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. 2023 Jul 17;23(1):92.
doi: 10.1186/s12880-023-01054-x.

Direct comparison of diagnostic and clinical values between Tc-99 m DPD and Tc-99 m PYP scintigraphy in patients with cardiac amyloidosis

Yong-Jin Park #  1   2 , Joohee Lee #  3 , Darae Kim  4 , Jin-Oh Choi  4 , Seok Jin Kim  5 , Kihyun Kim  5 , Joon Young Choi  6
Affiliations

Direct comparison of diagnostic and clinical values between Tc-99 m DPD and Tc-99 m PYP scintigraphy in patients with cardiac amyloidosis

Yong-Jin Park et al. BMC Med Imaging. .

Abstract

Background: Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) and technetium-99 m sodium pyrophosphate (PYP) are the two most commonly used radiotracers for cardiac amyloidosis (CA), but no studies have directly compared them. Therefore, in this study, we directly compared the diagnostic and clinical utility of DPD and PYP scintigraphy in patients with CA.

Methods: Ten patients with CA were enrolled. Eight clinical variables and 12 scintigraphic parameters were used. Clinical variables were age, sex, estimated glomerular filtration rate (eGFR), N-terminal pro brain natriuretic peptide (NT-proBNP), and the results of electromyography (EMG), a sensory test, electrocardiogram, and echocardiography (EchoCG). Four heart retention ratios (heart/whole-body profile, heart/pelvis, heart/skull, and heart/contralateral lung) were calculated from the DPD and PYP scans and two visual scoring systems (Perugini and Dorbala systems) were used. Comparative analyses were performed between radiotracers and between visual scoring systems using clinical variables and scintigraphic parameters.

Results: Twenty DPD parameters and nine PYP parameters had significant associations with age, eGFR, NT-proBNP, EchoCG, and EMG. DPD parameters had more frequent significant associations with clinical variables than PYP parameters. Compared to visual scores in the DPD scan, the proportion of patients with higher visual scores in the PYP scan was relatively greater than those with lower visual scores, and there were more patients with a visual score of 2 or higher in PYP scans than DPD scans.

Conclusions: DPD scintigraphy may reflect the disease severity of CA better than PYP scintigraphy, whereas PYP scintigraphy may be a more sensitive imaging modality for identifying CA involvement.

Keywords: Cardiac amyloidosis; Dorbala system; Perugini system; Tc-99m DPD; Tc-99m PYP.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
ROI drawing methods for heart retention ratios. (a) WB profile, heart, kidney, bladder, and pelvis ROIs were drawn manually. In addition, the skull ROI was drawn using a rectangular ROI. H/WBp, H/P, and H/S ratios were calculated using these ROIs. (b) To calculate the H/CL ratio, heart and contralateral lung ROIs were drawn using simplified circular ROIs Abbreviations: ROI, region of interest; WB, whole-body; H/WBp, heart/whole-body profile ratio; H/P, heart/pelvis ratio; H/S, heart/skull ratio; H/CL, heart/contralateral lung ratio
Fig. 2
Fig. 2
A representative case with the same visual score of 3 in (a) DPD and (b) PYP scans Abbreviations: DPD, technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid; PYP, technetium-99 m pyrophosphate.
Fig. 3
Fig. 3
A representative case with different visual scores in the DPD and PYP scans. (a) In the DPD scan, both Perugini and Dorbala scores of the case patient were 0. (b) Perugini and Dorbala scores were higher in the PYP scan than the DPD scan, and the Dorbala score (Score 2) was higher than the Perugini score (Score 1) Abbreviations: DPD, technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid; PYP, technetium-99 m pyrophosphate
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