Not All Heart Uptakes on 99mTc-DPD Scintigraphy Are Amyloidosis

Wakfie-Corieh, Cristina Gamila; Ramos-López, Noemí; Sanz, Melchor Sáiz-Pardo; Castejón, María Jesús Pérez; Vilacosta, Isidre

doi:10.1097/rlu.0000000000003387

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…It has also been reported by others that FLC assessment results can be a false negative for AL although underlying mechanisms remain elusive [ 17 , 19 ]. Aside from AL CA, other cardiomyopathies can also lead to faint myocardial tracer uptake, such as chloroquine-induced cardiomyopathy [ 20 , 21 ], myocardial ischemia or edema [ 22 ], hypertrophic cardiomyopathy [ 23 ], and hereditary apolipoprotein CA [ 7 ]. Two patients with ApoA4 CA in our cohort exhibited no myocardial tracer uptake.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

et al. 2022

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We aimed to ascertain the real-world diagnostic accuracy of bone scintigraphy in combination with free light chain (FLC) assessment for transthyretin (ATTR) cardiac amyloidosis (CA) using the histopathological diagnosis derived from endomyocardial biopsy (EMB) as a reference standard. We retrospectively analyzed 102 patients (22% women) with suspected CA from seven Austrian amyloidosis referral centers. The inclusion criteria comprised the available results of bone scintigraphy, FLC assessment, and EMB with histopathological analysis. ATTR and AL were diagnosed in 60 and 21 patients (59%, 21%), respectively, and concomitant AL and ATTR was identified in one patient. The specificity and positive predictive value (PPV) of Perugini score ≥ 2 for ATTR CA were 95% and 96%. AL was diagnosed in three out of 31 patients (10%) who had evidence of monoclonal proteins and a Perugini score ≥ 2. When excluding all patients with detectable monoclonal proteins (n = 62) from analyses, the PPV of Perugini score ≥ 2 for ATTR CA was 100% and the NPV of Perugini score < 2 for ATTR CA was 79%. Conclusively, ATTR CA can be diagnosed non-invasively in the case of a Perugini score ≥ 2 and an unremarkable FLC assessment. However, tissue biopsy is mandatory in suspected CA in any other constellation of non-invasive diagnostic work-up.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

et al. 2022

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“…Patients with prostate cancer, endstage renal disease on hemodialysis, myocarditis, and restrictive cardiomyopathies have an increased probability of heart uptake as compared to individuals with normal conditions [25][26][27][28]. The hydroxychloroquine long-term treatment in rheumatology could be associated with an increase in heart uptake [29,30]. The presence of myocardial tracer uptake on bone scintigraphy should suggest several differential diagnoses next to the TTR CA [28].…”

Section: Introductionmentioning

confidence: 99%

Census of Cardiac Uptake on Routine Bone Scintigraphy, a Methodology to Assess the Prevalence of the TTR Amyloidosis

Khoury¹,

Nasr²,

Chéhadé³

2022

JICOA

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Objective: Transthyretin cardiac amyloidosis is a rapidly progressive disease, remains underdiagnosed, and has long been considered a rare disease. Diagnosis decision making cannot be based on echography and MRI findings alone because they lack accuracy. However, it requires invasive test of myocardial or fat pad biopsies. Thus, the diagnosis is challenging, and the non-invasive scintigraphic technique using bone-seeking radiopharmaceuticals has become a cornerstone in the workup revealing a myocardial uptake. Our work consists of a single institution retrospective study aiming to estimate the bone scintigraphies, and the prevalence of the transthyretin cardiac amyloidosis in our population. Methods: We have carried out a census of the incidental cardiac uptake on routine bone scintigraphy in 2211 consecutive patients enrolled between 2009 and 2020, mostly performed for oncologic purposes. The visual analysis of the scintigraphic images classifies the cardiac uptake into 3 levels of gradation and evokes the diagnosis of the TTR cardiac amyloidosis in grades 2 and 3. Results: Different grades of myocardial uptake were observed in 1.37 % of all patients. Prevalence of uptake was 0.37% in the 50th, increased dramatically at the 60th (2.49%), and reached 4% above the age of 80. The diagnostic grades 2 and 3 cardiac uptakes were identified in 5 patients (0.23% of overall patients) ranging between 56- and 91-y-old. Our results concord with the trend of disease increases with age. Conclusion: The careful analysis of the bone scintigraphy of all incoming adult patients should allow to make the diagnosis of the TTR cardiac amyloidosis at a preclinical stage and establish new effective treatments. Our results provide an estimate of the number of patients that could be diagnosed and improve the awareness of the corresponding prevalence in our population. In this way, multicentric studies should be implemented by enrolling large cohorts of bone scintigraphy cases.

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“…The patient did not have a history of myocardial infarction, hypercalcemia, history of radiation therapy, recent iron infusion, cardioversion, or usage of cardiotoxicity drugs, which are the known causes of false-positives in 99m Tc-PYP scan for diagnosing transthyretin cardiomyopathy (ATTR-CM). [2][3][4][5] Monoclonal protein in serum was excluded by serum immunofixation and free light chain assay. These findings fulfilled the criteria to diagnose transthyretin cardiac amyloidosis clinically.…”

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confidence: 99%

“…Transaxial views of SPECT/CT images at 3 hours postinjection consistently revealed the uptake was in the myocardium with the apical region relatively spared ( B ). The patient did not have a history of myocardial infarction, hypercalcemia, history of radiation therapy, recent iron infusion, cardioversion, or usage of cardiotoxicity drugs, which are the known causes of false-positives in 99m Tc-PYP scan for diagnosing transthyretin cardiomyopathy (ATTR-CM) 2–5 . Monoclonal protein in serum was excluded by serum immunofixation and free light chain assay.…”

mentioning

confidence: 99%

Hyperphosphatemia-Related False-Positive 99mTc-Pyrophosphate Myocardial Scan: A Case Report With Endomyocardial Biopsy Result

Hu,

Kuo,

Chang

et al. 2023

Clin Nucl Med

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With documented high specificity, 99mTc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99mTc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition. In this case, hyperphosphatemia was the most likely and presumptive cause of the false-positive 99mTc-PYP scan. With this case, our experiences of the potential causes of false-positive results of 99mTc-PYP are further expanded.

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Not All Heart Uptakes on 99mTc-DPD Scintigraphy Are Amyloidosis

Cited by 6 publications

References 8 publications

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis—A Retrospective Austrian Multicenter Study

Census of Cardiac Uptake on Routine Bone Scintigraphy, a Methodology to Assess the Prevalence of the TTR Amyloidosis

Hyperphosphatemia-Related False-Positive 99mTc-Pyrophosphate Myocardial Scan: A Case Report With Endomyocardial Biopsy Result

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