Erschienen in:
01.04.2019 | Original Article
Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis
verfasst von:
Francesco Cappelli, MD, Chiara Gallini, MD, PhD, Carlo Di Mario, MD, PhD, Egidio Natalino Costanzo, MD, Luca Vaggelli, MD, Francesca Tutino, MD, Alfonso Ciaccio, MD, Simone Bartolini, MD, Paola Angelotti, MD, Sabrina Frusconi, BsC, Silvia Farsetti, MD, Giuseppe Vergaro, MD, PhD, Assuero Giorgetti, MD, Paolo Marzullo, MD, Dario Genovesi, MD, Michele Emdin, MD, PhD, Federico Perfetto, MD, PhD
Erschienen in:
Journal of Nuclear Cardiology
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Ausgabe 2/2019
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Abstract
Background and Aim
Either 99mTechnetium diphosphonate (Tc-DPD) or pyrophosphate (Tc-PYP) scintigraphy plays a relevant role in diagnosing transthyretin cardiac amyloidosis (CA), and labeled radiotracers have been extensively studied in diagnosing CA. Few studies have analyzed and validated 99mTc-Hydroxymethylene diphosphonate (Tc-HMDP). Our aim was to validate the diagnostic accuracy of Tc-HMDP total-body scintigraphy in a cohort of patients with biopsy-proven transthyretin CA.
Methods and Results
We retrospectively evaluated all patients undergoing 99mTc-HMDP total-body scintigraphy, in adjunct to a comprehensive diagnostic work-up for suspected CA. Sixty-five patients were finally diagnosed with CA, while it was excluded in 20 subjects with left ventricular hypertrophy of various etiologies. Twenty-six patients had AL-CA, 39 had TTR CA (16 TTRm, 23 TTRwt). At Tc-HMDP scintigraphy, 2 AL patients showed a Perugini score grade 1 heart uptake, while 24 showed no uptake. All TTR patients showed Tc-HMDP uptake, with three patients showing a Perugini score grade 1, 16 grade 2, and 20 grade 3, respectively. No uptake was observed in patients with left ventricular hypertrophy. A positive Tc-HMDP scintigraphy showed a 100% sensitivity and a 96% specificity for TTR CA identification.
Conclusions
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.