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

Abstract

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.

Nuclear imaging of cardiac amyloidosis

“…20 Similar findings have been reported with 18 F-florbetabir from other laboratories 22 and with another amyloid specific PET tracer, 18 F-florbetaben. 23 The current study by Capelli et al 21 confirms earlier findings of smaller studies and case reports 13,14 as well as the large-scale study by Gillmore et al 17 showing the potential of 99m Tc-HMDP nuclear imaging in patients with suspected TTR-CA, to reliably differentiate those from AL-CA and other causes of LVH. The biggest limitations, as the authors point out, are small sample size and lack of biopsy confirmation in several patients.…”

“…The biggest limitations, as the authors point out, are small sample size and lack of biopsy confirmation in several patients. 21 Their results are overall positive; however, there are a number of unanswered. Other than local availability, are there specific benefits of using 99m Tc-DPD over 99m Tc-PYP and 99m Tc-HMDP and vice versa, such as ease of labeling (radiochemistry), differences in cost, image quality, radiation exposure etc.?…”

“…21 Importantly, all patients underwent planar 99m Tc-HMDP total body scintigraphy and not SPECT imaging. All patients with TTR-CA had cardiac uptake of Tc-HMDP based on visual/qualitative evaluation using the Perugini score (N = 3 grade 1-mild cardiac uptake, inferior to bone uptake, N = 16 grade 2-moderate cardiac uptake associated with attenuated bone uptake and N = 20 grade 3-high cardiac uptake with decreased or absent bone uptake).…”

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

“…Of the 2947 studies, we identified 27 meeting the inclusion criteria, including data on 3493 patients ( Figure ). Twenty‐two studies evaluated the performance of CMR in diagnosing either cardiac amyloidosis or ATTR amyloidosis, with a further five studies assessing the diagnostic performance of nuclear scintigraphy . Seventeen studies assessing the performance of index tests in the diagnosis of cardiac amyloidosis included patients with a range of cardiac conditions, whereas 9 out of 11 studies diagnosing ATTR amyloidosis included patients with ATTR or AL amyloidosis only.…”

Molecular Imaging

“…Недавно разработанный консенсусом специалистов алгоритм для неинвазивной диагностики АС отводит центральную роль сцинтиграфии с 99mTc-PYP/DPD/HMDP [3]. Данные радиотрейсеры позволяют диагностировать транстиретиновый амилоидоз (ATTR) сердца с достаточно высокой чувствительностью [6], но не полностью специфичны [7][8][9][10][11]. Многоцентровое исследование 1217 пациентов показало положительную прогностическую ценность для ATTR АС в 100% (доверительный интервал 98,0-100) у пациентов с подозрением на амилоидоз по данным эхокардиограммы или МРТ и отсутствием моноклонального белка в сыворотке крови или моче [7].…”