Extracardiac Accumulation of Technetium-99m-Pyrophosphate in Transthyretin Cardiac Amyloidosis

Takahashi, Koji; Sasaki, Daisuke; Sakaue, Tomoki; Enomoto, Daijiro; Uemura, Shigeki; Okura, Takafumi; Ikeda, Shuntaro; Yamamoto, Daichi; Kono, Taizo; Yamamura, Nobuhisa

doi:10.1016/j.jaccas.2021.02.015

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…Few studies have investigated the usefulness of a skeletal muscle biopsy for confirming ATTR deposition in patients with ATTRwt-CA ( 22 ). We previously reported that the extracardiac 99m Tc-PYP uptake detected in patients with ATTRwt-CA indicated amyloid deposition ( 2 - 4 ). A 99m Tc-PYP imaging-based CT-guided core needle biopsy of the internal oblique muscle with a tracer uptake in patients with ATTRwt-CA has a high ATTR detection rate (88.9%), although tracer accumulation-negative patients have not been investigated ( 5 ).…”

Section: Discussionmentioning

confidence: 98%

A Gluteus Medius Muscle Biopsy to Confirm Amyloid Transthyretin Deposition in Wild-type Transthyretin Cardiac Amyloidosis: A Report of Two Cases

Takahashi,

Iwamura,

Hiratsuka

et al. 2024

Intern. Med.

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In patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), the uptake of the tracer on technetium-99m-labeled pyrophosphate ( 99m Tc-PYP) scintigraphy, which indicates amyloid transthyretin (ATTR) per se , is often observed in skeletal muscles, such as the abdominal oblique and gluteal muscles. Among extracardiac biopsies for confirming ATTR deposition in ATTRwt-CA, a 99m Tc-PYP imaging-based computed tomography (CT)-guided core needle biopsy of the internal oblique muscle has relatively high sensitivity. In some patients, the 99m Tc-PYP uptake is more pronounced in the gluteal muscles than in oblique muscles. We herein report two cases of ATTRwt-CA in which a CT-guided biopsy of the gluteus medius muscle with 99m Tc-PYP uptake confirmed the presence of ATTR deposits.

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Section: Discussionmentioning

confidence: 98%

A Gluteus Medius Muscle Biopsy to Confirm Amyloid Transthyretin Deposition in Wild-type Transthyretin Cardiac Amyloidosis: A Report of Two Cases

Takahashi,

Iwamura,

Hiratsuka

et al. 2024

Intern. Med.

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“…As for 99m Tc-PYP, Takahashi et al documented a case of acute decompensated heart failure where 99m Tc-PYP concentrated not only in the myocardium but also in extracardiac areas such as the thoracic and abdominal walls, confirmed by a positive fine-needle aspiration biopsy for ATTR amyloidosis [ 19 ]. While another study noted that extracardiac uptake of 99m Tc-PYP in heart failure was infrequent and seldom necessitated further investigation, it lacked specific data on cardiac amyloidosis, precluding any comparative analysis of uptake levels between patients with and without cardiac amyloidosis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Exacerbation of Idiopathic Pulmonary Fibrosis With Concurrent Cardiac Amyloidosis: A Technetium Pyrophosphate Study

Yanagihara,

Hatashima,

Ogata

et al. 2024

Cureus

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Amyloidosis presents a diagnostic challenge, particularly when concomitant with severe conditions like acute exacerbations of idiopathic pulmonary fibrosis (IPF). In this report, we detail the case of a 73-year-old patient with acute exacerbation of IPF and simultaneous emergence of cardiac amyloidosis. The patient's clinical journey began with persistent exertional dyspnea, progressing to hypoxemia on admission. Chest CT scans showed extensive ground-glass opacities, consolidations, and pre-existing honeycombing-like cysts and reticular shadows, accompanied by a right-sided pleural effusion. The therapeutic strategy for acute exacerbation of IPF encompassed methylprednisolone pulse therapy, tacrolimus, and nintedanib, augmented with intravenous immunoglobulin and recombinant thrombomodulin. Concurrently, heart failure with preserved ejection fraction was managed with a pharmacological trio: empagliflozin, diuretics, and eplerenone. A hypertrophied heart and low limb voltage prompted an investigation for cardiac amyloidosis, which 99m Technetium pyrophosphate ( 99m Tc-PYP) scintigraphy confirmed, yielding a probable diagnosis. Following steroid tapering, the patient was discharged home. This case prompted an investigation into the potential role of amyloidosis in pulmonary pathology. Our retrospective review of 10 patients, including four with cardiac amyloidosis, who underwent 99m Tc-PYP scintigraphy, revealed a nonsignificant yet notable trend of increased pulmonary accumulation in cardiac amyloidosis cases (median (interquartile range): 5.4×10 4 (5.3-13.1×10 4 ) vs. 3.6×10 4 (2.4-5.1×10 4 ), p=0.0667). Notably, the pulmonary counts in this patient exceeded the negative cohort's mean values, hinting at a possible contribution of amyloid deposition to pulmonary pathology. This study, pioneering in evaluating lung field accumulation of 99m Tc-PYP in cardiac amyloidosis, may provide novel insights into the influence of amyloidosis on pulmonary conditions.

