Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR cardiac amyloidosis: Comparison of quantitative and semi-qua
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´ de Montre ´ al (CHUM), Universite ´ de Montre ´ al, Montreal, QC, Centre Hospitalier de l’Universite Canada Department of Medical Imaging, Institut de Cardiologie de Montreal, Montreal, QC, Canada Department of Radiology, University of Manitoba, Winnipeg, MB, Canada BC Cancer Agency, Vancouver, BC, Canada Department of Radiology and Nuclear Medicine, Jewish General Hospital, Montreal, QC, Canada University of Ottawa Heart Institute, Ottawa, ON, Canada Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Received Feb 23, 2020; accepted May 12, 2020 doi:10.1007/s12350-020-02205-1
Background. ATTR cardiac amyloidosis (CA) can be diagnosed with Tc-99m-PYP scintigraphy. There are two recommended interpretative approaches: the quantitative heart-tocontralateral lung ratio (H/CL) at 1 hour and the semi-quantitative visual system at 3 hours. This study’s aim was to compare both approaches and to apply the semi-quantitative method at 1 hour. Methods. Tc-99m-PYP scans of 122 consecutive subjects were reviewed using both approaches. On 1 hour planar images, regions of interest were drawn over the heart and contralateral chest to determine H/CL. Myocardial uptake was graded on 1 and 3 hour SPECT images according to the semi-quantitative method. Concordance was examined using kappa statistics. Results. 31, 10, and 81 studies were positive, negative, and equivocal, respectively, for ATTR-CA using the H/CL approach. Using the grading system, 35, 77, and 10 scans were positive, negative, and equivocal, respectively. The quantitative approach led to a significantly higher proportion of equivocal studies compared to the semi-quantitative approach (P < .0001). These approaches yielded discordant results in 2 subjects; biopsy results were concordant with SPECT grade. 1 and 3 hour SPECT grades provided concordant result in 99% of cases. Conclusions. The H/CL approach resulted in a high proportion of equivocal studies. Using SPECT imaging, the semi-quantitative approach minimized this proportion and showed high concordance at 1 and 3 hours. (J Nucl Cardiol 2020) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02205-1) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPointfile, available for download at SpringerLink, which summarizes thecontents of the paper and is free for re-use at meetings andpresentations. Search for the article DOI on SpringerLink.com.
Daniel Juneau and Matthieu Pelletier-Galarneau are co-senior authors. Reprint requests: Matthieu Pelletier-Galarneau, MD, MSc, Department of Medical Imaging, Institut de Cardiologie de Montreal, 5000, Be´langer, Montreal, QC H1T1C8, Canada; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Re´gis et al Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR
Journal of Nuclear CardiologyÒ
Key Words: Cardiac amyloidosis Æ cardiovascular ima
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