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de Haro Del Moral FJ, Aguadé Bruix S, Tabuenca Mateo MJ, Pilar Tamayo Alonso M, Mohamed Salem L, Bernal L, Primiano D, Tarilonte P. Assessment of incidental cardiac uptake in bone scintigraphy across Spain: The ECCINGO study. Rev Esp Med Nucl Imagen Mol 2024; 43:500020. [PMID: 38821407 DOI: 10.1016/j.remnie.2024.500020] [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: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
AIM Myocardial uptake on bone scintigraphy has become useful for the detection of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to assess the prevalence of myocardial uptake in patients over 18 years of age with no clinical suspicion of cardiac amyloidosis (CA) who had undergone bone scintigraphy. METHODS AND RESULTS This was an observational, retrospective, multicenter study across 21 Spanish hospitals (September-November 2019). Of the 9864 scans analyzed (locally and centrally), incidental cardiac uptake was observed in 71 patients (0.72%), a prevalence that increased with age. A previous diagnosis of heart failure was found in 16.9% of patients with positive uptake, with >50% in NYHA II. ATTR-CA was diagnosed in 10 patients, with a mean delay of 10.4 months (95% CI: 5.1-15.7). All were >70 years old, primarily male, and had greater left ventricular hypertrophy than patients without a confirmed diagnosis (p<0.0001). ATTR-CA patients had higher rates of orthostatic hypotension (30.0% vs. 3.8% in non-ATTR-CA; p=0.025). CONCLUSIONS This is the first retrospective, national, multicenter study evaluating the prevalence of incidental cardiac uptake in bone scintigraphy performed for non-cardiac reasons, showing a prevalence of 0.72% in this population. Referral of these patients may facilitate early diagnosis of CA with a resulting benefit for patients.
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Juntunen E, Suomalainen O, Mätzke S, Heliö T, Loimaala A, Uusitalo V. Cardiac morbidity and the cause of death in elderly patients with prostate cancer and incidental cardiac uptake on bone scintigraphy. Clin Physiol Funct Imaging 2024; 44:49-55. [PMID: 37421321 DOI: 10.1111/cpf.12848] [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: 10/06/2022] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
Cardiac transthyretin amyloidosis (ATTR) is a possible incidental finding on bone scintigraphy imaged due to prostate cancer. We investigated its significance in 1426 elderly prostate cancer patients (>70 years) who underwent bone scintigraphy in three nuclear medicine departments in Finland. Patients with Perugini grade two or three uptakes were considered positive for cardiac uptake. Heart failure diagnoses and pacemaker implantations were collected from the hospital's records. Mortality data were gathered from the Finnish national statistical service (Statistics Finland). The Median follow-up time was 4 years (interquartile range: 2-5 years). Cardiac uptake was detected in 37 individuals (2.6%), and it was associated with an elevated risk of both overall and cardiovascular death in univariable analysis. However, cardiac uptake did not predict overall mortality in the multivariable analysis when adjusted to age, bone metastases or the diagnosis of heart failure (p > 0.05). The risk of heart failure was higher in patients with cardiac uptake (47% vs. 15%, p < 0.001), while the risk of pacemaker implantations was not elevated (5% vs. 5%, p = 0.89). In conclusion, cardiac uptake on bone scintigraphy imaged due to prostate cancer is associated with an elevated risk of heart failure and both overall and cardiovascular death. However, cardiac uptake was not independently associated with overall mortality when adjusted to age, bone metastasis or heart failure. Therefore, they are essential to consider when incidental cardiac uptake is detected on bone scintigraphy. The need for pacemaker implantation was not elevated in patients with cardiac uptake.
