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Miller RJ, Akincioglu C. Bone scintigraphy for cardiac amyloidosis: A Canadian perspective. J Med Imaging Radiat Sci 2024; 55:S39-S43. [PMID: 38461059 DOI: 10.1016/j.jmir.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Robert Jh Miller
- Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada
| | - Cigdem Akincioglu
- University of Western Ontario, Medical Imaging, Division of Nuclear Medicine, 339 Windermere Road, C3-209, London N6A5A5, ON, Canada.
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2
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Rettl R, Calabretta R, Duca F, Binder C, Kronberger C, Willixhofer R, Poledniczek M, Donà C, Nitsche C, Beitzke D, Loewe C, Auer-Grumbach M, Bonderman D, Kastl S, Hengstenberg C, Badr Eslam R, Kastner J, Bergler-Klein J, Hacker M, Kammerlander A. Reduction in 99mTc-DPD myocardial uptake with therapy of ATTR cardiomyopathy. Amyloid 2024; 31:42-51. [PMID: 37599395 DOI: 10.1080/13506129.2023.2247136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
Aims: Novel ribonucleic acid interference (RNAi) therapeutics such as patisiran and inotersen have been shown to benefit neurologic disease course and quality of life in patients with hereditary transthyretin amyloidosis (ATTRv). We aimed to determine the impact of RNAi therapeutics on myocardial amyloid load using quantitative single photon emission computed tomography/computed tomography (SPECT/CT) imaging in patients with ATTRv-related cardiomyopathy (ATTRv-CM). We furthermore compared them with wild-type ATTR-CM (ATTRwt-CM) patients treated with tafamidis.Methods and results: ATTRv-CM patients underwent [99mTc]-radiolabeled diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy and quantitative SPECT/CT imaging before and after 12 months (IQR: 11.0-12.0) of treatment with RNAi therapeutics (patisiran: n = 5, inotersen: n = 4). RNAi treatment significantly reduced quantitative myocardial uptake as measured by standardised uptake value (SUV) retention index (baseline: 5.09 g/mL vs. follow-up: 3.19 g/mL, p = .028) in ATTRv-CM patients without significant improvement in cardiac function. Tafamidis treatment resulted in a significant reduction in SUV retention index (4.96 g/mL vs. 3.27 g/mL, p < .001) in ATTRwt-CM patients (historical control cohort: n = 40) at follow-up [9.0 months (IQR: 7.0-10.0)] without beneficial impact on cardiac function.Conclusions: RNAi therapeutics significantly reduce quantitative myocardial uptake in ATTRv-CM patients, comparable to tafamidis treatment in ATTRwt-CM patients, without impact on cardiac function. Serial 99mTc-DPD SPECT/CT imaging may be a valuable tool to quantify and monitor response to disease-specific therapies in both ATTRv-CM and ATTRwt-CM.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Kronberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Robin Willixhofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michaela Auer-Grumbach
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine V, Favoriten Clinic, Vienna, Austria
| | - Stefan Kastl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jutta Bergler-Klein
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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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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Watanabe S, Nakajima K, Toshima F, Wakabayashi H, Yoshida S, Yoneyama H, Komatsu J, Konishi T, Kinuya S. Transthyretin amyloid cardiomyopathy disease burden quantified using 99mTc-pyrophosphate SPECT/CT: volumetric parameters versus SUVmax ratio at 1 and 3 hours. J Nucl Cardiol 2023; 30:2721-2735. [PMID: 37605060 PMCID: PMC10682282 DOI: 10.1007/s12350-023-03353-w] [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: 05/28/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Various parameters derived from technetium-99m pyrophosphate (99mTc-PYP) single-photon emission computed tomography (SPECT) correlate with the severity of transthyretin amyloid cardiomyopathy (ATTR-CM). However, the optimal metrics and image acquisition timing required to quantify the disease burden remain uncertain. METHODS AND RESULTS We retrospectively evaluated 99mTc-PYP SPECT/CT images of 23 patients diagnosed with ATTR-CM using endomyocardial biopsies and/or gene tests. All patients were assessed by SPECT/CT 1 hour after 99mTc-PYP injection, and 13 of them were also assessed at 3 hours. We quantified 99mTc-PYP uptake using the volumetric parameters, cardiac PYP volume (CPV) and cardiac PYP activity (CPA). We also calculated the SUVmax ratios of myocardial SUVmax/blood pool SUVmax, myocardial SUVmax/bone SUVmax, and the SUVmax retention index. We assessed the correlations between uptake parameters and the four functional parameters associated with prognosis, namely left ventricular ejection fraction, global longitudinal strain, myocardial extracellular volume, and troponin T. CPV and CPA correlated more closely than the SUVmax ratios with the four prognostic factors. Significant correlations between volumetric parameters and prognostic factors were equivalent between 1 and 3 hours. CONCLUSIONS The disease burden of ATTR-CM was quantified more accurately by volumetric evaluation of 99mTc-PYP SPECT/CT than SUVmax ratios and the performance was equivalent between 1 and 3 hours.
