Usefulness of technetium-99m pyrophosphate myocardial scintigraphy in amyloid polyneuropathy and correlation with echocardiography

Fournier, Claude; Grimon, G.; Rinaldi, J.-P.; Terral, Alain; Boujon, B.; Adams, David; Desgrez, A.; Blondeau, M

doi:10.1016/0002-9149(93)91085-v

Cited by 17 publications

(9 citation statements)

References 7 publications

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“…Scintigraphic results bare, however, shown a very good relationship with histopathological results and clinical evolution with time. In three patients (21,22,25) the heart involvement indicated by the TcA scintigraphy was confirmed by biopsy. Furthermore, in patient 21, who showed strong thyroid uptake of TcA, a post-mortem examination revealed massive perifollicular amyloid infiltration.…”

Section: Discussionmentioning

confidence: 89%

“…In fact, it was also possible to image myocardial involvement in a patient (25) with a hereditary form due to transthyretin gene mutation, and faint ~if-fllfi~ upfal~e was noted in patient C1 of the control group with pleural sarcoidosis and Congo red birefringence on biopsy specimens, probably related to the AA form. In an ongoing clinical trial thus fär including 25 subjects receiving chronic haemodialysis, TcA uptake has been observed in medium and large size joints in those patients with dialysis-related amyloidosis, but also in a patient presenting with both forms of amyloidosis.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

et al. 1995

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Antiproteases are known to be present in amyloid deposits. We evaluated the possibility of using an anti-serine protease (aprotinin) labelled with technetium-99m (TcA), usually employed as a cortical renal tracer, for the imaging of amyloid deposits. Because of the known high uptake of TcA by the kidneys, we limited our analysis to extra-abdominal amyloid localizations. We report the scintigraphic findings observed in 24 patients with light chain amyloidosis (AL) and one with a hereditary form who were known or suspected to have extra-abdominal involvement. Planar scans obtained 100min after i.v. TcA administration showed myocardial accumulation in 11 patients, pleuropulmonary accumulation in nine, pericardial accumulation in two and localization in the neck region (thyroid, salivary glands and tongue) in eight. TcA scintigraphy was negative in five patients without clinical or laboratory evidence of extra-abdominal involvement, as well as in 12 control group patients with cardiac and renal diseases. These preliminary results indicate TcA to be a low-cost, readily available radiopharmaceutical for imaging of extra-abdominal involvement in AL type amyloidosis.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

et al. 1995

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“…Examination of these patients has often been based solely on either invasive or noninvasive tests of cardiac function, ranging from echocardiography, EKG [18], and radionu clide ventriculography [19] to angiocardio- 150 Fiori/Salvi/Plasmati/Tcssari/Bianchi/ Tassinari lntramyocytc Amyloid Deposits in TTR-Met30 Amyloidosis graphic hemodynamics [20]; although gener ally unspecific, most of these techniques have succeeded in differentiating cardiac amyloid osis from other types of contrictive pericardi tis and restrictive cardiomyopathy. Observation of histopathological changes has mostly focused on extracardiac tissues (peripheral nerve, skin, skeletal muscle) ob tained by biopsy at various times in the course of the disease, while the myocardium has almost exclusively been studied in postmor tem specimens, which prevented parallel bio chemical analysis.…”

Section: Discussionmentioning

confidence: 99%

Amyloid Deposits inside Myocardial Fibers in Transthyretin-Met30 Familial Amyloidotic Polyneuropathy

et al. 1994

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A case of severe cardiac involvement is reported in a patient affected with familial amyloidotic polyneuropathy due to the Portuguese type I variant (Val→Met30) of the transthyretin (prealbumin) molecule. Echocardiographic and hemodynamic studies suggested the presence of a progressive infiltrative cardiomyopathy that was later confirmed by endomyocardial biopsy. Amyloid deposits were found in both intra- and extra-myofiber location and thought to be related to primary involvement of the heart. Norepinephrine content of myocardial bioptic specimens was about threefold lower than normal, indicating that autonomic denervation may contribute to the maintenance and progression of cardiomyopathy. A sample obtained from the sural nerve showed a loss of myelinated fibers along with accumulation of amyloid masses in the endoneurial space. This histopathologic pattern correlated with a sharp decrease in the activity of the enzyme subserving electrochemical conduction through the axonal membrane, Na⁺, K⁺-ATPase.

