospectively evaluated. A subgroup of 22 patients also underwent quantitative SPECT/CT of the thorax from which Standardized Uptake Values (SUVpeak) in the subcutaneous fat tissue of the left axillar region were evaluated. RESULTS The Perugini score was significantly increased in patients with cATTR and additional diagnosis of PNP compared to patients without (2.51 ± 0.51 vs 2.13 ± 0.52; P = 0.03). Quantitative SPECT/CT revealed that DPD uptake in the subcutaneous fat of the left axillar region was significantly increased in cATTR patients with compared to patients without (1.36 ± 0.60 vs 0.74 ± 0.52; P = 0.04). CONCLUSION This study suggests that DPD bone scintigraphy is a useful tool for identification of patients with cATTR and a risk for PNP due to increased DPD soft tissue uptake.
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Affiliation(s)
- Tim Wollenweber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Kretschmer-Chott
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oana Kulterer
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rene Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- 5th Medical Department with Cardiology, Clinic Favoriten, Vienna, Austria
| | | | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Takahashi K, Sakaue T, Uemura S, Okura T, Ikeda S. Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia Syndrome as a Clinical Profile Leading to the Diagnosis of Transthyretin Amyloidosis: A Report of Two Cases. Cureus 2022; 14:e25444. [PMID: 35774664 PMCID: PMC9238110 DOI: 10.7759/cureus.25444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
We describe two cases in which the onset of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome led to the diagnosis of transthyretin cardiac amyloidosis. In Case 1, BRASH syndrome developed shortly after a therapeutic dose of AV nodal blockers was prescribed for new-onset atrial flutter. BRASH syndrome improved with intravenous dopamine infusion and temporary cardiac pacing. In Case 2, BRASH syndrome developed immediately after bronchopneumonia followed by worsening heart failure, despite no change in medications such as AV nodal blockers. Intravenous injection of calcium dramatically improved BRASH syndrome.
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