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Affiliation(s)
- Satoru Watanabe
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan.
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Fumihito Toshima
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, Kanazawa, Japan
| | - Junji Komatsu
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takahiro Konishi
- Department of Radiological Technology, Kanazawa University Hospital, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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5
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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: 8] [Impact Index Per Article: 8.0] [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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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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7
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Pandey S, Teruya S, Rodriguez C, Deluca A, Kinkhabwala M, Johnson LL, Fine D, Sabogal N, Winburn M, Castillo M, Bhatia K, Malkovskaya R, Raiszadeh F, Kurian D, Miller EJ, Einstein AJ, Maurer MS, Ruberg FL. Diagnostic performance characteristics of planar quantitative and semi-quantitative parameters of Tc 99m pyrophosphate (PYP) imaging for diagnosis of transthyretin (ATTR) cardiac amyloidosis: the SCAN-MP study. J Nucl Cardiol 2023; 30:1414-1419. [PMID: 36823486 PMCID: PMC11268194 DOI: 10.1007/s12350-023-03203-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND The optimal heart-to-contralateral chest (H/CL) ratio threshold for non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) using Tc99m pyrophosphate (PYP) imaging in a population with low pretest probability is not known. METHODS Using myocardial PYP retention by SPECT as the reference standard, we evaluated the diagnostic performance of different semi-quantitative and quantitative (H/CL chest ratio) planar parameters obtained from 3-hour PYP imaging in a prospectively recruited cohort of minority older adults with heart failure and increased LV wall thickness. RESULTS Of 229 patients, 14 were found to have ATTR-CA (6.1%). No PYP uptake (grade 0) was observed in 77% of scans, all grade 3 scans were ATTR-CA, and only 4 of 11 (36%) grade 2 scans were ATTR-CA. An H/CL threshold of ≥ 1.4 maximized specificity (99%) and positive predictive value (93%) but resulted in decreased sensitivity (93%), compared to the ≥ 1.3 threshold which had 100% sensitivity. CONCLUSION Among patients with a low pretest likelihood of ATTR-CA, planar interpretation, while useful to exclude disease, must be interpreted with caution. H/CL ratio threshold of ≥ 1.3 resulted in clinically important misclassifications. These data suggest that quantitative planar imaging thresholds may not be appropriate to apply in low pretest likelihood populations being evaluated for ATTR-CA.
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Affiliation(s)
- Shivda Pandey
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
- Section of Cardiology, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, C-8, Boston, MA, 02118, USA.
| | - Sergio Teruya
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Carlos Rodriguez
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Albert Deluca
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mona Kinkhabwala
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lynne L Johnson
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Denise Fine
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Sabogal
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Morgan Winburn
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Michelle Castillo
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ketan Bhatia
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rita Malkovskaya
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Farbod Raiszadeh
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, NY, USA
| | - Damian Kurian
- Division of Cardiology, Harlem Hospital Center, New York City Health and Hospital Corporation, New York, NY, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
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8
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Ikoma T, Ohtani H, Ohno K, Iguchi K, Suwa K, Sawada M, Tanahashi Y, Sakamoto A, Saotome M, Ichikawa S, Goshima S, Maekawa Y. Diagnostic value of heart-to-mediastinum ratio in 99mTc-pyrophospate SPECT/CT for transthyretin cardiac amyloidosis. J Nucl Cardiol 2023; 30:1374-1381. [PMID: 36547805 DOI: 10.1007/s12350-022-03180-5] [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: 06/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In transthyretin cardiac amyloidosis (ATTR-CA), 99mTc-pyrophosphate myocardial scintigraphy (99mTc-PYP) is a diagnostic tool that utilizes visual and quantitative evaluation. However, false positive cases can occur because of tracer accumulation in the blood. We investigated the effectiveness of the heart-to-mediastinum (H/M) ratio of 99mTc-PYP in ATTR-CA diagnosis. METHODS We retrospectively included 164 patients who underwent 99mTc-PYP single-photon emission computed tomography/computed tomography between March 2019 and January 2022. The diagnostic accuracy of ATTR-CA was examined by the heart-to-contralateral lung (H/CL) and H/M ratio calculated at 3 hours post-tracer administration. RESULTS After the exclusion of patients who did not undergo endomyocardial biopsy, 30 patients (15 each with ATTR-CA and without ATTR-CA) were included. The receiver operating characteristic curve used to distinguish ATTR-CA from non-ATTR-CA patients revealed an area under the curve of 0.986 and 0.943, respectively. A H/M ratio of > 1.41 identified ATTR-CA patients with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100, 93.3, 93.3, and 100%, respectively. Conversely, an H/CL ratio of > 1.3 identified ATTR-CA patients with 100% sensitivity, 40.0% specificity, 62.5% PPV, and 100% NPV. CONCLUSION The H/M ratio obtained at 3 hours post-injection has the potential to be a novel indicator for ATTR-CA.
