99mTechnetium-labeled cardiac scintigraphy for suspected amyloidosis: a review of current and future directions

Saad, Jean Michel; Ahmed, Ahmed Ibrahim; Han, Yushui; Saeed, Subha; Pournazari, Payam; Al-Mallah, Mouaz

doi:10.1007/s10741-021-10174-x

Cited by 5 publications

(8 citation statements)

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“…Cardiac scintigraphy provides incremental value in the workup of CA because it can differentiate between AL and ATTR amyloidosis. 3 , 51 More importantly, 99m Tc-labeled radiotracer cardiac scintigraphy prevents the need for invasive diagnostic procedures in patients screened for monoclonal gammopathies, effectively rewriting previous diagnostic approaches to CA, especially ATTR-CA. 3 , 52 Initial interest in 99m Tc-labeled bone scans as an imaging tool for amyloidosis began during the 1970s and 1980s after studies reported diffuse myocardial uptake, particularly in the right and left ventricles of patients with CA.…”

Section: Technetium-labeled Cardiac Scintigraphymentioning

confidence: 99%

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Saad

Ahmed

Anugula

et al. 2022

Methodist DeBakey Cardiovascular Journal

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Cardiac amyloidosis (CA) is the buildup and infiltration of amyloid plaque in cardiac muscle. An underdiagnosed form of restrictive cardiomyopathy, CA can rapidly progress into heart failure. CA is evaluated using a multimodality approach that includes echocardiography, cardiac magnetic imaging, and nuclear imaging. Echocardiography remains an essential first-line modality that raises suspicion for CA and establishes functional baselines. Cardiac magnetic imaging provides additional incremental value via high-resolution imaging, robust functional assessment, and superior tissue characterization, all of which enable a more comprehensive investigation of CA. Cardiac scintigraphy has eliminated the need for invasive diagnostic approaches and helps differentiate CA subtypes. Positron emission tomography is the first modality introducing targeted amyloid binding tracers that allow for precise burden quantification, early detection, and disease monitoring. In this review, we highlight the role of several cardiac imaging techniques in the evaluation of CA.

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Section: Technetium-labeled Cardiac Scintigraphymentioning

confidence: 99%

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Saad

Ahmed

Anugula

et al. 2022

Methodist DeBakey Cardiovascular Journal

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“…[ 99m Tc]Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ([ 99m Tc]Tc-DPD), [ 99m Tc]Tc-hydroxy-methylene diphosphonate ([ 99m Tc]Tc-HMDP) and [ 99m Tc]Tc-pyrophosphate ([ 99m Tc]Tc-PYP) are the three SPECT bone tracers approved for assessing ATTR-CM diagnostic [11,12]. [ 99m Tc]Tc-PYP is not recommended in Europe for amyloidosis exploration, although it is preferentially used in the United States of America [13]. Not all 99m Tc-bisphosphonates necessarily have the same sensitivity for detecting ATTR-CM, and some authors do not recommend the use of [99mTc]Tc-methylene diphosphonate ([ 99m Tc]Tc-MDP) in this indication [6].…”

Section: Introductionmentioning

confidence: 99%

Bone tracers for transthyretin amyloid cardiomyopathy: are [^99mTc]Tc-DPD and [^99mTc]Tc-HMDP truly equivalent?

Dubois,

Kucharczak,

Mariano-Goulart

et al. 2024

Preprint

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Background The management of transthyretin amyloid cardiomyopathy (ATTR-CM) has revolved around the scintigraphic diagnosis since the introduction of a specific treatment; however, the equivalency of the bone radiotracers remains unclear. This retrospective monocentric observational study compared [99mTc]Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ([99mTc]Tc-DPD) and [99mTc]Tc-hydroxy-methylene diphosphonate ([99mTc]Tc-HMDP) for ATTR-CM diagnosis. Methods One hundred and twenty-nine patients who underwent single photon emission computed tomography (SPECT/CT) after intravenous injection of [99mTc]Tc-DPD or [99mTc]Tc-HMDP for ATTR-CM were included. The patients' current visual Perugini grades were retrieved. Regions of interest (ROI) were measured on the heart (H) and on contralateral mediastinum (CM), and H/CM ratios were calculated. Results Although the distribution of quantitative assessments of heart to contralateral mediastinum ratios is wider with [99mTc]Tc-DPD, suggesting a trend towards improved diagnosis, no difference in Perugini grades was found between [99mTc]Tc-DPD or [99mTc]Tc-HMDP for the diagnosis of ATTR-CM in evocative/non-evocative conditions. There was no difference in ATTR-CM diagnosis between the 2 tracers with a threshold of 1.5 (p-value = 3.316*10-10 for [99mTc]Tc-HMDP and p-value = 2.59*10-15 for [99mTc]Tc-DPD). Conclusions We show in our local cohort that [99mTc]Tc-DPD and [99mTc]Tc-HMDP for amyloidosis diagnostic are equivalent for ATTR-CM diagnosis based on the Perugini grading scale. With [99mTc]Tc-DPD, a wider range of the H/CM ratio was noted, which may be considered as a better discrimination of the disease by this bone tracer. Additional research with a final diagnosis of the disease is necessary to evaluate the utility of this quantitative evaluation.

