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Comparison of planar with tomographic pyrophosphate scintigraphy for transthyretin cardiac amyloidosis: Perils and pitfalls

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Tc-99m pyrophosphate (PYP) SPECT is recommended for indeterminate findings on planar imaging. We aimed to compare the findings on planar PYP scintigraphy alone to that of routinely performed PYP SPECT.

Methods

PYP scintigraphy data of 133 patients (53% men; mean age 76 years) were evaluated. SPECT was routinely performed following 1-hour planar imaging, in all cases. Semiquantitative visual score and heart-to-contralateral (H/CL) ratio were determined in all patients as recommended.

Results

PYP images from 35 patients (26%) were considered to be positive based on SPECT myocardial uptake. Among them, 20 (57%) had a H/CL ratio ≥1.5 and 34 had a visual score ≥ 2. SPECT identified myocardial uptake in one patient with a visual score < 2 and refuted the presence of myocardial uptake in two patients with a visual score ≥ 2. Visual score correlated well with SPECT (r = 0.94; P < .0001) and had an accuracy of 98% for tomographic myocardial uptake. Addition of H/CL ratio reduced the diagnostic performance of visual score.

Conclusions

Planar-derived visual score has an excellent accuracy for tomographic myocardial uptake, though it misclassifies a small proportion of patients. H/CL ratio decreases the diagnostic certainty of planar imaging. Tomographic imaging prevents misdiagnoses and should always be performed.

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Abbreviations

PYP:

Techneticum-99m pyrophosphate

TTR-CA:

Transthyretin cardiac amyloidosis

H/CL:

Heart-to-contralateral

ASNC:

American Society of Nuclear Cardiology

SPECT:

Single photon emission computed tomography

LVEF:

Left ventricular ejection fraction

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Disclosures

Talal Asif, Javier Gomez-Valencia, Vasvi Singh, Rami Doukky, and Arlet Nedeltcheva have nothing to disclose. Saurabh Malhotra—Speakers Bureau: Pfizer and Akcea Therapeutics, and Advisory Board: Akcea Therapeutics

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Authors and Affiliations

  1. Division of Cardiology, Cook County Health, Chicago, USA

    Talal Asif MD, Javier Gomez MD, MSc, Rami Doukky MD, MSc, FASNC, Arlet Nedeltcheva MD & Saurabh Malhotra MD, MPH, FASNC

  2. Division of Cardiology, Rush Medical College, Chicago, USA

    Javier Gomez MD, MSc, Rami Doukky MD, MSc, FASNC & Saurabh Malhotra MD, MPH, FASNC

  3. Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA

    Vasvi Singh MD & Saurabh Malhotra MD, MPH, FASNC

  4. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Vasvi Singh MD

  5. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Vasvi Singh MD

Authors
  1. Talal Asif MD
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  2. Javier Gomez MD, MSc
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  3. Vasvi Singh MD
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  4. Rami Doukky MD, MSc, FASNC
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  5. Arlet Nedeltcheva MD
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  6. Saurabh Malhotra MD, MPH, FASNC
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Corresponding author

Correspondence to Saurabh Malhotra MD, MPH, FASNC.

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Funding

This study was supported in part by the Becker Fund for Heart Research, Community Foundation of Greater Buffalo.

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Asif, T., Gomez, J., Singh, V. et al. Comparison of planar with tomographic pyrophosphate scintigraphy for transthyretin cardiac amyloidosis: Perils and pitfalls. J. Nucl. Cardiol. 28, 104–111 (2021). https://doi.org/10.1007/s12350-020-02328-5

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  • DOI: https://doi.org/10.1007/s12350-020-02328-5

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