Comparison of planar with tomographic pyrophosphate scintigraphy for transthyretin cardiac amyloidosis: Perils and pitfa
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Division of Cardiology, Cook County Health, Chicago Division of Cardiology, Rush Medical College, Chicago Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
Received Jun 20, 2020; accepted Aug 5, 2020 doi:10.1007/s12350-020-02328-5
Background. Tc-99m pyrophosphate (PYP) SPECT is recommended for indeterminate findings on planar imaging. We aimed to compare the findings on planar PYP scintigraphy alone to that of routinely performed PYP SPECT. Methods. PYP scintigraphy data of 133 patients (53% men; mean age 76 years) were evaluated. SPECT was routinely performed following 1-hour planar imaging, in all cases. Semiquantitative visual score and heart-to-contralateral (H/CL) ratio were determined in all patients as recommended. Results. PYP images from 35 patients (26%) were considered to be positive based on SPECT myocardial uptake. Among them, 20 (57%) had a H/CL ratio ‡1.5 and 34 had a visual score ‡ 2. SPECT identified myocardial uptake in one patient with a visual score < 2 and refuted the presence of myocardial uptake in two patients with a visual score ‡ 2. Visual score correlated well with SPECT (r = 0.94; P < .0001) and had an accuracy of 98% for tomographic myocardial uptake. Addition of H/CL ratio reduced the diagnostic performance of visual score. Conclusions. Planar-derived visual score has an excellent accuracy for tomographic myocardial uptake, though it misclassifies a small proportion of patients. H/CL ratio decreases the diagnostic certainty of planar imaging. Tomographic imaging prevents misdiagnoses and should always be performed. (J Nucl Cardiol 2020) Key Words: Amyloid heart disease Æ SPECT Æ Image analysis
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Funding This study was supported in part by the Becker Fund for Heart Research, Community Foundation of Greater Buffalo. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02328-5) contains supplementary material, which is available to authorized users.
Reprint requests: Saurabh Malhotra, MD, MPH, FASNC, Division of Cardiology, Cook County Health, Chicago; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Asif et al Limitations of planar PYP scintigraphy
Abbreviations PYP Techneticum-99m pyrophosphate TTR-CA Transthyretin cardiac amyloidosis H/CL Heart-to-contralateral ASNC American Society of Nuclear Cardiology SPECT Single photon emission computed tomography LVEF Left ventricular ejection fraction
INTRODUCTION Technetium-99m pyrop
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