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Quantitative single photon emission computed tomography derived standardized uptake values on 99mTc-PYP scan in patients with suspected ATTR cardiac amyloidosis

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Journal of Nuclear Cardiology Aims and scope

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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Abbreviations

ATTR:

Transthyretin related amyloid

ATTR-CA:

Transthyretin related cardiac amyloidosis

SPECT:

Single photon emission computed tomography

xSPECT/CT:

Quantitative single photon emission computed tomography

SUV:

Standardized uptake value

H/CL:

Heart: contralateral chest ratio

CMR:

Cardiac MRI

ECV:

Extracellular volume

99mTc-PYP:

Technetium 99 pyrophosphate

BNP:

B-natriuretic peptide

LVMI:

Left ventricular mass index

BMI:

Body mass index

HF:

Heart failure

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Acknowledgements

Jennifer Pettry BS, RT (R) (N) (PET), Julie Coddington RT (R) (N), Department of Radiology and Nuclear Medicine, West Virginia University

Disclosures

The authors have no disclosures or conflicts of interest. Juan Carlo Avalon DO, Jacob Fuqua MD, Seth Deskins MD, Tyler Miller MD, Justin Conte MD, Raymond Raylman, PhD, Daniel Martin MD, Gary Marano MD, Naveena Yanamala PhD, James Mills MD, Christopher Bianco DO, Brijesh Patel DO, Karthik Seetharam, MD, Partho P. Sengupta MD, and Yasmin S. Hamirani MD have no disclosures or conflicts of interest.

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Authors and Affiliations

  1. School of Medicine, West Virginia University, Morgantown, WV, USA

    Juan Carlo Avalon, Jacob Fuqua, Seth Deskins, Tyler Miller & Justin Conte

  2. Department of Radiology, West Virginia University, Morgantown, WV, USA

    Daniel Martin, Gary Marano & Raymond Raylman

  3. Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA

    Naveena Yanamala, James Mills, Christopher Bianco, Brijesh Patel, Karthik Seetharam & Yasmin S. Hamirani

  4. Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, 125 Patterson St, New Brunswick, NJ, 08901, USA

    Partho P. Sengupta

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Avalon, J.C., Fuqua, J., Deskins, S. et al. Quantitative single photon emission computed tomography derived standardized uptake values on 99mTc-PYP scan in patients with suspected ATTR cardiac amyloidosis. J. Nucl. Cardiol. 30, 127–139 (2023). https://doi.org/10.1007/s12350-022-02988-5

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