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99mTc-PYP SPECT and SPECT/CT quantitation for diagnosing cardiac transthyretin amyloidosis

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We investigated quantitative 99mTc-pyrophosphate (PYP) SPECT/CT reproducibility and accuracy for diagnosing cardiac transthyretin amyloidosis (ATTR), and whether SPECT/CT improved visual and quantitative results compared to SPECT-only.

Methods

Data were reviewed for 318 patients with suspected ATTR who underwent PYP SPECT/CT. Myocardial-to-blood pool count (MBP) ratios were computed and repeated independently > 1 month later. A physician independently scored LV myocardial-to-rib uptake on SPECT/CT as: 0 (negative), 1 < rib (equivocal), 2 = rib (positive) or 3 > rib (positive), and the image quality as: 1 (poor), 2 (adequate), and 3 (good). SPECT-only MBP ratios and visual scores were assessed separately for a subgroup of the first sequential 191 patients.

Results

25% of patients had positive myocardial uptake (myocardial-to-rib uptake score of ≥ 2). SPECT/CT MBP ratios were reproducible (1.35 ± .68 vs 1.33 ± .74, p = .09) and corresponded with visual scores ≥ 2 (ROC AUC = 99 ± 1%) more accurately than SPECT-only MBPs (93 ± 3%, p = .02). SPECT/CT image quality was better than that of SPECT-only (2.7 ± .5 vs 2.1 ± .5, p < .0001) with fewer equivocal results (2.6% vs 22.5%, p < .0001).

Conclusion

SPECT/CT produces MBP ratios that are reproducible and accurately identify a positive scan, with better image quality and fewer equivocal cases than SPECT-only.

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Abbreviations

ATTR:

Transthyretin amyloidosis

HCL:

Heart-to-contralateral lung

LV:

Left ventricle

MBP:

Myocardial-to-blood pool

MIP:

Maximum intensity projection

PYP:

Pyrophosphate

ROI:

Region of interest

SPECT:

Single photon emission computed tomography

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Funding

There are no funding sources to disclose for this investigation.

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Authors and Affiliations

  1. Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Kenneth J. Nichols PhD & Christopher J. Palestro MD

  2. Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA

    Se-Young Yoon MD

  3. St. Francis Hospital, Roslyn, NY, USA

    Andrew Van Tosh MD

  4. Division of Nuclear Medicine and Molecular Imaging, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 10040, USA

    Kenneth J. Nichols PhD

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  1. Kenneth J. Nichols PhD
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Correspondence to Kenneth J. Nichols PhD.

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Disclosures

Andrew Van Tosh serves as a consultant to Astellas Pharma Global Development, Inc. Kenneth Nichols participates in royalties from Syntermed, Inc.

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Nichols, K.J., Yoon, SY., Van Tosh, A. et al. 99mTc-PYP SPECT and SPECT/CT quantitation for diagnosing cardiac transthyretin amyloidosis. J. Nucl. Cardiol. 30, 1235–1245 (2023). https://doi.org/10.1007/s12350-022-03133-y

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