Towards reducing inter- and intra-observer variability: Reasons for optimism?
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Saint Luke’s Mid America Heart Institute, Kansas City, MO Cleveland Clinic Lerner College of Medicine, Fuad Jubran Endowed Chair in Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
Received Oct 12, 2020; accepted Oct 12, 2020 doi:10.1007/s12350-020-02422-8
See related article, doi: https://doi.org/1 0.1007/s12350-020-02353-4. ‘‘Admiration before the general spectacle and skepticism before the individual case.’’ James Baldwin Cardiac amyloidosis is a disorder where misfolded proteins aggregate as amyloid fibrils into various tissues or organs leading to their dysfunction. The most common type of cardiac amyloidosis was traditionally thought to result from immunoglobulin light chain aggregation (AL amyloidosis). However, with aging of the general population and the re-purposing of bone radiotracers previously used for myocardial infarction imaging and the advent of life-saving medication, there has been a dramatic increase in the diagnosis rates of transthyretin (ATTR) cardiac amyloidosis. Unfortunately, multiple bone radiotracers are available for this indication with availability dependent on the country, and there are multiple imaging protocols and time points at which to acquire images. This has made standardization and interpretation of sensitivity, specificity, and diagnostic accuracy of various reports from different centers and countries challenging. Practice points put out by ASNC and a multisociety expert consensus recommendations document have attempted to provide clarity to the indications for imaging, protocols, and interpretations using these radiotracers.1,2 However, multiple imaging protocols are suggested and
Reprint requests: Wael A. Jaber, MD FACC, FESC, Cleveland Clinic Lerner College of Medicine, Fuad Jubran Endowed Chair in Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH 44195; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
comparison among these protocols as well as inter- and intra-observer variability analyses are limited. The current study in this issue of the Journal of Nuclear CardiologyÒ by Singh et al. evaluated 100 consecutive patients at the Brigham and Women’s Hospital who were referred for technetium pyrophosphate (TcPYP) for the diagnosis of transthyretin cardiac amyloidosis (ATTR). Both planar and SPECT/CT images were obtained and were analyzed by the original reading physician, an additional experienced nuclear imager, and 2 novice nuclear imagers to assess inter- and intra-observer variability. About half of the images were acquired after 1-hour incubation and the rest at 2.5-3hour incubation. The results of the study showed a very high correlation for H/CL ratio on the planar images which is reassuring and has been described in several prior studies.3,4 Analysis of the SPECT/CT images showed a 100% correlation with respect to the study being considered positive or negative for ATTR among both the experienced and novice r
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