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Affiliation(s)
- Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan.
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Kazuto Ohno
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Michifumi Sawada
- Department of Radiology, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Atsushi Sakamoto
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Shintaro Ichikawa
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Satoshi Goshima
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192, Japan
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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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10
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Sperry BW, Bateman TM, Akin EA, Bravo PE, Chen W, Dilsizian V, Hyafil F, Khor YM, Miller RJH, Slart RHJA, Slomka P, Verberne H, Miller EJ, Liu C. Hot spot imaging in cardiovascular diseases: an information statement from SNMMI, ASNC, and EANM. J Nucl Cardiol 2023; 30:626-652. [PMID: 35864433 DOI: 10.1007/s12350-022-02985-8] [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: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.
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Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA.
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA
| | - Esma A Akin
- George Washington University Hospital, Washington, DC, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Européen Georges-Pompidou, DMU IMAGINA, Assistance Publique -Hôpitaux de Paris, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hein Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA.
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11
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Khor YM, Cuddy SAM, Singh V, Falk RH, Di Carli MF, Dorbala S. 99mTc Bone-Avid Tracer Cardiac Scintigraphy: Role in Noninvasive Diagnosis of Transthyretin Cardiac Amyloidosis. Radiology 2023; 306:e221082. [PMID: 36537896 PMCID: PMC9885342 DOI: 10.1148/radiol.221082] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is an overlooked cause of heart failure, with substantial morbidity and mortality. The emergence of several novel therapies has fueled the interest in early and accurate diagnosis of ATTR-CA so that potentially life-saving pharmacologic therapy can be administered in a timely manner. The most promising imaging modality and biomarker is SPECT imaging with technetium 99m (99mTc)-radiolabeled bone-seeking tracers, which have high specificity in the diagnosis of ATTR-CA, potentially obviating biopsy. In this article, the authors provide a focused review on the use of 99mTc pyrophosphate (PYP), 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD), and hydroxymethylene diphosphonate (HMDP) for diagnosis of ATTR-CA, present a systematic approach to interpretation of the scans, and highlight several common pitfalls to illustrate important diagnostic principles for accurate interpretation of these images. The authors indicate when to use endomyocardial biopsy for the diagnosis of cardiac amyloidosis and conclude with a section on quantitation of 99mTc-PYP/DPD/HMDP imaging.
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Affiliation(s)
- Yiu Ming Khor
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
| | - Sarah A. M. Cuddy
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
| | - Vasvi Singh
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
| | - Rodney H. Falk
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
| | - Marcelo F. Di Carli
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
| | - Sharmila Dorbala
- From the Department of Nuclear Medicine and Molecular Imaging,
Singapore General Hospital, Singapore (Y.M.K.); Division of Nuclear Medicine and
Molecular Imaging, Department of Radiology (Y.M.K., V.S., M.F.D.C., S.D.),
Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine
(S.A.M.C., R.H.F., S.D.), and CV Imaging Program, Cardiovascular Division and
Department of Radiology (S.A.M.C., V.S., M.F.D.C., S.D.), Brigham and
Women’s Hospital and Harvard Medical School, 70 Francis St, Boston, MA
02115; and Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas
City, Mo (V.S.)
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12
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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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13
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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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14
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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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15
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Watanabe S, Nakajima K, Wakabayashi H, Yoneyama H, Yoshida S, Komatsu J, Konishi T, Inaki A, Kinuya S. Volumetric evaluation of 99mTc-pyrophosphate SPECT/CT for transthyretin cardiac amyloidosis: Methodology and correlation with cardiac functional parameters. J Nucl Cardiol 2022; 29:3102-3110. [PMID: 34907500 PMCID: PMC9834362 DOI: 10.1007/s12350-021-02857-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/23/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Volumetric evaluation of 99mTechnetium-pyrophosphate (99mTc-PYP) SPECT/CT is a useful method for assessing transthyretin cardiac amyloidosis (ATTR-CA). We investigated the methodology and assessed its relationship with conventional parameters. METHODS AND RESULTS We retrospectively evaluated 99mTc-PYP SPECT/CT scans of 25 patients who underwent endomyocardial biopsy and/or gene testing. Fourteen (56%) patients were diagnosed with ATTR-CA. SPECT/CT images were acquired at 3 hours after injection. Total volumes of the myocardial regions where uptakes were > 1.2 and 1.4 × aortic blood pool SUVmax were evaluated and defined as cardiac pyrophosphate volume (CPV1.2 and CPV1.4). The heart-to-contralateral lung (H/CL) ratio and myocardial SUVmax were also calculated. CPV1.2 achieved the highest sensitivity and specificity in diagnosing ATTR-CA. In patients diagnosed with ATTR-CA (n = 14), CPV1.2 negatively correlated with left ventricular ejection fraction and positively correlated with left ventricular posterior wall thickness and QRS duration. The correlation was stronger in CPV1.2 than in the H/CL ratio and SUVmax. CONCLUSION Volumetric evaluation of 99mTc-PYP SPECT/CT may be superior to the H/CL ratio and SUVmax in assessing the disease burden of ATTR-CA. Larger studies are warranted to clarify whether volumetric measurement can assess prognosis and disease progression.
