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Review
. 2023 May 31;10(6):242.
doi: 10.3390/jcdd10060242.

Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis-A New Dimension of Molecular Imaging

Mirela Gherghe  1   2 , Alexandra Maria Lazar  2   3 , Maria-Carla Sterea  2 , Paula Monica Spiridon  2 , Natalia Motas  4   5 , Laurentia Nicoleta Gales  6   7 , Daniel Coriu  8   9 , Sorina Nicoleta Badelita  9 , Mario-Demian Mutuleanu  1   2
Affiliations
Review

Quantitative SPECT/CT Parameters in the Assessment of Transthyretin Cardiac Amyloidosis-A New Dimension of Molecular Imaging

Mirela Gherghe et al. J Cardiovasc Dev Dis. .

Abstract

Aims: Cardiac transthyretin amyloidosis (ATTR) represents the accumulation of misfolded transthyretin in the heart interstitium. Planar scintigraphy with bone-seeking tracers has long been established as one of the three main steps in the non-invasive diagnosis of ATTR, but lately, single-photon emission computed tomography (SPECT) has gained wide recognition for its abilities to exclude false positive results and offer a possibility for amyloid burden quantitation. We performed a systematic review of the existing literature to provide an overview of the available SPECT-based parameters and their diagnostic performances in the assessment of cardiac ATTR. Methods and Methods: Among the 43 papers initially identified, 27 articles were screened for eligibility and 10 met the inclusion criteria. We summarised the available literature based on radiotracer, SPECT acquisition protocol, analysed parameters and their correlation to planar semi-quantitative indices.

Results: Ten articles provided accurate details about SPECT-derived parameters in cardiac ATTR and their diagnostic potential. Five studies performed phantom studies for accurate calibration of the gamma cameras. All papers described good correlation of quantitative parameters to the Perugini grading system.

Conclusions: Despite little published literature on quantitative SPECT in the assessment of cardiac ATTR, this method offers good prospects in the appraisal of cardiac amyloid burden and treatment monitoring.

Keywords: ATTR amyloidosis; SPECT/CT; amyloid burden; cardiac amyloidosis; molecular imaging; myocardium; restrictive cardiomyopathy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
SPECT/CT advantages in comparison to planar scintigraphy in the assessment of cardiac transthyretin amyloidosis.
Figure 2
Figure 2
Schematic representation of the process of literature selection for this qualitative review.
Figure 3
Figure 3
Radiotracers distribution among the included studies. Abbreviations: DPD: 3,3-diphosphono-1,2-propanodicarboxylic acid; HDP: hydroxy-methylene diphosphonate; HDMP: hydroxy-dimethylene diphosphonate; PYP: pyrophosphate.
Figure 4
Figure 4
SPECT/CT-derived myocardial SUVmax variation in correlation to Perugini grading (images from our laboratory).
Figure 5
Figure 5
47 year old patient diagnosed with familial ATTR (Glu54Gln). The planar bone scan shows 99mTc-PYP cardiac uptake greater than bone uptake, transcribing into Perugini score 3. Quantitative SPECT/CT confirms this observation, with the myocardium showing an SUVmax of 7.27 g/mL, which is higher than the one in bone (namely T12 vertebrae), with SUVmax of 6.84 g/mL (Images from our laboratory. Quantitative SPECT/CT was performed using Q.VolumetrixAI software, provided by General Electric Healthcare, on images obtained 3 h post-radiotracer administration. The heart volume was manually segmented and a region-of-interest for measuring the SUVmax of the myocardium was inserted and adjusted to the myocardial uptake).
See this image and copyright information in PMC

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