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Affiliation(s)
- Eero Juntunen
- Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Olli Suomalainen
- Heart and Lung Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Sorjo Mätzke
- Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Loimaala
- Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valtteri Uusitalo
- Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Radiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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Poli L, Labella B, Cotti Piccinelli S, Caria F, Risi B, Damioli S, Padovani A, Filosto M. Hereditary transthyretin amyloidosis: a comprehensive review with a focus on peripheral neuropathy. Front Neurol 2023; 14:1242815. [PMID: 37869146 PMCID: PMC10585157 DOI: 10.3389/fneur.2023.1242815] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Amyloidoses represent a group of diseases characterized by the pathological accumulation in the extracellular area of insoluble misfolded protein material called "amyloid". The damage to the tissue organization and the direct toxicity of the amyloidogenic substrates induce progressive dysfunctions in the organs involved. They are usually multisystem diseases involving several vital organs, such as the peripheral nerves, heart, kidneys, gastrointestinal tract, liver, skin, and eyes. Transthyretin amyloidosis (ATTR) is related to abnormalities of transthyretin (TTR), a protein that acts as a transporter of thyroxine and retinol and is produced predominantly in the liver. ATTR is classified as hereditary (ATTRv) and wild type (ATTRwt). ATTRv is a severe systemic disease of adults caused by mutations in the TTR gene and transmitted in an autosomal dominant manner with incomplete penetrance. Some pathogenic variants in TTR are preferentially associated with a neurological phenotype (progressive peripheral sensorimotor polyneuropathy); others are more frequently associated with restrictive heart failure. However, many mutations express a mixed phenotype with neurological and cardiological involvement. ATTRv is now a treatable disease. A timely and definite diagnosis is essential in view of the availability of effective therapies that have revolutionized the management of affected patients. The purpose of this review is to familiarize the clinician with the disease and with the correct diagnostic pathways in order to obtain an early diagnosis and, consequently, the possibility of an adequate treatment.
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Affiliation(s)
- Loris Poli
- Unit of Neurology, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Beatrice Labella
- Unit of Neurology, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Barbara Risi
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Alessandro Padovani
- Unit of Neurology, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
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Treglia G, Martinello C, Dondi F, Albano D, Bertagna F, Rizzo A, Delgado Bolton RC, Tersalvi G, Muoio B, Riegger M, Cecchin D. Prevalence of Incidental Findings Suspicious for Transthyretin Cardiac Amyloidosis among Patients Undergoing Bone Scintigraphy: A Systematic Review and a Meta-Analysis. J Clin Med 2023; 12:5698. [PMID: 37685765 PMCID: PMC10488435 DOI: 10.3390/jcm12175698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The myocardial uptake of bone-seeking tracers suspicious for transthyretin cardiac amyloidosis (ATTR-CA) can be incidentally detected in patients undergoing bone scintigraphy for noncardiac reasons. We conducted a systematic review and meta-analysis to assess the prevalence of these scintigraphic findings. METHODS A comprehensive literature search was performed using two bibliographic databases (PubMed/MEDLINE and Cochrane Library), searching for articles related to the review question. Eligible articles were selected, and relevant data were extracted by two authors. The pooled prevalence of incidental findings suspicious for ATTR-CA among patients undergoing bone scintigraphy was calculated on a per-patient-based analysis using a random-effects model. The pooled measure was provided with 95% confidence interval (95% CI) values. RESULTS Among 219 records, 11 articles were selected for the systematic review and 10 for the meta-analysis. The pooled prevalence of incidental findings suspicious for ATTR-CA was 1.1% (95% CI: 0.7-1.4%) with heterogeneity due to the characteristics of the included studies, patients, and index tests. These findings are more prevalent in older men. CONCLUSIONS The prevalence of incidental findings of ATTR-CA among patients undergoing bone scintigraphy is low but not negligible. Nuclear medicine physicians should suggest, in the scintigraphic report, further clinical investigations when these findings are detected. Prospective studies are warranted.
