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Diagnosis of cardiac amyloid transthyretin (ATTR) amyloidosis by early (soft tissue) phase [99mTc]Tc-DPD whole body scan: comparison with late (bone) phase imaging

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

A Correction to this article was published on 03 February 2022

This article has been updated

Abstract

Objectives

Although expert consensus recommendations suggest 2–3 h as the time interval between bone-seeking radiotracers injection and acquisition, it has been reported that images obtained early after [99mTc]Tc-HMDP administration are sufficient to diagnose cardiac amyloidosis. We evaluated the diagnostic performance of [99mTc]Tc-DPD early phase whole body scan with respect to late phase imaging.

Methods

We qualitatively and semiquantitatively reviewed [99mTc]Tc-DPD imaging of 53 patients referred for suspect cardiac amyloidosis. Findings of early and late phase images were compared with SPECT results (considered the standard-of-reference) determining sensitivity and specificity for visual analysis of each phase imaging and for each semiquantitative index.

Results

SPECT imaging was negative for cardiac accumulation in 25 patients and positive in 28. Visual analysis of early phase whole body scan had an extremely significant capability to predict SPECT results; nevertheless, complete agreement was not reached. Visual analysis of late phase imaging showed slightly better results. Semiquantitative analysis of early phase images, namely heart to mediastinum ratio, performed better than semiquantitative analysis of late phase images.

Conclusion

Visual analysis of [99mTc]Tc-DPD early phase whole body scan is promising in diagnosing cardiac amyloidosis; further studies are needed to confirm our results in different clinical scenarios.

Key Points

• Visual analysis of early phase planar imaging using [99mTc]Tc-DPD is accurate to diagnose cardiac amyloidosis and may be satisfactory at least in frail patients with high cardiac burden of amyloid fibrils.

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Change history

Abbreviations

ATTR :

Amyloid transthyretin

ATTRv :

Hereditary ATTR

ATTRwt :

Wild type ATTR

DPD :

3, 3-Diphosphono-1, 2-propanodicarboxylic acid

H/CL :

Heart to contralateral ratio

H/M :

Heart to mediastinum ratio

H/WB :

Heart/whole body ratio

HMDP :

Hydroxymethylene diphosphonate

HR :

Heart retention

PND :

Polyneuropathy disability score

PYP :

Pyrophosphate

ROI :

Region of interest

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Acknowledgements

Minutoli Fabio acknowledges speaker fee from Pfizer. Russo Massimo acknowledges speaker fee and consulting honoraria from Pfizer. Travel grant from Alnylam and Akcea. Gentile Luca acknowledges speaker fee and consulting honoraria from Pfizer. Mazzeo Anna acknowledges financial support from Pfizer, Alnylam and Akcea for participation in national and international meetings, participation in Advisory Board of Pfizer, Alnylam and Akcea. Vita Giuseppe acknowledges speaker fee and consulting honoraria from Alnylam, Akcea, Avexis, Roche and Biogen. Di Bella Gianluca acknowledges speaker fee and consulting honoraria from Pfizer, Akcea Therapeutics, Alaylam. Baldari Sergio, Laudicella Riccardo, Spataro Alessandro, Vento Antonio, Comis Alessio have nothing to disclose.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy

    Fabio Minutoli, Riccardo Laudicella, Alessandro Spataro, Antonio Vento, Alessio Comis & Sergio Baldari

  2. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Massimo Russo, Gianluca Di Bella, Luca Gentile, Anna Mazzeo & Giuseppe Vita

  3. Nuclear Medicine Unit, University Hospital “Policlinico G.Martino”, via Consolare Valeria n.1, 98125, Messina, Italy

    Riccardo Laudicella

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  1. Fabio Minutoli
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Correspondence to Riccardo Laudicella.

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The scientific guarantor of this publication is Sergio Baldari.

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The authors declare no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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• performed at one institution

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The original online version of this article was revised: In this article, the author’s name Gianluca Di Bella was incorrectly written as Gianluca Di Bellaearly phase planar imaging. The original article has been corrected.

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Minutoli, F., Russo, M., Di Bella, G. et al. Diagnosis of cardiac amyloid transthyretin (ATTR) amyloidosis by early (soft tissue) phase [99mTc]Tc-DPD whole body scan: comparison with late (bone) phase imaging. Eur Radiol 32, 3035–3044 (2022). https://doi.org/10.1007/s00330-021-08420-9

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