Tc-99m HMDP bone scintigraphy for cardiac amyloidosis diagnosis: A false positive case

Lades, Guillaume; Carpenet, Hélène; Benoit, Unvoy; Aboyans, Victor; Monteil, Jacques

doi:10.1007/s12350-020-02451-3

Cited by 5 publications

(5 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 54 Case reports on false‐positive myocardial uptake following intravenous iron injections have been published for 99m Tc‐DPD and 99m Tc‐HMDP scintigraphy. 77 , 78 In contrast, Grade 0 or 1 myocardial uptake, an insufficient amount of amyloid deposits, 79 rib fractures, 10 valvular/annular calcifications, 10 recent myocardial infarction, 10 delayed or premature acquisition in 99m Tc‐PYP scintigraphy, 10 ATTRv‐CM with a low sensitivity for 99m Tc‐labelled bone radiotracer scintigraphy (Ser77Tyr or Phe64Leu mutation), 10 , 80 and initial diagnosis of cardiac pools with myocardial deposits 81 are examples of possible false‐negative cases ( Table 2 ). In case of inconsistencies between planar 99m Tc‐PYP scintigraphy results and biopsy findings, potential causes should be suspected and investigated, such as errors in scintigraphy imaging time or interpretation, errors in biopsy sampling or pathological diagnosis, deposits of proteins other than TTR (e.g.…”

Section: Data Interpretation and Common Pitfalls Of 99m Tc‐pyp Scintigraphymentioning

confidence: 99%

“…False‐positive cases in 99m Tc‐PYP scintigraphy for ATTR‐CM may include Grade 2 or 3 myocardial uptake; a recent history of acute myocardial infarction 54 ; AL amyloidosis 34,54,69–73 ; apolipoprotein AI amyloidosis (AApoAI), apolipoprotein AII amyloidosis (AApoAII), apolipoprotein A‐IV amyloidosis (ApoAAIV), or β2‐microglobulin amyloidosis (Aβ2M) 10 ; hypertrophic cardiomyopathy 74,75 ; hydroxychloroquine toxicity 76 ; and cardiac blood pools 54 . Case reports on false‐positive myocardial uptake following intravenous iron injections have been published for 99m Tc‐DPD and 99m Tc‐HMDP scintigraphy 77,78 . In contrast, Grade 0 or 1 myocardial uptake, an insufficient amount of amyloid deposits, 79 rib fractures, 10 valvular/annular calcifications, 10 recent myocardial infarction, 10 delayed or premature acquisition in 99m Tc‐PYP scintigraphy, 10 ATTRv‐CM with a low sensitivity for 99m Tc‐labelled bone radiotracer scintigraphy (Ser77Tyr or Phe64Leu mutation), 10,80 and initial diagnosis of cardiac pools with myocardial deposits 81 are examples of possible false‐negative cases ( Table 2 ).…”

Section: Data Interpretation and Common Pitfalls Of 99mtc‐pyp Scintig...mentioning

confidence: 99%

See 1 more Smart Citation

^99mTechnetium‐pyrophosphate scintigraphy: a practical guide for early diagnosis of transthyretin amyloid cardiomyopathy

