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Comparison of 18F-sodium fluoride positron emission tomography imaging and 99mTc-pyrophosphate in cardiac amyloidosis

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Pyrophosphate (PYP) scintigraphy provides high diagnostic accuracy for the detection of transthyretin (ATTR) cardiac amyloidosis (CA). There has recently been emerging interest in using 18F-sodium fluoride (NaF) for this application, yet its sensitivity has never been directly compared to that of PYP, the current molecular gold standard

Methods

Twelve subjects with ATTR-CA and 5 controls referred for PYP-SPECT were prospectively enrolled. 18F-NaF PET/CT scans were performed at 1 and 3 hours. Qualitative and quantitative analyses of the images were performed, and the sensitivity of 18F-NaF PET/CT and PYP-SPECT were compared

Results

Visual interpretation of NaF PET/CT yielded a sensitivity of 0.25 (95% CI 0.089 to 0.53) for the detection of ATTR-CA, which is significantly inferior to that of PYP-SPECT/CT (100%, P = .016). Visual interpretation at 3 hours yielded a similar sensitivity of 0.30 (95% CI 0.11 to 0.60, P  = 1.00). There were no false-positive NaF PET studies. Mean target-to-background ratio (TBRmean) at 1h did not differ significantly (P = .21) in ATTR-CA subjects (0.83 ± 0.15) compared to controls (0.72 ± 0.15). Receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.69 ± 0.16 (95% CI 0.37 to 1.00, P = .23).

Conclusion

With qualitative and quantitative analyses, sensitivity of NaF PET/CT is significantly inferior to that of PYP-SPECT for the diagnosis of ATTR-CA

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Abbreviations

CA:

Cardiac amyloidosis

AL:

Light-chain

ATTR:

Transthyretin

DPD:

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

EMB:

Endomyocardial biopsy

LVH:

Left ventricular hypertrophy

MBF:

Myocardial blood flow

NaF:

Sodium fluoride

PYP:

Pyrophosphate

SUV:

Standard uptake value

TBR:

Target-to-background ratio

SRS:

Summed rest score

References

  1. Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med (Lond). 2018;18:s30–5.

    Google Scholar 

  2. Rapezzi C, Merlini G, Quarta CC, Riva L, Longhi S, Leone O, et al. Systemic cardiac amyloidoses: disease profiles and clinical courses of the 3 main types. Circulation. 2009;120:1203–12.

    Article  CAS  Google Scholar 

  3. González-López E, Gallego-Delgado M, Guzzo-Merello G, de Haro-Del Moral FJ, Cobo-Marcos M, Robles C, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015;36:2585–94.

    Article  Google Scholar 

  4. Morgenstern R, Yeh R, Castano A, Maurer MS, Bokhari S. (18)Fluorine sodium fluoride positron emission tomography, a potential biomarker of transthyretin cardiac amyloidosis. J Nucl Cardiol. 2018;25:1559–67.

    Article  Google Scholar 

  5. Adams D, Gonzalez-Duarte A, O’Riordan WD, Yang CC, Ueda M, Kristen AV, et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis. N Engl J Med. 2018;379:11–21.

    Article  CAS  Google Scholar 

  6. Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med. 2018;379:1007–16.

    Article  CAS  Google Scholar 

  7. Régis C, Harel F, Martineau P, Grégoire J, Abikhzer G, Juneau D et al. Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR cardiac amyloidosis: Comparison of quantitative and semi-quantitative approaches. J Nucl Cardiol 2020.

  8. Yamamoto H, Yokochi T. Transthyretin cardiac amyloidosis: an update on diagnosis and treatment. ESC Heart Fail. 2019;6:1128–39.

    Article  Google Scholar 

  9. Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133:2404–12.

    Article  CAS  Google Scholar 

  10. Perugini E, Guidalotti PL, Salvi F, Cooke RM, Pettinato C, Riva L, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol. 2005;46:1076–84.

    Article  Google Scholar 

  11. Rapezzi C, Gagliardi C, Milandri A. Analogies and disparities among scintigraphic bone tracers in the diagnosis of cardiac and non-cardiac ATTR amyloidosis. J Nucl Cardiol. 2019;26:1638–41.

    Article  Google Scholar 

  12. Treglia G, Glaudemans A, Bertagna F, Hazenberg BPC, Erba PA, Giubbini R, et al. Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging. 2018;45:1945–55.

    Article  CAS  Google Scholar 

  13. Rapezzi C, Quarta CC, Guidalotti PL, Longhi S, Pettinato C, Leone O, et al. Usefulness and limitations of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy. Eur J Nucl Med Mol Imaging. 2011;38:470–8.

