Absolute Quantitation of Cardiac <sup>99m</sup>Tc-Pyrophosphate Using Cadmium-Zinc-Telluride–Based SPECT/CT

Dorbala, Sharmila; Park, Mi-Ae; Cuddy, Sarah; Singh, Vinod K.; Sullivan, Kyle; Kim, Sirwoo; Falk, Rodney H.; Taqueti, Viviany R.; Skali, Hicham; Blankstein, Ron; Bay, Camden; Kijewski, Marie Foley; Carli, Marcelo F. Di

doi:10.2967/jnumed.120.247312

Cited by 63 publications

(51 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent clinical research has positioned 99m Tc‐labelled bone radiotracer scintigraphy as a highly sensitive and specific diagnostic tool for ATTR‐CM and suggests its potential as a quantitative diagnostic tool for ATTR‐CM. For example, the use of quantitative metrics for 99m Tc‐PYP imaging (SPECT/CT or SPECT) showed a higher diagnostic accuracy compared with the traditional visual grading approach 82 , 83 as well as its potential as a non‐invasive marker for prognosis. 83 Nevertheless, challenges remain in terms of appropriate implementation of this technique in daily clinical practice.…”

Section: Future Perspectivesmentioning

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

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: Future Perspectivesmentioning

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

“…Multiple authors have investigated the link between the uptake of

Tc-labeled bone-seeking agents and whether a bone lesion is benign or malignant [ 26 , 27 , 28 , 29 ]. In cardiac imaging, the uptake of a

Tc-labeled bone-seeking agent has been shown to correlate with current clinical standard quantitative measures for amyloid burden in cardiac amyloidosis, therapy response, extracellular volume as measured on NMR, and left ventricular mass index, as measured on echocardiography [ 30 ]. Together, these preliminary applications illustrate that further progress in absolute quantification in diagnostic applications can significantly increase the value of these imaging studies as a truly quantitative biomarker of disease severity, patient outcomes, or predictor of treatment response.…”

Section: Understanding the Need For Quantificationmentioning

confidence: 99%

Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise

et al. 2021

View full text Add to dashboard Cite

The application of absolute quantification in SPECT/CT has seen increased interest in the context of radionuclide therapies where patient-specific dosimetry is a requirement within the European Union (EU) legislation. However, the translation of this technique to diagnostic nuclear medicine outside this setting is rather slow. Clinical research has, in some examples, already shown an association between imaging metrics and clinical diagnosis, but the applications, in general, lack proper validation because of the absence of a ground truth measurement. Meanwhile, additive manufacturing or 3D printing has seen rapid improvements, increasing its uptake in medical imaging. Three-dimensional printed phantoms have already made a significant impact on quantitative imaging, a trend that is likely to increase in the future. In this review, we summarize the data of recent literature to underpin our premise that the validation of diagnostic applications in nuclear medicine using application-specific phantoms is within reach given the current state-of-the-art in additive manufacturing or 3D printing.

show abstract

“…11 Dorbala et al demonstrated significant correlations with extracellular volume estimates from CMR. 12 Many of the previously discussed studies have also demonstrated associations with clinical outcomes; however, the patient sample sizes preclude making firm conclusions based on these results. Overall, these studies provide some confidence that these measures may be useful for assessing disease burden non-invasively.…”

mentioning

confidence: 97%

“…10 There are now several methods which have been proposed to quantify bone radiotracer uptake from SPECT imaging. 8,9,[11][12][13][14][15][16] A few of these studies are outlined in Table 1. Some methods are based on measuring maximal standardized uptake volumes (SUV max ).…”

mentioning

confidence: 99%

Quantifying is believing: Techniques for evaluating transthyretin cardiac amyloidosis burden for expanded clinical applications

Miller

Fine

2022

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Absolute Quantitation of Cardiac ^99mTc-Pyrophosphate Using Cadmium-Zinc-Telluride–Based SPECT/CT

Cited by 63 publications

References 18 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

Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise

Quantifying is believing: Techniques for evaluating transthyretin cardiac amyloidosis burden for expanded clinical applications

Contact Info

Product

Resources

About

Absolute Quantitation of Cardiac 99mTc-Pyrophosphate Using Cadmium-Zinc-Telluride–Based SPECT/CT

Cited by 63 publications

References 18 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

Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise

Quantifying is believing: Techniques for evaluating transthyretin cardiac amyloidosis burden for expanded clinical applications

Contact Info

Product

Resources

About

Absolute Quantitation of Cardiac ^99mTc-Pyrophosphate Using Cadmium-Zinc-Telluride–Based SPECT/CT

^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