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Affiliation(s)
- Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | | | - Francesco Dondi
- Division of Nuclear Medicine, Università degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Domenico Albano
- Division of Nuclear Medicine, Università degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Bertagna
- Division of Nuclear Medicine, Università degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, 10060 Turin, Italy
| | - Roberto C. Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), 26006 Logroño, Spain
- Servicio Cántabro de Salud, 39011 Santander, Spain
| | - Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Barbara Muoio
- Division of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501 Bellinzona, Switzerland
| | - Martin Riegger
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Division of Orthopedics and Traumatology, Department of Surgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine (DIMED), Padova University Hospital, 35128 Padua, Italy
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Delbarre MA, Girardon F, Roquette L, Blanc-Durand P, Hubaut MA, Hachulla É, Semah F, Huglo D, Garcelon N, Marchal E, El Esper I, Tribouilloy C, Lamblin N, Duhaut P, Schmidt J, Itti E, Damy T. Deep Learning on Bone Scintigraphy to Detect Abnormal Cardiac Uptake at Risk of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2023; 16:1085-1095. [PMID: 37227330 DOI: 10.1016/j.jcmg.2023.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cardiac uptake on technetium-99m whole-body scintigraphy (WBS) is almost pathognomonic of transthyretin cardiac amyloidosis. The rare false positives are often related to light-chain cardiac amyloidosis. However, this scintigraphic feature remains largely unknown, leading to misdiagnosis despite characteristic images. A retrospective review of all WBSs in a hospital database to detect those with cardiac uptake may allow the identification of undiagnosed patients. OBJECTIVES The authors sought to develop and validate a deep learning-based model that automatically detects significant cardiac uptake (Perugini grade ≥2) on WBS from large hospital databases in order to retrieve patients at risk of cardiac amyloidosis. METHODS The model is based on a convolutional neural network with image-level labels. The performance evaluation was performed with C-statistics using a 5-fold cross-validation scheme stratified so that the proportion of positive and negative WBSs remained constant across folds and using an external validation data set. RESULTS The training data set consisted of 3,048 images: 281 positives (Perugini grade ≥2) and 2,767 negatives. The external validation data set consisted of 1,633 images: 102 positives and 1,531 negatives. The performance of the 5-fold cross-validation and external validation was as follows: 98.9% (± 1.0) and 96.1% for sensitivity, 99.5% (± 0.4) and 99.5% for specificity, and 0.999 (SD = 0.000) and 0.999 for the area under the curve of the receiver-operating characteristic curves. Sex, age <90 years, body mass index, injection-acquisition delay, radionuclides, and the indication of WBS only slightly affected performances. CONCLUSIONS The authors' detection model is effective at identifying patients with cardiac uptake Perugini grade ≥2 on WBS and may help in the diagnosis of patients with cardiac amyloidosis.
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Affiliation(s)
- Marc-Antoine Delbarre
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France. https://twitter.com/ma_delbarre
| | | | - Lucien Roquette
- Department of Research and Development, Codoc SAS, Paris, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de la Recherche Biomédicale (IMRB), Team 8, Université Paris Est Créteil (UPEC), Créteil, France; Institut National de Recherhe en Informatique et en automatique, Epione Team, Sophia Antipolis Epione Team, Sophia Antipolis, France
| | - Marc-Antoine Hubaut
- Department of Nuclear Medicine, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for Rare Systemic Autoimmune Diseases North and North-West of France, Centre Hospitalier et Universitaire (University Hospital Center) Lille, Lille, France; University of Lille, Inserm, U1286 Institute for Translational Research in Inflammation, Lille, France
| | - Franck Semah
- Department of Nuclear Medicine, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Nicolas Garcelon
- Department of Research and Development, Codoc SAS, Paris, France
| | - Etienne Marchal
- Nuclear Medicine Department, Amiens University Hospital, Amiens, France
