Usefulness and limitations of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy

  • Claudio Rapezzi
  • Candida Cristina Quarta
  • Pier Luigi Guidalotti
  • Simone Longhi
  • Cinzia Pettinato
  • Ornella Leone
  • Alessandra Ferlini
  • Fabrizio Salvi
  • Pamela Gallo
  • Christian Gagliardi
  • Angelo Branzi
Original Article



We previously reported in a small series of patients that 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy tested positive in transthyretin-related (TTR) (both mutant and wild-type) but not in primary (AL) amyloidotic cardiomyopathy (AC). We extended our study to a larger cohort of patients with AC.


We evaluated (1) 45 patients with TTR-related AC (28 mutant and 17 wild-type), (2) 34 with AL-related AC and (3) 15 non-affected controls. Myocardial uptake of 99mTc-DPD (740 MBq i.v.) was semiquantitatively and visually assessed at 5 min and at 3 h.


Heart retention (HR) and heart to whole-body retention ratio (H/WB) of late 99mTc-DPD uptake were higher among TTR-related AC (HR 7.8%; H/WB 10.4) compared with both unaffected controls (HR 3.5%; H/WB 5.7; p < 0.0001) and AL-related AC (HR 4.0%; H/WB 6.1; p < 0.0001). For the diagnosis of TTR-related AC, positive and negative predictive accuracy of visual scoring of cardiac retention were: 80 and 100% (visual score ≥1); 88 and 100% (visual score ≥2); and 100 and 68% (visual score = 3). At adjusted linear regression analysis, TTR aetiology turned out to be the only positive predictor of increasing 99mTc-DPD uptake in terms of both HR [β 2.5, 95% confidence interval (CI) 1.5–3.5; p < 0.0001] and H/WB (β 3.5, 95% CI 2.1–4.9; p < 0.0001).


While 99mTc-DPD scintigraphy was confirmed to be useful for differentiating TTR from AL-related AC, diagnostic accuracy was lower than previously reported due to a mild degree of tracer uptake in about one third of AL patients. 99mTc-DPD scintigraphy can provide an accurate differential diagnosis in cases of absent or intense uptake evaluated by visual score.


Amyloid Cardiomyopathy 99mTc-DPD scintigraphy Differential diagnosis Accuracy 


Conflicts of interest



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Claudio Rapezzi
    • 1
  • Candida Cristina Quarta
    • 1
  • Pier Luigi Guidalotti
    • 2
  • Simone Longhi
    • 1
  • Cinzia Pettinato
    • 2
  • Ornella Leone
    • 3
  • Alessandra Ferlini
    • 4
  • Fabrizio Salvi
    • 5
  • Pamela Gallo
    • 1
  • Christian Gagliardi
    • 1
  • Angelo Branzi
    • 1
  1. 1.Institute of CardiologyUniversity of Bologna and Policlinico S. Orsola-Malpighi HospitalBolognaItaly
  2. 2.Nuclear Medicine UnitS. Orsola-Malpighi HospitalBolognaItaly
  3. 3.Department of PathologyUniversity of Bologna and S. Orsola-Malpighi HospitalBolognaItaly
  4. 4.Department of Diagnostic and Experimental Medicine, Section of Medical GeneticsUniversity of FerraraFerraraItaly
  5. 5.Department of NeurologyOspedale BellariaBolognaItaly

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