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Technetium pyrophosphate nuclear scintigraphy for cardiac amyloidosis: Imaging at 1 vs 3 hours and planar vs SPECT/CT

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Multi-societal consensus recommendations endorse both planar and single photon emission tomographic (SPECT) image acquisitions for the evaluation of cardiac amyloidosis. However, the correlation between planar and SPECT findings and the optimal timing of image acquisitions remain uncertain.

Methods

This is an analysis of 109 consecutive patients who underwent technetium pyrophosphate nuclear scintigraphy for the evaluation of cardiac amyloidosis. Patients were imaged at 1 and 3 hours after radiotracer injection using both planar and SPECT/CT, and the correlations between imaging protocols were compared.

Results

In the overall cohort (median age 77 years, 75% male), 33 patients had radiotracer localized to the myocardium on SPECT/CT images. There was strong correlation between 1- and 3-hour planar heart-to-contralateral lung ratios (mean difference 0.07, r = 0.94). However, there was discordance between planar image interpretation (based upon semiquantitative score and H/CL ratio) and myocardial localization of radiotracer on SPECT/CT in 17 patients (16%). The pattern of SPECT/CT uptake was identical at 1 and 3 hours in all cases (32 diffuse, 1 focal).

Conclusion

These data support the recommendation that SPECT/CT should be obtained in addition to planar images when performing nuclear scintigraphy for the detection of cardiac amyloidosis. A 1-hour planar and SPECT/CT protocol appears optimal.

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Abbreviations

ASNC:

American Society of Nuclear Cardiology

ATTR:

Transthyretin cardiac amyloidosis

H/CL:

Heart-to-contralateral lung

SPECT/CT:

Single photon emission tomography with computed tomography

TcPYP:

Technetium-99m pyrophosphate

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Disclosures

BWS is a consultant for Alnylam and has received research funding from Pfizer.

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Authors and Affiliations

  1. Saint Luke’s Mid America Heart Institute, 4330 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA

    Brett W. Sperry MD, Eric Burgett CNMT, Kevin A. Bybee MD, A. Iain McGhie MD, James H. O’Keefe MD, Ibrahim M. Saeed MD, Randall C. Thompson MD & Timothy M. Bateman MD

  2. University of Missouri-Kansas City, Kansas City, MO, USA

    Brett W. Sperry MD, Kevin A. Bybee MD, A. Iain McGhie MD, James H. O’Keefe MD, Ibrahim M. Saeed MD, Randall C. Thompson MD & Timothy M. Bateman MD

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  1. Brett W. Sperry MD
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  2. Eric Burgett CNMT
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  4. A. Iain McGhie MD
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  5. James H. O’Keefe MD
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Correspondence to Brett W. Sperry MD.

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Sperry, B.W., Burgett, E., Bybee, K.A. et al. Technetium pyrophosphate nuclear scintigraphy for cardiac amyloidosis: Imaging at 1 vs 3 hours and planar vs SPECT/CT. J. Nucl. Cardiol. 27, 1802–1807 (2020). https://doi.org/10.1007/s12350-020-02139-8

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  • DOI: https://doi.org/10.1007/s12350-020-02139-8

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