    Article  Google Scholar 

  14. Pelletier-Galarneau M, Abikhzer G, Giraldeau G, Harel F. Molecular imaging of cardiac amyloidosis. Curr Cardiol Rep. 2019;21:12.

    Article  Google Scholar 

  15. Bokhari S, Castaño A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. (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.

    Article  Google Scholar 

  16. Stats MA, Stone JR. Varying levels of small microcalcifications and macrophages in ATTR and AL cardiac amyloidosis: implications for utilizing nuclear medicine studies to subtype amyloidosis. Cardiovasc Pathol. 2016;25:413–7.

    Article  CAS  Google Scholar 

  17. Algalarrondo V, Piekarski E, Eliahou L, Le Guludec D, Slama MS, Rouzet F. Can nuclear imaging techniques predict patient outcome and guide medical management in hereditary transthyretin cardiac amyloidosis? Curr Cardiol Rep. 2018;20:33.

    Article  Google Scholar 

  18. Rapezzi C, Quarta CC, Guidalotti PL, Pettinato C, Fanti S, Leone O, et al. Role of (99m)Tc-DPD scintigraphy in diagnosis and prognosis of hereditary transthyretin-related cardiac amyloidosis. JACC Cardiovasc Imaging. 2011;4:659–70.

    Article  Google Scholar 

  19. Trivieri MG, Dweck MR, Abgral R, Robson PM, Karakatsanis NA, Lala A, et al. (18)F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis. J Am Coll Cardiol. 2016;68:2712–4.

    Article  CAS  Google Scholar 

  20. Martineau P, Finnerty V, Giraldeau G, Authier S, Harel F, Pelletier-Galarneau M. Examining the sensitivity of 18F-NaF PET for the imaging of cardiac amyloidosis. J Nucl Cardiol 2019.

  21. Lortie M, Beanlands RS, Yoshinaga K, Klein R, Dasilva JN, DeKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging. 2007;34:1765–74.

    Article  Google Scholar 

  22. Van Der Gucht A, Galat A, Rosso J, Guellich A, Garot J, Bodez D, et al. [18F]-NaF PET/CT imaging in cardiac amyloidosis. J Nucl Cardiol. 2016;23:846–9.

    Article  Google Scholar 

  23. Ng QKT, Sethi P, Saunders TA, Pampaloni MH, Flavell RR. Discordant Findings on 18F-NaF and 99mTc-HDP Bone Scans in a Patient With ATTR Cardiac Amyloidosis. Clin Nucl Med. 2018;43:e89–92.

    Article  Google Scholar 

  24. Gagliardi C, Tabacchi E, Bonfiglioli R, Diodato S, Nanni C, Guidalotti P, et al. Does the etiology of cardiac amyloidosis determine the myocardial uptake of [18F]-NaF PET/CT? J Nucl Cardiol. 2017;24:746–9.

    Article  Google Scholar 

  25. Kim SH, Kim YS, Kim SJ. Diagnostic performance of PET for detection of cardiac amyloidosis: A systematic review and meta-analysis. J Cardiol 2020.

  26. Dweck MR, Jenkins WS, Vesey AT, Pringle MA, Chin CW, Malley TS, et al. 18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis. Circ Cardiovasc Imaging. 2014;7:371–8.

    Article  Google Scholar 

  27. Silva Mendes BI, Oliveira-Santos M, Vidigal Ferreira MJ. Sodium fluoride in cardiovascular disorders: A systematic review. J Nucl Cardiol 2019.

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Acknowledgment

M.P.-G. is supported by a Junior 1 Research Award from the Fonds de Recherche du Québec – Santé (FRQS).

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Authors and Affiliations

  1. Department of Medical Imaging, Institut de Cardiologie de Montréal, Montréal, Canada

    Li Xin Zhang, Vincent Finnerty MSc, François Harel MD, PhD & Matthieu Pelletier-Galarneau MD, MSc

  2. BC Cancer Agency, Vancouver, BC, Canada

    Patrick Martineau MD, PhD

  3. Department of Medicine, Institut de Cardiologie de Montréal, Montréal, Canada

    Geneviève Giraldeau MD & Marie-Claude Parent MD

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

    Matthieu Pelletier-Galarneau MD, MSc

Authors
  1. Li Xin Zhang
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  2. Patrick Martineau MD, PhD
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Correspondence to Matthieu Pelletier-Galarneau MD, MSc.

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Zhang, L.X., Martineau, P., Finnerty, V. et al. Comparison of 18F-sodium fluoride positron emission tomography imaging and 99mTc-pyrophosphate in cardiac amyloidosis. J. Nucl. Cardiol. 29, 1132–1140 (2022). https://doi.org/10.1007/s12350-020-02425-5

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  • DOI: https://doi.org/10.1007/s12350-020-02425-5

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