Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis

• Published in: Journal of nuclear cardiology Vol. 26; no. 2; pp. 497 - 504
• Main Authors: Cappelli, Francesco, Gallini, Chiara, Di Mario, Carlo, Costanzo, Egidio Natalino, Vaggelli, Luca, Tutino, Francesca, Ciaccio, Alfonso, Bartolini, Simone, Angelotti, Paola, Frusconi, Sabrina, Farsetti, Silvia, Vergaro, Giuseppe, Giorgetti, Assuero, Marzullo, Paolo, Genovesi, Dario, Emdin, Michele, Perfetto, Federico
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01.04.2019; Springer International Publishing
• Subjects: Aged; Amyloid Neuropathies, Familial - diagnostic imaging; amyloidosis; BIOPSY; Cardiology; DIAGNOSIS; Echocardiography; Echocardiography, Doppler; Female; HEART; Humans; HYPERTROPHY; Hypertrophy, Left Ventricular; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Original Article; PATIENTS; Prealbumin - chemistry; PYROPHOSPHATES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Imaging; Reproducibility of Results; Retrospective Studies; scintigraphy; SCINTISCANNING; Tc-HMDP; TECHNETIUM 99; Technetium Tc 99m Medronate - analogs & derivatives; TRACER TECHNIQUES; UPTAKE; Whole Body Imaging; TTR CA; amyloidosis; NT-proBNP; AL CA; Tc-DPD; scintigraphy; Tc-PYP; Tc-HMDP; LVH
• ISSN: 1071-3581; 1532-6551; 1532-6551
• DOI: 10.1007/s12350-017-0922-z

Either 99mTechnetium diphosphonate (Tc-DPD) or pyrophosphate (Tc-PYP) scintigraphy plays a relevant role in diagnosing transthyretin cardiac amyloidosis (CA), and labeled radiotracers have been extensively studied in diagnosing CA. Few studies have analyzed and validated 99mTc-Hydroxymethylene diphosphonate (Tc-HMDP). Our aim was to validate the diagnostic accuracy of Tc-HMDP total-body scintigraphy in a cohort of patients with biopsy-proven transthyretin CA. We retrospectively evaluated all patients undergoing 99mTc-HMDP total-body scintigraphy, in adjunct to a comprehensive diagnostic work-up for suspected CA. Sixty-five patients were finally diagnosed with CA, while it was excluded in 20 subjects with left ventricular hypertrophy of various etiologies. Twenty-six patients had AL-CA, 39 had TTR CA (16 TTRm, 23 TTRwt). At Tc-HMDP scintigraphy, 2 AL patients showed a Perugini score grade 1 heart uptake, while 24 showed no uptake. All TTR patients showed Tc-HMDP uptake, with three patients showing a Perugini score grade 1, 16 grade 2, and 20 grade 3, respectively. No uptake was observed in patients with left ventricular hypertrophy. A positive Tc-HMDP scintigraphy showed a 100% sensitivity and a 96% specificity for TTR CA identification. Tc-HMDP scintigraphy is as accurate as Tc-DPD or Tc-PYP, and may therefore de facto be considered a valuable tool for the diagnosis of TTR CA.