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“…However, chest- and abdomen-centered scans provide additional information. The extracardiac uptake of 99m Tc-PYP indicates the presence of amyloid deposits, which can guide the selection of a biopsy site 7,12,13 . Hutt et al 22 reported the usefulness of skeletal muscle biopsies in ATTR-CA, although these results were not described in detail.…”

Section: Discussionmentioning

confidence: 99%

“…The extracardiac uptake of 99m Tc-PYP indicates the presence of amyloid deposits, which can guide the selection of a biopsy site. 7,12,13 Hutt et al 22 reported the usefulness of skeletal muscle biopsies in ATTR-CA, although these results were not described in detail. Screening biopsies minimize the requirement for high-risk and more invasive target organ biopsies, such as endomyocardial biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…11 We previously reported the detection of moderate to high 99m Tc-PYP uptake in the subcutaneous abdominal fat of some patients with ATTRwt-CA, and this finding could reflect the regional amyloid burden confirmed using fine-needle aspiration biopsy of the tissue. 12,13 In this study, we investigated the frequency of 99m Tc-PYP uptake in the extracardiac soft tissues, particularly the skeletal muscles of the trunk, in patients with ATTRwt-CA.…”

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confidence: 99%

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99mTc-Pyrophosphate Scintigraphy Can Image Tracer Uptake in Skeletal Trunk Muscles of Transthyretin Cardiac Amyloidosis

Takahashi

Hiratsuka²,

Sasaki³

et al. 2022

Clin Nucl Med

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Purpose: 99m Tc-pyrophosphate ( 99m Tc-PYP) uptake in the skeletal muscles is minimal in patients with transthyretin cardiac amyloidosis (ATTR-CA) when assessed qualitatively and quantitatively. We previously demonstrated moderate-to high-grade 99m Tc-PYP uptake in the subcutaneous abdominal fat of some patients with ATTR-CA and showed that this abnormal finding could reflect the regional amyloid burden of this tissue. We aimed to investigate the frequency of 99m Tc-PYP uptake in skeletal trunk muscles of patients with ATTR-CA. Methods: Chest-and abdomen-centered 99m Tc-PYP scintigraphy images were obtained 2 hours after IV injections of the tracer (20 mCi) in 36 patients with ATTR-CA. The frequency of 99m Tc-PYP uptake in the following 11 skeletal trunk muscles was investigated: pectoralis major, deltoid, subscapularis, infraspinatus, trapezius, latissimus dorsi, erector spinae, psoas major, abdominal oblique, rectus abdominis, and the gluteus muscles. Results: Ten of the 11 muscles were involved in patients with the highest number of 99m Tc-PYP uptake in the skeletal trunk muscles examined, whereas no muscle was involved in a patient with the least uptake. The muscle with the highest rate of 99m Tc-PYP uptake, observed in 34 of 36 patients (94.4%), was the abdominal oblique. No tracer uptake was observed in the psoas major. The frequency of radiotracer uptake in the remaining examined muscles was between those of abdominal oblique and psoas major muscles. Conclusions: Radiotracer uptake was often detectable in some skeletal trunk muscles of ATTR-CA, although the muscles of patients examined and the skeletal trunk muscles of 1 patient showed heterogeneity in the uptake of 99m Tc-PYP.

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Extracardiac Accumulation of Technetium-99m-Pyrophosphate in Transthyretin Cardiac Amyloidosis

Cited by 11 publications

References 4 publications

A Gluteus Medius Muscle Biopsy to Confirm Amyloid Transthyretin Deposition in Wild-type Transthyretin Cardiac Amyloidosis: A Report of Two Cases

A Gluteus Medius Muscle Biopsy to Confirm Amyloid Transthyretin Deposition in Wild-type Transthyretin Cardiac Amyloidosis: A Report of Two Cases

Acute Exacerbation of Idiopathic Pulmonary Fibrosis With Concurrent Cardiac Amyloidosis: A Technetium Pyrophosphate Study

99mTc-Pyrophosphate Scintigraphy Can Image Tracer Uptake in Skeletal Trunk Muscles of Transthyretin Cardiac Amyloidosis

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