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“…This infiltration of the heart interstitium by amyloid causes the stiffening of the myocardium, resulting in progressive cardiac dysfunction, which has a great impact on the quality of life [ 4 ]. Deposits can derive from different precursors, the most common accumulations being immunoglobulin-derived amyloid light chains (AL), produced by monoclonal plasma cells, and transthyretin amyloidosis (ATTR), which results from misfolded proteins synthesized by the liver [ 5 , 6 ]. At present, over 98% of diagnosed cardiac amyloidosis results from fibrils pertaining to one of the two aforementioned types [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…AL and ATTR amyloidosis exhibit different and diverse patterns of deposition throughout the body, distinct clinical courses, dissimilar prognoses and specially tailored therapies [ 1 , 5 , 7 ]. Due to these distinct characteristics, AL and ATTR cardiac amyloidosis present differently in diagnostic tests.…”

Section: Introductionmentioning

confidence: 99%

“…Although cardiac scintigraphy with bone-seeking tracers lacks the ability to offer structural or hemodynamic information, it can provide incremental value through its unique ability to differentiate between ATTR and AL amyloidosis [ 5 , 21 , 25 ]. Perugini et al [ 26 ] were the first group of authors to establish a semiquantitative approach in differentiation between AL and ATTR amyloidosis based on planar 99m Tc-DPD scintigraphy.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis—A New Dimension of Molecular Imaging

Gherghe,

Lazar,

Sterea

et al. 2023

JCDD

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Aims: Cardiac transthyretin amyloidosis (ATTR) represents the accumulation of misfolded transthyretin in the heart interstitium. Planar scintigraphy with bone-seeking tracers has long been established as one of the three main steps in the non-invasive diagnosis of ATTR, but lately, single-photon emission computed tomography (SPECT) has gained wide recognition for its abilities to exclude false positive results and offer a possibility for amyloid burden quantitation. We performed a systematic review of the existing literature to provide an overview of the available SPECT-based parameters and their diagnostic performances in the assessment of cardiac ATTR. Methods and Methods: Among the 43 papers initially identified, 27 articles were screened for eligibility and 10 met the inclusion criteria. We summarised the available literature based on radiotracer, SPECT acquisition protocol, analysed parameters and their correlation to planar semi-quantitative indices. Results: Ten articles provided accurate details about SPECT-derived parameters in cardiac ATTR and their diagnostic potential. Five studies performed phantom studies for accurate calibration of the gamma cameras. All papers described good correlation of quantitative parameters to the Perugini grading system. Conclusions: Despite little published literature on quantitative SPECT in the assessment of cardiac ATTR, this method offers good prospects in the appraisal of cardiac amyloid burden and treatment monitoring.

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99mTechnetium-labeled cardiac scintigraphy for suspected amyloidosis: a review of current and future directions

Cited by 5 publications

References 58 publications

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Bone tracers for transthyretin amyloid cardiomyopathy: are [^99mTc]Tc-DPD and [^99mTc]Tc-HMDP truly equivalent?

Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis—A New Dimension of Molecular Imaging

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99mTechnetium-labeled cardiac scintigraphy for suspected amyloidosis: a review of current and future directions

Cited by 5 publications

References 58 publications

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Bone tracers for transthyretin amyloid cardiomyopathy: are [99mTc]Tc-DPD and [99mTc]Tc-HMDP truly equivalent?

Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis—A New Dimension of Molecular Imaging

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Bone tracers for transthyretin amyloid cardiomyopathy: are [^99mTc]Tc-DPD and [^99mTc]Tc-HMDP truly equivalent?