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Affiliation(s)
- Satoru Watanabe
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan.
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroto Yoneyama
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Junji Komatsu
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takahiro Konishi
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Anri Inaki
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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16
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Pandey S. Quantitative SPECT in PYP imaging: Ready for prime time or too early to tell? J Nucl Cardiol 2022; 29:2691-2693. [PMID: 34893962 DOI: 10.1007/s12350-021-02882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Shivda Pandey
- Section of Cardiology, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
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17
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Khoury AE, Nasr S, Chehade F. 99mTc-PYP scintigraphic diagnosis of cardiac amyloidosis in a patient with new onset heart failure. J Nucl Cardiol 2022; 29:1434-1438. [PMID: 34036526 DOI: 10.1007/s12350-021-02666-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: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Antoine El Khoury
- Department of Cardiology, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital, Hazmieh, Lebanon
| | - Feras Chehade
- Department of Nuclear Medicine, Mount Lebanon Hospital, Hazmieh, Lebanon.
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18
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Santarelli MF, Genovesi D, Positano V, Di Sarlo R, Scipioni M, Giorgetti A, Landini L, Marzullo P. Cardiac amyloidosis detection by early bisphosphonate (99mTc-HMDP) scintigraphy. J Nucl Cardiol 2022; 29:307-318. [PMID: 32596791 DOI: 10.1007/s12350-020-02239-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine one or more indexes able to detect the presence of cardiac amyloidosis (CA) from planar scintigraphy images after injection of 99mTc-HMDP tracer and to identify the earliest acquisition time able to ensure an accurate diagnosis of amyloid transthyretin CA. METHODS AND RESULTS A total of 38 patients were included: 18 subjects with a final diagnosis of ATTR-CA and 20 controls. Dynamic planar images of the anterior thorax were acquired, starting at intravenous injection of ≈ 700 MBq of 99mTc-HMDP. From time/activity curves (TAC) of regions of interest such as heart, vascular region, right ribcage, and soft tissues, several indices were considered. From the analysis, it resulted that both TACHeart/Bone(t) and RIheart-bone(t), for t > 6 minutes, well distinguish ATTR-CA patients from controls subjects. This is confirmed by the area under curves (AUC) analysis giving AUC values =.9 at t ≅ 6 minutes and AUC ≅ 1 for t > 10 minutes. CONCLUSIONS The method proposed allows determining the presence of ATTR-CA, in an inexpensive manner both in terms of examination costs and time spent.
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Affiliation(s)
- M F Santarelli
- CNR Institute of Clinical Physiology, CNR Research Area, Via Moruzzi 1, 56124, Pisa, Italy.
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy.
| | - D Genovesi
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy
| | - V Positano
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy
| | - R Di Sarlo
- Dipartimento di Ingegneria dell'Informazione: DII, Pisa University, Via Caruso 16, Pisa, Italy
| | - M Scipioni
- CNR Institute of Clinical Physiology, CNR Research Area, Via Moruzzi 1, 56124, Pisa, Italy
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Giorgetti
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy
| | - L Landini
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy
- Dipartimento di Ingegneria dell'Informazione: DII, Pisa University, Via Caruso 16, Pisa, Italy
| | - P Marzullo
- Fondazione Toscana "G. Monasterio", CNR Research Area, Via Moruzzi 1, Pisa, Italy
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19
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Ogasawara K, Shiraishi S, Tsuda N, Sakamoto F, Oda S, Takashio S, Tsujita K, Hirai T. Usefulness of quantitative 99mTc-pyrophosphate SPECT/CT for predicting the prognosis of patients with wild-type transthyretin cardiac amyloidosis. Jpn J Radiol 2022; 40:508-517. [PMID: 34973114 PMCID: PMC9068718 DOI: 10.1007/s11604-021-01221-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is an increasingly recognized cause of heart failure especially in elderly patients. The purpose of the present study was to determine retrospectively whether the quantitative indices of 99mTc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters. MATERIALS AND METHODS Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan-Meier curves. RESULTS High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e' ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034-1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012-4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007-1.238; P = 0.037) were significant independent prognostic factors. CONCLUSION This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.