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“…pyrophosphate ( 99m Tc-PPi) [4,7,10,12], 99m-technetium methylene diphosphonate ( 99m Tc-MDP) [1], and 99m-technetium 3,3-diphosphono-1,2-propanodicarboxylic acid ( 99m Tc-DPD). However, conflicting results in terms of diagnostic performance do occur, since extra-osseous bone uptake of bone tracers has been attributed to a variety of pathological conditions -from myocardial infarction to amyloidosis or neoplastic diseases.…”

Section: Current Issues In Pharmacy and Medical Sciencesmentioning

confidence: 99%

In vitro study: binding of ^99mTc-DPD to synthetic amyloid fibrils

Buroni

Persico

Lodola

et al. 2015

Current Issues in Pharmacy and Medical Sciences

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This paper is an report of the investigation of the in vitro binding of 99mTc-DPD for synthetic amyloid fibrils used for the diagnosis of cardiac amyloidosis (CA), as compared with the use of 99mTc-HMDP and 99mTc-PPI. It also includes an inquiry into the role played by Ca2+ ions and serum proteins on binding to amyloid like materials, as well as the saturability and specificity of DPD for fibrils versus amorphous precipitates (AP). In the work, synthetic insulin fibrils (SIF) and AP were characterized by Congo red staining and TEM imaging. An equal amount of three radiopharmaceuticals were then added to fibrils in Ca2+ (0-4.2 mmol/L) or human serum (HS) adjoined samples and radiopharmaceutical uptake was assessed. To test the saturability of amyloid binding sites, a displacement assays with cold DPD was performed, while adding 50-1500 nmol of 99mTc-DPD to SIF or AP, saturation binding tests were subsequently carried out for evaluating its specificity for amyloid. Herein, synthetic fibrils and AP showed conformational differences at TEM and polarized microscopy analysis. In our study, 99mTc-DPD fibrils uptake was seen to be the highest and increased with calcium ions concentration. What is more, serum proteins reduced the bound fraction to the amyloid deposits of about 15%, and the Kd values of 90 nM and 114 nM relative to SIF and AP, respectively, did not significantly differ. We saw that 99mTc-DPD is the best seeker for amyloid fibrils in cardiac amyloidosis, and that Ca2+ concentration positively influenced DPD fibrils binding. Furthermore, the radioactivity bound to the serum protein clear up the idea of nuclide exchanging dynamic balance between amyloid and circulating proteins. Moreover, non-labeled DPD did not exert a competition for 99mTc-DPD binding sites, and, finally, DPD cannot be defined a radiopharmaceutical specific for amyloid deposits.

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Usefulness of technetium-99m pyrophosphate myocardial scintigraphy in amyloid polyneuropathy and correlation with echocardiography

Cited by 17 publications

References 7 publications

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

Amyloid Deposits inside Myocardial Fibers in Transthyretin-Met30 Familial Amyloidotic Polyneuropathy

In vitro study: binding of ^99mTc-DPD to synthetic amyloid fibrils

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Usefulness of technetium-99m pyrophosphate myocardial scintigraphy in amyloid polyneuropathy and correlation with echocardiography

Cited by 17 publications

References 7 publications

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

Cardiac and pleuropulmonary AL amyloid imaging with technetium-99m labelled aprotinin

Amyloid Deposits inside Myocardial Fibers in Transthyretin-Met30 Familial Amyloidotic Polyneuropathy

In vitro study: binding of 99mTc-DPD to synthetic amyloid fibrils

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In vitro study: binding of ^99mTc-DPD to synthetic amyloid fibrils