Incidental cardiac uptake in bone scintigraphy: increased importance and association with cardiac amyloidosis

Delaney, Francis T.; Dempsey, P.; Welaratne, Ivan; Buckley, Bryan; O’Sullivan, D; O’Connell, Martin

doi:10.1259/bjrcr.20200161

Cited by 6 publications

(7 citation statements)

References 31 publications

(44 reference statements)

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“…In addition, it is important for clinicians to be aware of the relevance of incidental DPD uptake on bone scintigraphy in prostate cancer. 51 To reduce diagnosis-related missed opportunities, education regarding CA may be necessary for echocardiographers who report scans and doctors to appropriately interpret bloods, ECG and imaging tests. Examples of common presentations and the sources of referrals to a specialist with an interest in CA are shown Figure 3.…”

Section: Reducing Missed Opportunities In Camentioning

confidence: 99%

The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis

Kwok,

Moody

2023

Therapeutic Advances in Cardiovascular Disease

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Cardiac amyloidosis (CA) is a condition caused by extracellular deposition of amyloid fibrils in the heart. It is an underdiagnosed disease entity which can present with a variety of cardiac and non-cardiac manifestations. Diagnosis usually follows an initial suspicion based on clinical evaluation or imaging findings before confirmation with subsequent imaging (echocardiography, cardiac magnetic resonance imaging, 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy) in combination with biochemical screening for monoclonal dyscrasia (serum free light chains and serum and urine electrophoresis) and/or histology (bone marrow trephine, fat or endomyocardial biopsy). More than 95% of CA can be classified as either amyloid light-chain (AL) CA or amyloid transthyretin (ATTR) CA; these two conditions have very different management strategies. AL-CA, which may be associated with multiple myeloma, can be managed with chemotherapy agents, autologous stem cell transplantation, cardiac transplant and supportive therapies. For ATTR-CA, there is increasing importance in making an early diagnosis because of novel treatments in development, which have transformed this once incurable disease to a potentially treatable disease. Timely diagnosis is crucial as there may only be a small window of opportunity where patients can benefit from treatment beyond which therapies may be less effective. Reviewing the existing patient pathway provides a basis to better understand the complexities of real-world activities which may be important to help reduce missed opportunities related to diagnosis and treatment for patients with CA. With healthcare provider interest in improving the care of patients with CA, the development of an optimal care pathway for the condition may help reduce delays in diagnosis and treatment and thus enhance patient outcomes.

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Section: Reducing Missed Opportunities In Camentioning

confidence: 99%

The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis

Kwok,

Moody

2023

Therapeutic Advances in Cardiovascular Disease

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“…The simplicity of imaging and a high specificity of nearly 100% (in the absence of light chains and monoclonal protein) for ATTR-CA are the advantages of scintigraphy emphasized by many authors. [44][45][46] Currently, a semi-quantitative visual assessment is applied using the Perugini 4-point scale (0-3). 44 The degree of isotope accumulation is compared to the flat sections of the ribs.…”

Section: Radioisotope Techniquesmentioning

confidence: 99%

Updates for the diagnosis and management of cardiac amyloidosis

et al. 2022

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A substantial increase in the interest in transthyretin cardiac amyloidosis (ATTR-CA) is a result of the constantly growing number of patients, the use of clear diagnostic protocols and the availability of the first selective drug for these patients. This has also raised the awareness of the disease among physicians of all specialties. The topic is particularly relevant to cardiologists, who use non-invasive multimodal imaging in their daily practice.The differential diagnosis of the causes of myocardial hypertrophy includes arterial hypertension, hypertrophic cardiomyopathy, aortic stenosis (AS), athletic heart syndrome, Fabry disease, and cardiac amyloidosis (CA). It turns out that in patients with myocardial hypertrophy >15 mm, amyloidosis is the most common cause of left ventricular (LV) hypertrophy. In parallel, CA is one of the most common infiltrative diseases leading to a clinical picture that may mimic heart failure with preserved ejection fraction (HFpEF).The accumulation of amyloid in the extracellular space impairs the diastolic function of the myocardium, which is observed as the restrictive cardiomyopathy phenotype. In advanced cases, the LV systolic function is also impaired. Moreover, protein deposits contribute to the disturbances of calcium metabolism and cell metabolism as well as to cardiotoxicity, leading to edema and damage to cardiomyocytes.

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“…Radiotracers used for bone scintigraphy, such as the technetium‐99m labeled phosphate analogues, are known to accumulate in sites of infarction, such as the myocardium 51 . 18 F‐NaF has also been used to assess myocardial infarction with PET‐MRI.…”

Section: Pet‐mri and Myocardial Imaging In Coronary Artery Diseasementioning

confidence: 99%

PET‐MRI of Coronary Artery Disease

Whittington

Dweck

Beek

et al. 2022

Magnetic Resonance Imaging

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Simultaneous positron emission tomography and magnetic resonance imaging (PET‐MRI) combines the anatomical detail and tissue characterization of MRI with the functional information from PET. Within the coronary arteries, this hybrid technique can be used to identify biological activity combined with anatomically high‐risk plaque features to better understand the processes underlying coronary atherosclerosis. Furthermore, the downstream effects of coronary artery disease on the myocardium can be characterized by providing information on myocardial perfusion, viability, and function. This review will describe the current capabilities of PET‐MRI in coronary artery disease and discuss the limitations and future directions of this emerging technique.Level of Evidence5Technical EfficacyStage 3

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Incidental cardiac uptake in bone scintigraphy: increased importance and association with cardiac amyloidosis

Cited by 6 publications

References 31 publications

The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis

The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis

Updates for the diagnosis and management of cardiac amyloidosis

PET‐MRI of Coronary Artery Disease

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