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Affiliation(s)
- Kouji Ogasawara
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan.
| | - Noriko Tsuda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Fumi Sakamoto
- Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Seitarou Oda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
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Cuscaden C, Ramsay SC, Prasad S, Goodwin B, Smith J. Estimation of prevalence of transthyretin (ATTR) cardiac amyloidosis in an Australian subpopulation using bone scans with echocardiography and clinical correlation. J Nucl Cardiol 2021; 28:2845-2856. [PMID: 32385832 DOI: 10.1007/s12350-020-02152-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bone scans differentiate transthyretin (ATTR) cardiac amyloidosis from light chain amyloidosis and other causes of increased left ventricular (LV) wall thickness. We examined the prevalence and implications of cardiac uptake in the general population. METHODS Patients were included based on having undertaken a bone scan for non-cardiac indications using Technetium 99m hydroxymethylene diphosphonate (HMDP) or Technetium 99m methylene diphosphonate (MDP). Blinded image review was undertaken. Positive was defined as cardiac uptake ≥ rib AND heart/whole body ratio (H/WB) > 0.0388. Echocardiography and clinical records were reviewed. RESULTS 6918 patients were included. 15/3472 HMDP scans were positive (14 males, 1 female): none in individuals aged < 65; 1.44% in males and 0.17% in females ≥ 65; 6.15% in males and 1.69% in females ≥ 85. Only 1/3446 MDP scans were positive. All HMDP positive patients had increased septal wall thickness on echocardiography. H/WB correlated positively with LV mass, and negatively with LV ejection fraction. No individual had an explanation other than ATTR for their positive scan. CONCLUSION In this Australian subpopulation, the prevalence of positive bone scans consistent with cardiac ATTR is 0% in individuals aged < 65. Prevalence increased with age, reaching 6.15% in men ≥ 85. The amount of HMDP uptake correlated with echocardiographic features of more advanced cardiac involvement. MDP does not appear useful in ATTR.
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Affiliation(s)
- Claire Cuscaden
- Department of Medical Imaging, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Australia
| | - Stuart C Ramsay
- Department of Nuclear Medicine and Specialised PET Service, Royal Brisbane and Women's Hospital (RBWH), Ned Hanlon Building, Herston, QLD, 4029, Australia.
- School of Medicine, James Cook University, 1 James Cook Dr, Douglas, QLD, 4814, Australia.
| | - Sandhir Prasad
- Department of Cardiology, RBWH, Herston, QLD, 4029, Australia
| | - Bruce Goodwin
- Department of Nuclear Medicine, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Jye Smith
- Department of Nuclear Medicine and Specialised PET Service, Royal Brisbane and Women's Hospital (RBWH), Ned Hanlon Building, Herston, QLD, 4029, Australia
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21
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Ruan D, Sun L. Diagnostic efficacy of bone scintigraphy in transthyretin cardiac amyloidosis: an updated systematic review and Bayesian bivariate meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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99mTechnetium-labeled cardiac scintigraphy for suspected amyloidosis: a review of current and future directions. Heart Fail Rev 2021; 27:1493-1503. [PMID: 34709500 DOI: 10.1007/s10741-021-10174-x] [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: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Cardiac amyloidosis (CA) is an underdiagnosed form of restrictive cardiomyopathy leading to a rapid progression into heart failure. Evaluation of CA requires a multimodality approach making use of echocardiography, cardiac magnetic imaging, and nuclear imaging. Technetium (Tc)-labeled cardiac scintigraphy has witnessed a resurgence in its application for the workup of CA. Advancements in disease-modifying therapies have fueled the rapid adoption of cardiac scintigraphy using bone tracers and the need for transformative novel studies. The goal of this review is to present diagnostic utility, currently recommended protocols, as well as a glimpse into the rapid evolution of Tc-labeled cardiac scintigraphy in the diagnosis of CA.
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23
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Ben-Haim S, Chicheportiche A, Goshen E, Arad M, Smekhov M, Menezes LJ, Elliott PM, O'Mahoney E, Stern E, Yuzefovich B, Bomanji JB. Quantitative SPECT/CT parameters of myocardial 99mTechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) uptake in suspected cardiac transthyretin amyloidosis. EJNMMI Res 2021; 11:86. [PMID: 34487268 PMCID: PMC8421473 DOI: 10.1186/s13550-021-00828-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 01/15/2023] Open
Abstract
Background 99mTc-labelled bisphosphonates are used for imaging assessment of patients with transthyretin cardiac amyloidosis (ATTR). Present study evaluates whether quantitative SPECT/CT measurement of absolute myocardial 99mTc-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (Tc-DPD) uptake can diagnose patients with suspected ATTR. Methods Twenty-eight patients (25 male, age 80.03 ± 6.99 years) with suspected ATTR referred for Tc-DPD imaging had planar and SPECT/CT imaging of the chest. Three operators independently obtained Tc-DPD myocardial SUVmax and SUVmean above threshold (SMaT) (20, 40 and 60% of SUVmax), using a semi-automated threshold segmentation method. Results were compared to visual grading (0–3) of cardiac uptake. Results Twenty-two patients (78%) had cardiac uptake (2 grade 1, 15 grade 2, 5 grade 3). SUVmax and SMaT segmentation thresholds enabled separating grades 2/3 from 0/1 with excellent inter- and intra-reader correlation. Cut-off values 6.0, 2.5, 3 and 4 for SUVmax, SMaT20,40,60, respectively, separated between grades 2/3 and 0 /1 with PPV and NPV of 100%. SMaT20,40,60(cardiac)/SUVmean (liver) and SMaT20,40,60(cardiac)/SUVmean(liver/lung) separated grades 2 and 3. Conclusion Quantitative SPECT/CT parameters of cardiac Tc-DPD uptake are robust, enabling separation of patients with grades 2 and 3 cardiac uptake from grades 0 and 1. Larger patient cohorts will determine the incremental value of SPECT/CT quantification for ATTR management.
