Does [99mTc]-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) soft tissue uptake allow the identification of patients with the diagnosis of cardiac transthyretin-related (ATTR) amyloidosis with higher risk for polyneuropathy?

Abstract

Background With the introduction of several drugs for the therapy of transthyretin-related amyloidosis (ATTR) which slow down the disease, early detection of polyneuropathy (PNP) is becoming increasingly of interest. [99mTc]-3,3-Diphosphono-1,2-Propanodicarboxylic Acid (DPD) bone scintigraphy, which is used for the diagnosis of cardiac (c)ATTR, can possibly make an important contribution in the identification of patients at risk for PNP. Methods Fifty patients with cATTR, who underwent both planar whole-body DPD scintigraphy and nerve conduction studies (NCS) were retrospectively evaluated. A subgroup of 22 patients also underwent quantitative SPECT/CT of the thorax from which Standardized Uptake Values (SUVpeak) in the subcutaneous fat tissue of the left axillar region were evaluated. Results The Perugini score was significantly increased in patients with cATTR and additional diagnosis of PNP compared to patients without (2.51 ± 0.51 vs 2.13 ± 0.52; P = 0.03). Quantitative SPECT/CT revealed that DPD uptake in the subcutaneous fat of the left axillar region was significantly increased in cATTR patients with compared to patients without (1.36 ± 0.60 vs 0.74 ± 0.52; P = 0.04). Conclusion This study suggests that DPD bone scintigraphy is a useful tool for identification of patients with cATTR and a risk for PNP due to increased DPD soft tissue uptake.

Cardiac DPD-uptake time dependency in ATTR patients verified by quantitative SPECT/CT and semiquantitative planar parameters

“…suggesting that a higher blood pool is not the reason for the non-significant difference in H/CL between 1 and 3 hours p.i. Furthermore, we included patients with wtATTR and hATTR, who may present different tracer distribution behavior 15,27 with a higher lung uptake in the early imaging phase consecutively influencing the H/CL rations as shown in Figure 3. Examining patients with wtATTR and hATTR separately no significant difference were also observed making it unlikely that a different tissue and compartment composition may affected the H/CL rate at 1 hours p.i.…”

Bone scintigraphy imaging and transthyretin-related (ATTR) cardiac amyloidosis: New tricks from an old tool?

“…13 In this issue of the Journal of Nuclear Cardiology, Wollenweber et al reported the potential utility of increased [ 99m Tc]-3,3-Diphosphono-1,2-Propanodicarboxylic Acid (DPD) soft tissue uptake to serve as an imaging marker that identifies patients with ATTR-CA at a higher risk for having concomitant PNP. 14 The authors of this study hypothesized that there would be higher soft tissue DPD uptake in ATTR-CA patients with PNP as compared to ATTR-CA patients without PNP. In this retrospective, single center study, a cohort of 50 patients with ATTR-CA (41 wild-type and 9 hereditary) who had undergone whole body DPD scintigraphy and a nerve conduction study (NCS) were evaluated.…”