| | - Isabelle El Esper
- Nuclear Medicine Department, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France; Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Nicolas Lamblin
- Department of Cardiology, Cœur-Poumons Institut, Lille University Hospital, Lille, France; Inserm UMR1167, Institut Pasteur of Lille, Lille, France
| | - Pierre Duhaut
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France
| | - Jean Schmidt
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France
| | - Thibaud Damy
- Department of Cardiology, French Referral Center for Cardiac Amyloidosis, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France; InsermUnit U955, Clinical Epidemiology and Ageing, Paris-Est Créteil University, Val-de-Marne, Créteil, France. https://twitter.com/ThibaudDamy
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Campi C, Briani C, Salvalaggio A, Giraudo C, Cipriani A, Zorzi A, Zucchetta P, Vettor R, Cecchin D. Semi-Quantification of Myocardial Uptake of Bone-Seeking Agents in Suspected Cardiac Amyloidosis. J Cardiovasc Dev Dis 2023; 10:jcdd10050184. [PMID: 37233151 DOI: 10.3390/jcdd10050184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Bone scintigraphy has emerged as a key tool for non-invasive etiologic diagnosis of transthyretin (ATTR) cardiac amyloidosis (CA). We focused on a new semi-quantification method (on planar imaging) that could complement the qualitative/visual Perugini scoring system, especially when SPET/CT is not available. MATERIAL AND METHODS We retrospectively/qualitatively evaluated 8674 consecutive, planar 99mTc-biphosphonate scintigraphies (performed for non-cardiac reasons), identifying 68 (0.78%) individuals (mean age 79 ± 7 years, range 62-100 years; female/male ratio 16/52) presenting myocardial uptake. Due to the retrospective nature of the study, no SPET/CT, pathologic or genetic confirmation was obtained. The Perugini scoring system was determined (in patients presenting cardiac uptake) and compared with three newly proposed semi-quantitative indices. We took 349 consecutive bone scintigraphies, qualitatively absent of any cardiac/pulmonary uptake, as "healthy controls" (HC). RESULTS The heart-to-thigh ratio (RHT) and lung-to-thigh ratio (RLT) indices were significantly higher in patients than in HCs (p ≤ 0.0001). There were statistically significant differences for RHT in HCs vs. patients with qualitative Perugini scores of 1 or >1 (with p ranging from ≤0.001 to ≤0.0001). ROC curves showed that RHT outperformed the other indices and was more accurate in both male and female groups. Furthermore, in the male population, RHT accurately distinguished HCs and patients with scores of 1 (less likely affected by ATTR) from patients with qualitative scores >1 (more likely affected by ATTR) with an AUC of 99% (sensitivity: 95%; specificity: 97%). CONCLUSION The proposed semi-quantitative RHT index can accurately/semi-quantitatively distinguish between HCs and subjects probably affected by CA (Perugini scores from 1 to 3), and could be particularly useful when no SPET/CT data are available (such as in retrospective studies and data mining). Furthermore, RHT can semi-quantitatively predict, with very high accuracy, subjects in the male population more likely to be affected by ATTR. The present study, although using a very large sample, is however retrospective, monocentric, and therefore the generalizability of the results should be proved by an accurate external validation. ADVANCES IN KNOWLEDGE The proposed heart-to-thigh ratio (RHT) can distinguish healthy controls and subjects that are probably affected by cardiac amyloidosis in a simple and more reproducible way, as compared to standard qualitative/visual evaluation.
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Affiliation(s)
- Cristina Campi
- Department of Mathematics, University of Genoa, 16126 Genoa, Italy
| | - Chiara Briani
- Department of Neurosciences (DNS), University of Padua, 35128 Padua, Italy
| | | | - Chiara Giraudo
- Nuclear Medicine Unit, Department of Medicine-DIMED, Padua University Hospital, 35128 Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, 35128 Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, 35128 Padua, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, Padua University Hospital, 35128 Padua, Italy
| | - Roberto Vettor
- Internal Medicine Unit, Department of Medicine-DIMED, Padua University Hospital, 35128 Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, Padua University Hospital, 35128 Padua, Italy
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