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Affiliation(s)
- Simona Ben-Haim
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel. .,NIHR Biomedical Research Centre, UCL Institute of Nuclear Medicine, London, UK.
| | | | - E Goshen
- Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Arad
- Chaim Sheba Medical Center, Ramat Gan, Israel
| | - M Smekhov
- Chaim Sheba Medical Center, Ramat Gan, Israel
| | - L J Menezes
- NIHR Biomedical Research Centre, UCL Institute of Nuclear Medicine, London, UK
| | - P M Elliott
- NIHR Biomedical Research Centre, UCL Institute of Nuclear Medicine, London, UK
| | - E O'Mahoney
- NIHR Biomedical Research Centre, UCL Institute of Nuclear Medicine, London, UK
| | - E Stern
- GE Healthcare, Haifa, Israel
| | | | - J B Bomanji
- NIHR Biomedical Research Centre, UCL Institute of Nuclear Medicine, London, UK
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Ren C, Ren J, Tian Z, Du Y, Hao Z, Zhang Z, Fang W, Li F, Zhang S, Hsu B, Huo L. Assessment of cardiac amyloidosis with 99mTc-pyrophosphate (PYP) quantitative SPECT. EJNMMI Phys 2021; 8:3. [PMID: 33411102 PMCID: PMC7790978 DOI: 10.1186/s40658-020-00342-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background 99mTc-PYP scintigraphy provides differential diagnosis of ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders without biopsy. This study was aimed to assess the diagnostic feasibility and the operator reproducibility of 99mTc-PYP quantitative SPECT. Method Thirty-seven consecutive patients who underwent a 99mTc-PYP thorax planar scan followed by SPECT and CT scans to diagnose suspected ATTR-CM were enrolled. For the quantitative SPECT, phantom studies were initially performed to determine the image conversion factor (ICF) and partial volume correction (PVC) factor to recover 99mTc-PYP activity concentration in the myocardium for calculating the standardized uptake value (SUV) (unit: g/ml). SUVmax was compared among groups of ATTR-CM, AL cardiac amyloidosis, and other pathogens (others) and among categories of Perugini visual scores (grades 0–3). The intra- and inter-operator reproducibility of quantitative SPECT was verified, and the corresponded repeatability coefficient (RPC) was calculated. Results The ICF was 79,327 Bq/ml to convert count rate in pixel to 99mTc activity concentration. PVC factor as a function of the measured activity concentration ratio in the myocardium and blood-pool was [y = 1.424 × (1 − exp(− 0.759 × x)) + 0.104]. SUVmax of ATTR-CM (7.50 ± 2.68) was significantly higher than those of AL (1.96 ± 0.35) and others (2.00 ± 0.74) (all p < 0.05). SUVmax of grade 3 (8.95 ± 1.89) and grade 2 (4.71 ± 0.23) were also significantly higher than those of grade 1 (1.92 ± 0.31) and grade 0 (1.59 ± 0.39) (all p < 0.05). Correlation coefficient (R2) of SUVmax reached 0.966 to 0.978 with only small systematic difference (intra = − 0.14; inter = − 0.23) between two repeated measurements. Intra- and inter-operator RPCs were 0.688 and 0.877. Conclusions 99mTc-PYP quantitative SPECT integrated with adjustable PVC factors is feasible to quantitatively and objectively assess the burden of cardiac amyloidosis for diagnosis of ATTR-CM.
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Affiliation(s)
- Chao Ren
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jingyun Ren
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Shuaifuyuan, Dongcheng District, Beijing, People's Republic of China
| | - Yanrong Du
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhixin Hao
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zongyao Zhang
- Department of Nuclear Medicine, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Shuaifuyuan, Dongcheng District, Beijing, People's Republic of China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA.
