Skip to main content
SpringerLink
Log in

Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR cardiac amyloidosis: Comparison of quantitative and semi-quantitative approaches

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

ATTR cardiac amyloidosis (CA) can be diagnosed with Tc-99m-PYP scintigraphy. There are two recommended interpretative approaches: the quantitative heart-to-contralateral lung ratio (H/CL) at 1 hour and the semi-quantitative visual system at 3 hours. This study’s aim was to compare both approaches and to apply the semi-quantitative method at 1 hour.

Methods

Tc-99m-PYP scans of 122 consecutive subjects were reviewed using both approaches. On 1 hour planar images, regions of interest were drawn over the heart and contralateral chest to determine H/CL. Myocardial uptake was graded on 1 and 3 hour SPECT images according to the semi-quantitative method. Concordance was examined using kappa statistics.

Results

31, 10, and 81 studies were positive, negative, and equivocal, respectively, for ATTR-CA using the H/CL approach. Using the grading system, 35, 77, and 10 scans were positive, negative, and equivocal, respectively. The quantitative approach led to a significantly higher proportion of equivocal studies compared to the semi-quantitative approach (P < .0001). These approaches yielded discordant results in 2 subjects; biopsy results were concordant with SPECT grade. 1 and 3 hour SPECT grades provided concordant result in 99% of cases.

Conclusions

The H/CL approach resulted in a high proportion of equivocal studies. Using SPECT imaging, the semi-quantitative approach minimized this proportion and showed high concordance at 1 and 3 hours.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

Abbreviations

AL-CA:

Light-chain cardiac amyloidosis

ATTR-CA:

Transthyretin cardiac amyloidosis

ASNC:

American Society of Nuclear Cardiology

CA:

Cardiac amyloidosis

DPD:

Diphosphono-1,2-propanodicarboxylic acid

EMB:

Endomyocardial biopsy

H/CL:

Heart-to-contralateral lung ratio

PIV:

Post-intravenous injection

PYP:

Pyrophosphate

ROI:

Region of interest

References

  1. Fikrle M, Paleček T, Kuchynka P, et al. Cardiac amyloidosis: A comprehensive review. Cor Vasa 2013;55:e60-75. https://doi.org/10.1016/j.crvasa.2012.11.018.

    Article  Google Scholar 

  2. Siddiqi OK, Ruberg FL. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med 2018;28:10-21.

    Article  CAS  PubMed  Google Scholar 

  3. Oerlemans MIFJ, Rutten KHG, Minnema MC, et al. Cardiac amyloidosis: The need for early diagnosis. Neth Heart J 2019;27:525-36. https://doi.org/10.1007/s12471-019-1299-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016;133:2404-12. https://doi.org/10.1161/CIRCULATIONAHA.116.021612.

    Article  CAS  PubMed  Google Scholar 

  5. Dorbala S, Bokhari S, Miller E, et al (2019) ASNC practice point: 99mTechnetium-pyrophosphate imaging for transthyretin cardiac amyloidosis. Am Soc Nucl Cardiol.

  6. Dorbala S, Ando Y, Bokhari S, et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2—evidence base and standardized methods of imaging. J Nucl Cardiol 2019;26:2065-123. https://doi.org/10.1007/s12350-019-01760-6.

    Article  PubMed  Google Scholar 

  7. Perugini E, Guidalotti PL, Salvi F, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol 2005;46:1076-84. https://doi.org/10.1016/j.jacc.2005.05.073.

    Article  PubMed  Google Scholar 

  8. Bokhari S, Castaño A, Pozniakoff T, et al. 99m Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging 2013;6:195-201. https://doi.org/10.1161/CIRCIMAGING.112.000132.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Castano A, Haq M, Narotsky DL, et al. Multicenter study of planar technetium 99m pyrophosphate cardiac imaging: Predicting survival for patients with ATTR cardiac amyloidosis. JAMA Cardiol 2016;1:880. https://doi.org/10.1001/jamacardio.2016.2839.

    Article  PubMed  Google Scholar 

  10. Gallini C, Tutino F, Martone R, 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.

    Article  PubMed  Google Scholar 

Download references

Disclosure

DJ has received consultant fees from AbbVie and Advanced Accelerator Applications. MPG, CR, FH, PM, JG, and GA have no disclosures.

Author information

Author notes

  1. Daniel Juneau and Matthieu Pelletier-Galarneau are co-senior authors.

Authors and Affiliations

  1. Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada

    Claudine Régis MD & Daniel Juneau MD

  2. Department of Medical Imaging, Institut de Cardiologie de Montreal, 5000, Bélanger, Montreal, QC, H1T1C8, Canada

    Claudine Régis MD, François Harel MD, PhD, Jean Grégoire MD & Matthieu Pelletier-Galarneau MD, MSc

  3. Department of Radiology, University of Manitoba, Winnipeg, MB, Canada

    Patrick Martineau MD, PhD

  4. BC Cancer Agency, Vancouver, BC, Canada

    Patrick Martineau MD, PhD

  5. Department of Radiology and Nuclear Medicine, Jewish General Hospital, Montreal, QC, Canada

    Gad Abikhzer MD

  6. University of Ottawa Heart Institute, Ottawa, ON, Canada

    Daniel Juneau MD

  7. Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Matthieu Pelletier-Galarneau MD, MSc

Authors
  1. Claudine Régis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. François Harel MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Martineau MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Grégoire MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gad Abikhzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Juneau MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthieu Pelletier-Galarneau MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthieu Pelletier-Galarneau MD, MSc.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (PPTX 10626 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Régis, C., Harel, F., Martineau, P. et al. Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR cardiac amyloidosis: Comparison of quantitative and semi-quantitative approaches. J. Nucl. Cardiol. 27, 1808–1815 (2020). https://doi.org/10.1007/s12350-020-02205-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-020-02205-1

Keywords

Search

Navigation