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. 2022 Feb;29(1):307-318.
doi: 10.1007/s12350-020-02239-5. Epub 2020 Jun 28.

Cardiac amyloidosis detection by early bisphosphonate (99mTc-HMDP) scintigraphy

M F Santarelli  1   2 , D Genovesi  3 , V Positano  3 , R Di Sarlo  4 , M Scipioni  5   6 , A Giorgetti  3 , L Landini  3   4 , P Marzullo  3
Affiliations

Cardiac amyloidosis detection by early bisphosphonate (99mTc-HMDP) scintigraphy

M F Santarelli et al. J Nucl Cardiol. 2022 Feb.

Abstract

Objective: To determine one or more indexes able to detect the presence of cardiac amyloidosis (CA) from planar scintigraphy images after injection of 99mTc-HMDP tracer and to identify the earliest acquisition time able to ensure an accurate diagnosis of amyloid transthyretin CA.

Methods and results: A total of 38 patients were included: 18 subjects with a final diagnosis of ATTR-CA and 20 controls. Dynamic planar images of the anterior thorax were acquired, starting at intravenous injection of ≈ 700 MBq of 99mTc-HMDP. From time/activity curves (TAC) of regions of interest such as heart, vascular region, right ribcage, and soft tissues, several indices were considered. From the analysis, it resulted that both TACHeart/Bone(t) and RIheart-bone(t), for t > 6 minutes, well distinguish ATTR-CA patients from controls subjects. This is confirmed by the area under curves (AUC) analysis giving AUC values =.9 at t ≅ 6 minutes and AUC ≅ 1 for t > 10 minutes.

Conclusions: The method proposed allows determining the presence of ATTR-CA, in an inexpensive manner both in terms of examination costs and time spent.

Keywords: Amyloid transthyretin (ATTR); Cardiac amyloidosis; Dynamic time-activity curves; Early 99mTc-HMDP scintigraphy; Retention index.

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