Inter-observer reproducibility and intra-observer repeatability in 99m Tc-pyrophosphate scan interpretation for diagnosi
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Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Heart & Vascular Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
Received Apr 13, 2020; accepted Aug 6, 2020 doi:10.1007/s12350-020-02353-4
Aim. The purpose of this study was to determine the inter- and intra-observer variability in technetium-pyrophosphate (99mTc-PYP) scan interpretation for diagnosis of transthyretin cardiac amyloidosis (ATTR). Methods and Results. Our study cohort comprised 100 consecutive subjects referred for 99mTc-PYP imaging based on clinical suspicion of ATTR cardiac amyloidosis. Myocardial 99mTc-PYP uptake was assessed by both visual (comparison of myocardial to rib uptake) and semi-quantitative (heart-to-contralateral lung uptake ratio, H:CL) methods. Twenty scans were analyzed twice, at least 48 hours apart, by each of two independent observers. Patients with visual scores of ‡ 2 on planar imaging as well as myocardial uptake on SPECT/CT were classified as ATTR positive. Diagnosis of ATTR by visual 99mTc-PYP grade was perfectly reproducible [concordance: positive and negative scans 100% (53/53 and 47/47, respectively). Both inter- and intra-observer correlations for H:CL ratio (r2 = 0.90, 0.99 (Observer 1) and 0.98 (Observer 2), respectively) and repeatability values on Bland–Altman plots were excellent. The coefficient of variation (%) for Observers 1 and 2 was 3.21 (2.14 to 4.29) and 7.49 (4.95 to 10.09), respectively. In addition, there was 100% concordance in positive and negative scan interpretation by visual grading between novice CV imagers (< 3 years’ experience) and an experienced CV imager (10 years’ experience). Conclusions. This study showed excellent inter-observer reproducibility and intra-observer repeatability of 99mTc-PYP visual scan interpretation and H:CL ratio for diagnosis of cardiac ATTR amyloidosis. Cardiac ATTR amyloidosis can be diagnosed reliably using 99mTc-PYP SPECT/CT by novice and experienced CV imagers. (J Nucl Cardiol 2020) Key Words: Amyloid heart disease Æ SPECT Æ molecular imaging 99m
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02353-4) contains supplementary material, which is available to authorized users. 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 SD and RF are supported by NIH RO1 Grant (RO1 HL 130563); SD is supported by American Heart Association Grant (AHA 16 CSA 2888 0004).
Reprint requests: Sharmila Dorbala, MD, MPH, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115; [email protected] 1071-3581/$34.00 Cop
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