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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Dorbala S, Kijewski MF, Park MA. Quantitative Bone-Avid Tracer SPECT/CT for Cardiac Amyloidosis: A Crucial Step Forward. JACC Cardiovasc Imaging 2020; 13:1364-1367. [PMID: 32498922 DOI: 10.1016/j.jcmg.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Marie Foley Kijewski
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mi-Ae Park
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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In Vivo Quantification of Myocardial Amyloid Deposits in Patients with Suspected Transthyretin-Related Amyloidosis (ATTR). J Clin Med 2020; 9:jcm9113446. [PMID: 33120935 PMCID: PMC7693120 DOI: 10.3390/jcm9113446] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Current diagnosis of Transthyretin-related Amyloidosis (ATTR) using bone scintigraphy is primarily based on visual scoring and semi-quantitative indices. With the introduction of new potential life-prolonging drugs for ATTR, a more precise quantification of myocardial amyloid burden is desirable for improved response prediction and therapy monitoring. Methods: At first, quantification experiments using an anthropomorphic thorax phantom were performed. Second, 32 patients underwent both planar whole body [99mTc]- 3,3-Diphosphono-1,2-Propanodicarboxylic Acid (DPD)-scintigraphy and quantitative Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) of the thorax. SPECT/CT standardized myocardial uptake values SUVpeak and SUVpeak normalized to bone uptake (nSUVpeak) were determined. Results: Phantom measurements showed a strong linear relationship between the activity in the myocardial insert and the measured activity (r = 0.9998, p = 0.01), but the measured activity was systematically underestimated by approximately 30%. Receiver operating characteristics (ROC) analysis revealed a 100% sensitivity and specificity at a cut-off of 3.1 for SUVpeak for the differentiation of both patient groups. Conclusion: SUV quantification of ATTR amyloid burden is feasible using novel SPECT/CT technology. With a SUVpeak cut-off of 3.1, patients with Perugini grade 2 and 3 could be clearly separated from those with Perugini grade 0 and 1. Besides ATTR diagnostics, quantification of amyloid deposits could potentially be used for therapy monitoring and prognostication in patients with cardiac ATTR.
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Caobelli F, Braun M, Haaf P, Wild D, Zellweger MJ. Quantitative 99mTc-DPD SPECT/CT in patients with suspected ATTR cardiac amyloidosis: Feasibility and correlation with visual scores. J Nucl Cardiol 2020; 27:1456-1463. [PMID: 31538322 DOI: 10.1007/s12350-019-01893-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE While a visual interpretation of 99mTc-DPD scintigraphy by means of Perugini score can provide a reliable diagnosis of transthyretin-related (ATTR) cardiac amyloidosis (CA), a quantitative approach is expected to play a major role in risk stratification and therapy evaluation. The aim of our study was to test the feasibility of a quantitative assessment and to correlate various parameters to Perugini score. METHODS in this retrospective study, consecutive patients underwent a 99mTc-DPD whole-body bone scintigraphy and a SPECT/CT of the thorax. XSPECT-QUANT software was used to quantify the DPD uptake in the heart. RESULTS Thirteen patients were included. CA was confirmed in 8 and rejected in 5. Myocardial SUVmax and SUVpeak showed a fairly strong correlation with Perugini score (both ρ = .71, P = .006). Same held true for to-bone normalized values (both ρ = .75, P = .003). There was a great degree of overlap for quantitative values in patients with Perugini score 2 and 3. CONCLUSION Quantitative 99mTc-DPD SPECT/CT in suspected ATTR CA patients is feasible and allows for a more accurate assessment of myocardial uptake.
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Affiliation(s)
- Federico Caobelli
- Nuclear Medicine Department, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Martin Braun
- Nuclear Medicine Department, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philip Haaf
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Damian Wild
- Nuclear Medicine Department, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael J Zellweger
- Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Ramsay SC, Cuscaden C. The current status of quantitative SPECT/CT in the assessment of transthyretin cardiac amyloidosis. J Nucl Cardiol 2020; 27:1464-1468. [PMID: 31691134 DOI: 10.1007/s12350-019-01935-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/23/2023]
Abstract
Nuclear medicine bone scans differentiate ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders, helping to make the diagnosis without biopsy. Standard bone scans are not absolutely quantitative, so are assessed by comparing the heart to other tissues. The standard visual scoring system compares heart to bone. This accurately diagnoses ATTR-CM and has been validated in a multicenter study, but has limitations. Semiquantitative techniques including heart/contralateral thorax (H/CL) and heart/whole body ratio (H/WB) improve on visual scoring but still rely on extracardiac sites as comparators. Absolute quantitation of myocardial uptake using quantitative SPECT should help overcome these shortcomings. In ATTR-CM, this technique is practical, accurately makes the diagnosis and provides information that is not identical to visual scores. However, more work needs to be done. The reproducibility in ATTR-CM must be tested. Larger studies need to be undertaken to determine whether quantitative SPECT measurements can assess prognosis, disease progression or treatment response. As ATTR-CM is relatively uncommon multicenter trials will help recruit enough subjects to answer these questions. Accurate measurement techniques are needed in ATTR-CM to enable appropriate use of proven therapy and to conduct trials of new therapeutic agents. Quantitative bone scans offer a promising avenue.
