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Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis

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

Abstract

Background and Aim

Either 99mTechnetium diphosphonate (Tc-DPD) or pyrophosphate (Tc-PYP) scintigraphy plays a relevant role in diagnosing transthyretin cardiac amyloidosis (CA), and labeled radiotracers have been extensively studied in diagnosing CA. Few studies have analyzed and validated 99mTc-Hydroxymethylene diphosphonate (Tc-HMDP). Our aim was to validate the diagnostic accuracy of Tc-HMDP total-body scintigraphy in a cohort of patients with biopsy-proven transthyretin CA.

Methods and Results

We retrospectively evaluated all patients undergoing 99mTc-HMDP total-body scintigraphy, in adjunct to a comprehensive diagnostic work-up for suspected CA. Sixty-five patients were finally diagnosed with CA, while it was excluded in 20 subjects with left ventricular hypertrophy of various etiologies. Twenty-six patients had AL-CA, 39 had TTR CA (16 TTRm, 23 TTRwt). At Tc-HMDP scintigraphy, 2 AL patients showed a Perugini score grade 1 heart uptake, while 24 showed no uptake. All TTR patients showed Tc-HMDP uptake, with three patients showing a Perugini score grade 1, 16 grade 2, and 20 grade 3, respectively. No uptake was observed in patients with left ventricular hypertrophy. A positive Tc-HMDP scintigraphy showed a 100% sensitivity and a 96% specificity for TTR CA identification.

Conclusions

Tc-HMDP scintigraphy is as accurate as Tc-DPD or Tc-PYP, and may therefore de facto be considered a valuable tool for the diagnosis of TTR CA.

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Abbreviations

Tc-DPD:

99mTc-3,3-diphosphono-1,2-propanodicarboxylic

Tc-PYP:

99m-Tc-Pyrophosphate

Tc-HMDP:

99mTc-Hydroxymethylene diphosphonate

NT-proBNP:

N-terminal fragment of pro-brain natriuretic peptide

TTR CA:

Transthyretin cardiac amyloidosis

AL CA:

Light chain cardiac amyloidosis

LVH:

Left ventricular hypertrophy

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Disclosure

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

    Francesco Cappelli MD, Paola Angelotti MD, Sabrina Frusconi BsC, Silvia Farsetti MD & Federico Perfetto MD, PhD

  2. Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy

    Francesco Cappelli MD, Carlo Di Mario MD, PhD & Simone Bartolini MD

  3. Nuclear Medicine Division, Careggi University Hospital, Florence, Italy

    Chiara Gallini MD, PhD, Egidio Natalino Costanzo MD, Luca Vaggelli MD, Francesca Tutino MD & Alfonso Ciaccio MD

  4. Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy

    Michele Emdin MD, PhD

  5. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Giuseppe Vergaro MD, PhD, Assuero Giorgetti MD, Paolo Marzullo MD, Dario Genovesi MD & Michele Emdin MD, PhD

  6. Department of Heart, Lung and Vessels, Intensive Cardiac Care Unit, Interventional Structural Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Francesco Cappelli MD

Authors
  1. Francesco Cappelli MD
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  2. Chiara Gallini MD, PhD
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  10. Sabrina Frusconi BsC
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  17. Federico Perfetto MD, PhD
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Correspondence to Francesco Cappelli MD.

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Cappelli, F., Gallini, C., Di Mario, C. et al. Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis. J. Nucl. Cardiol. 26, 497–504 (2019). https://doi.org/10.1007/s12350-017-0922-z

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  • DOI: https://doi.org/10.1007/s12350-017-0922-z

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