et al. 2021

View full text Add to dashboard Cite

Transthyretin amyloid cardiomyopathy (ATTR‐CM) is caused by the cardiac deposition of insoluble amyloid fibrils formed by misfolded transthyretin proteins and is associated with various cardiac symptoms, such as progressive heart failure, conduction disturbance, and arrhythmia. The implementation of 99mtechnetium (99mTc)‐labelled bone radiotracer scintigraphy for diagnosing ATTR‐CM has enabled accurate diagnosis of the disease with high sensitivity and specificity and positioned this diagnostic modality as an integral part of disease diagnostic algorithms. In 2020, 99mTc‐pyrophosphate scintigraphy received exceptional approval for Japanese national health insurance reimbursement as a diagnostic method of ATTR‐CM. Nevertheless, the utility of 99mTc‐labelled bone radiotracer scintigraphy and the importance of an early diagnosis of suspected ATTR‐CM using this technique have yet to be internalized as common practice by general cardiologists, and guidance on daily clinical scenarios to consider this technique for a diagnosis of suspected ATTR‐CM is warranted. In this review, we discuss the utility of 99mTc‐labelled bone radiotracer scintigraphy for the early diagnosis of ATTR‐CM based on published literature and the outcomes of an advisory board meeting. This review also discusses clinical scenarios that could support early diagnosis of suspected ATTR‐CM as well as common pitfalls, correct implementation, and future perspectives of 99mTc‐labelled bone radiotracer scintigraphy in daily clinical practice. The clinical scenarios to consider 99mTc‐labelled bone radiotracer scintigraphy in daily practice may include, but are not limited to, patients with a family history of the hereditary type of disease; elderly patients (aged ≥60 years) with unexplained cardiac findings (e.g. cardiac hypertrophy associated with abnormalities on an electrocardiogram, heart failure with preserved ejection fraction associated with unexplained left ventricular hypertrophy, and heart failure with reduced ejection fraction associated with atrial fibrillation and left ventricular hypertrophy); and patients with cardiac hypertrophy associated with diastolic dysfunction, right ventricular/interatrial septum/valve thickness, left ventricular sparkling, or apical sparing. Cardiac hypertrophy and persistent elevation in cardiac troponin in elderly patients are also suggestive of ATTR‐CM. 99mTc‐labelled bone radiotracer scintigraphy is also recommended in patients with characteristic cardiac magnetic resonance findings (e.g. diffuse subendocardial late gadolinium enhancement patterns, native T1 increase, and increase in extracellular volume) or patients with cardiac hypertrophy and bilateral carpal tunnel syndrome.

show abstract

Section: Data Interpretation and Common Pitfalls Of 99m Tc‐pyp Scintigraphymentioning

confidence: 99%

Section: Data Interpretation and Common Pitfalls Of 99mtc‐pyp Scintig...mentioning

confidence: 99%

^99mTechnetium‐pyrophosphate scintigraphy: a practical guide for early diagnosis of transthyretin amyloid cardiomyopathy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The complete study was eventually reported as negative for amyloidosis transthyretin deposits. Recently, other authors 4 reported that [ 99m Tc]Tc-HMDP scintigraphy could show a similar pattern after the administration of intravenous iron. Combining previous recent drug history interview and a SPECT/CT study may clarify the source of the uptake, as high intravascular uptake is not a characteristic of cardiac amyloidosis.…”

mentioning

confidence: 83%

False Positive in [99mTc]Tc-DPD Scintigraphy for Cardiac Amyloidosis Due to Intravenous Iron Administration

Rudolphi Solero,

Feriche Aragón,

Amrani Raissouni

et al. 2023

Clin Nucl Med

View full text Add to dashboard Cite

[99mTc]Tc-DPD (3,3-diphosphono-1,2-propanodicarboxylic acid) scintigraphy is an essential tool for diagnosing transthyretin amyloid cardiac amyloidosis. An 86-year-old woman suffering from heart failure with preserved ejection fraction underwent [99mTc]Tc-DPD scintigraphy and a SPECT/CT for suspected transthyretin amyloid cardiac amyloidosis. The scan showed intracardiac and liver uptake. As the patient had taken intravenous iron on the morning of the scan, we decided to repeat the scan, but this time, it showed no uptake in the heart or the liver. Accordingly, we concluded the first result was a false positive due to drug interaction.

show abstract

“…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.…”

mentioning

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

View full text Add to dashboard Cite

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.

show abstract

Tc-99m HMDP bone scintigraphy for cardiac amyloidosis diagnosis: A false positive case

Cited by 5 publications

References 3 publications

^99mTechnetium‐pyrophosphate scintigraphy: a practical guide for early diagnosis of transthyretin amyloid cardiomyopathy

^99mTechnetium‐pyrophosphate scintigraphy: a practical guide for early diagnosis of transthyretin amyloid cardiomyopathy

False Positive in [99mTc]Tc-DPD Scintigraphy for Cardiac Amyloidosis Due to Intravenous Iron Administration

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

Contact Info

Product

Resources

About