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Affiliation(s)
- Stuart C Ramsay
- Nuclear Medicine and PET, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- School of Medicine, James Cook University, Townsville, Australia.
| | - Claire Cuscaden
- Department of Medical Imaging, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
- The University of Queensland, St Lucia, QLD, Australia
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Incidentally detected cardiac amyloidosis on 99mTc-MDP bone scintigraphy. Radiol Case Rep 2020; 15:705-708. [PMID: 32280403 PMCID: PMC7139139 DOI: 10.1016/j.radcr.2020.03.010] [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: 02/02/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/22/2022] Open
Abstract
Cardiac amyloidosis (CA) is an important cause of restrictive cardiomyopathy and heart failure with preserved ejection fraction (HFpEF). At present, 3 bone-seeking tracers, 99mTc-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD), 99mTc-pyrophosphate (99mTc-PYP), and 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP), have been evaluated for detecting CA, but they are not widely available. In contrast, methylene diphosphate (MDP) is widely available. However, only sporadic case reports have shown that MDP can accumulate in patients with CA. We report an 86-year-old man with multiple medical problems, including hypertension, hyperlipidemia, HFpEF, and a history of treated prostate cancer, who was referred for a 99mTc-MDP bone scan to rule out bone metastasis. The bone scan was negative for bone metastasis, but there was mild tracer accumulation in the heart, suggestive of CA. Subsequently, CA was diagnosed on 99mTc-PYP imaging. MDP may play a role comparable to other bone-seeking tracers in the diagnosis of CA and may be used as a noninvasive adjunct in the diagnosis of CA. Future research should compare MDP with other bone-seeking tracers for the diagnosis of CA. In addition, mechanistic studies on tracer binding to amyloid fibrils may help understand the pathophysiology of CA and facilitate the development of better and more specific tracers for CA.
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Abstract
The continuous development of SPECT over the past 50 years has led to improved image quality and increased diagnostic confidence. The most influential developments include the realization of hybrid SPECT/CT devices, as well as the implementation of attenuation correction and iterative image reconstruction techniques. These developments have led to a preference for SPECT/CT devices over SPECT-only systems and to the widespread adoption of the former, strengthening the role of SPECT/CT as the workhorse of Nuclear Medicine imaging. New trends in the ongoing development of SPECT/CT are diverse. For example, whole-body SPECT/CT images, consisting of acquisitions from multiple consecutive bed positions in the manner of PET/CT, are increasingly performed. Additionally, in recent years, some interesting approaches in detector technology have found their way into commercial products. For example, some SPECT cameras dedicated to specific organs employ semiconductor detectors made of cadmium telluride or cadmium zinc telluride, which have been shown to increase the obtainable image quality by offering a higher sensitivity and energy resolution. However, the advent of quantitative SPECT/CT which, like PET, can quantify the amount of tracer in terms of Bq/mL or as a standardized uptake value could be regarded as most important development. It is a major innovation that will lead to increased diagnostic accuracy and confidence, especially in longitudinal studies and in the monitoring of treatment response. The current work comprises two main aspects. At first, physical and technical fundamentals of SPECT image formation are described and necessary prerequisites of quantitative SPECT/CT are reviewed. Additionally, the typically achievable quantitative accuracy based on reports from the literature is given. Second, an extensive list of studies reporting on clinical applications of quantitative SPECT/CT is provided and reviewed.
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Affiliation(s)
- Philipp Ritt
- Clinic of Nuclear Medicine, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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31
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De Schepper S, Ritt P, Van den Wyngaert T, Kuwert T. Quantitative radionuclide imaging of bone metastases. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:129-135. [DOI: 10.23736/s1824-4785.19.03204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Costache II, Buburuz AM, Crisu D, Statescu AM, Ungureanu C, Aursulesei V. The role of echocardiography and 99mTc-HDP scintigraphy in non-invasive diagnosis of cardiac amyloidosis: A case series and literature review. Medicine (Baltimore) 2019; 98:e17256. [PMID: 31567998 PMCID: PMC6756609 DOI: 10.1097/md.0000000000017256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and Tc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy. PATIENTS CONCERNS The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture. DIAGNOSES All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and "pseudo-infarct" pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. Tc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative. INTERVENTIONS The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure. OUTCOMES During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established. LESSONS Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.
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Affiliation(s)
- Irina Iuliana Costache
- Department of Cardiology, “St. Spiridon” Emergency Clinical Hospital
- University of Medicine and Pharmacy “Grigore T. Popa”
| | - Ana Maria Buburuz
- Department of Cardiology, “St. Spiridon” Emergency Clinical Hospital
- University of Medicine and Pharmacy “Grigore T. Popa”
| | - Daniela Crisu
- Department of Cardiology, “St. Spiridon” Emergency Clinical Hospital
| | - Ana Maria Statescu
- Department of Nuclear Medicine, “St. Spiridon” Emergency Clinical Hospital
| | - Carmen Ungureanu
- University of Medicine and Pharmacy “Grigore T. Popa”
- Department of Pathology, “St. Spiridon” Emergency Clinical Hospital, Iasi, Romania
| | - Viviana Aursulesei
- Department of Cardiology, “St. Spiridon” Emergency Clinical Hospital
- University of Medicine and Pharmacy “Grigore T. Popa”
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