Abstract
Background
The aim of this study was to investigate the feasibility of assessing absolute myocardial 99mTc-HMDP uptake in patients with suspected cardiac ATTR using SUV with a whole-body CZT SPECT-CT camera (DNM670CZT).
Methods
Fifteen patients with suspected cardiac ATTR (Perugini ≥ 2) underwent a conventional 99mTc-HMDP planar imaging and a thoracic SPECT/CT using a DNM 670CZT. A control group consisted of 15 patients with negative scintigraphy (Perugini < 2). SUVmax (mg·L−1) and percentage of injected dose (%ID) were calculated in a cardiac volume of interest (VOI) encompassing the left ventricle. VOIs were also placed in the lung, the right pectoris major, and the sternum. A heart-to-lung SUVmax ratio (HLR) was calculated.
Results
All ATTR patients demonstrated an increased cardiac HMDP SUVmax (12.2 ± 3.7 mg·L−1) vs controls (3.5 ± 1.2, P < .0001). Percentage of ID, pectoral uptake and HLR were significantly higher in the ATTR group (1.1 ± 0.3 vs 0.15 ± 0.8, P < .0001; 1.5 ± 0.3 vs 0.9 ± 0.3, P < .0001; 9.7 ± 3 vs 4.3 ± 2.2, P < .0001). Bone uptake was not statistically different between the two groups.
Conclusion
This study demonstrated the feasibility of quantitative 99mTc-HMDP SUVmax measurement using a whole-body SPECT/CT CZT camera in patients with suspected cardiac ATTR.
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Abbreviations
- ATTR:
-
Transthyretin-related amyloidosis
- CZT:
-
Cadmium zinc telluride
- SPECT:
-
Single photon emission computed tomography
- SUV:
-
Standardized uptake value
- %ID:
-
Percentage of injected dose
- HMDP:
-
Hydroxy-dimethylene diphosphonate
- LVEF:
-
Left ventricular ejection fraction
- IVS:
-
Inter-ventricular septum
- HLR:
-
Heart-to-lung SUVmax ratio
- MBR:
-
Muscle-to-bone SUVmax ratio
References
Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016;133:2404-12.
Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 2018;379:1007-16.
Emdin M, Aimo A, Rapezzi C, Fontana M, Perfetto F, Seferović PM, et al. Treatment of cardiac transthyretin amyloidosis: an update. Eur Heart J 2019;40:3699-706.
Glaudemans AWJM, van Rheenen RWJ, van den Berg MP, Noordzij W, Koole M, Blokzijl H, et al. Bone scintigraphy with (99m)technetium-hydroxymethylene diphosphonate allows early diagnosis of cardiac involvement in patients with transthyretin-derived systemic amyloidosis. Amyloid 2014;21:35-44.
Habib G, Bucciarelli-Ducci C, Caforio ALP, Cardim N, Charron P, Cosyns B, et al. Multimodality imaging in restrictive cardiomyopathies: An EACVI expert consensus document In collaboration with the “Working Group on myocardial and pericardial diseases” of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography. Eur Heart J Cardiovasc Imaging 2017;18:1090-121.
Andrikopoulou E, Bhambhvani P. Nuclear imaging of cardiac amyloidosis. J Nucl Cardiol 2019;26:505-8.
Perugini E, Guidalotti PL, Salvi F, Cooke RMT, Pettinato C, Riva L, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3- diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol 2005;46:1076-84.
Cappelli F, Gallini C, Di Mario C, Costanzo EN, Vaggelli L, Tutino F, et al. Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis. J Nucl Cardiol 2019;26:497-504.
Hutt DF, Fontana M, Burniston M, Quigley A-M, Petrie A, Ross JC, et al. Prognostic utility of the Perugini grading of 99mTc-DPD scintigraphy in transthyretin (ATTR) amyloidosis and its relationship with skeletal muscle and soft tissue amyloid. Eur Heart J Cardiovasc Imaging 2017;18:1344-50.
Gallini C, Tutino F, Martone R, Ciaccio A, Costanzo EN, Taborchi G, et al. Semi-quantitative indices of cardiac uptake in patients with suspected cardiac amyloidosis undergoing 99mTc-HMDP scintigraphy. J Nucl Cardiol 2019. https://doi.org/10.1007/s12350-019-01643-w.
Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R. EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 2017;44:17-31.
Dickson J, Ross J, Vöö S. Quantitative SPECT: the time is now. EJNMMI Phys 2019;6:4.
GE Healthcare. NM quantification - Q metrix for SPECT/CT package (White Paper); 2017.
Collarino A, Pereira Arias-Bouda LM, Valdés Olmos RA, van der Tol P, Dibbets- Schneider P, de Geus-Oei L-F, et al. Experimental validation of absolute SPECT/CT quantification for response monitoring in breast cancer. Med Phys 2018;45:2143-53.
Castano A, Haq M, Narotsky DL, Goldsmith J, Weinberg RL, Morgenstern R, et al. Multicenter study of planar technetium 99m pyrophosphate cardiac imaging: Predicting survival for patients with ATTR cardiac amyloidosis. JAMA Cardiol 2016;1:880-9.
Cappelli F, Gallini C, Costanzo EN, Tutino F, Ciaccio A, Vaggelli L, et al. Lung uptake during 99mTc-hydroxymethylene diphosphonate scintigraphy in patient with TTR cardiac amyloidosis: An underestimated phenomenon. Int J Cardiol 2018;01:346-50.
Carr AS, Pelayo-Negro AL, Jaunmuktane Z, Scalco RS, Hutt D, Evans MRB, et al. Transthyretin V122I amyloidosis with clinical and histological evidence of amyloid neuropathy and myopathy. Neuromuscul Disord 2015;25:511-5.
Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med 2004;45:1519-27.
Lasnon C, Houdu B, Kammerer E, Salomon T, Devreese J, Lebasnier A, et al. Patient’s weight: a neglected cause of variability in SUV measurements? A survey from an EARL accredited PET centre in 513 patients. Eur J Nucl Med Mol Imaging 2016;43:197-9.
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 2019. https://doi.org/10.1007/s12350-019-01893-8.
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Bellevre, D., Bailliez, A., Delelis, F. et al. Quantitation of myocardial 99mTc-HMDP uptake with new SPECT/CT cadmium zinc telluride (CZT) camera in patients with transthyretin-related cardiac amyloidosis: Ready for clinical use?. J. Nucl. Cardiol. 29, 506–514 (2022). https://doi.org/10.1007/s12350-020-02274-2
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DOI: https://doi.org/10.1007/s12350-020-02274-2