Temporal Changes in Myocardial Uptake on Serial Bone Scans in Two Cases of Presumed Senile Cardiac Amyloidosis

Abstract Background/Introduction Transthyretin amyloidosis (TTR) is a cause of restrictive cardiomyopathy and heart failure predominantly in elderly men. Two main factors have moved TTR amyloidosis from super-specialist centres into mainstream cardiology: We aimed to determine the potential magnitude of referrals to our embryonic cardiac TTR service from patients having routine bone scans for non-cardiac reasons. We planned to estimate the prevalence of cardiac TTR in our local over 65 male population to plan service provision. Methods All HDP bone scans performed at a teaching and research hospital in the UK from the 2017/18 financial year were reviewed (n=1530). Our hospital is the only provider of these scans locally. Of these, 1399 were for oncological and musculoskeletal (oncology/MSK) indications and 37 were referred to specifically “exclude amyloidosis”. We excluded paediatric and duplicate follow-up imaging. There are approximately 140,000 people over aged 65 living within our catchment region. We have assumed approximately 50% are male. Results Myocardial uptake was present in 7/1399 of the oncology/MSK group and 3/7 (43%) of these already had features of heart failure. In these 7 patients bone scans were performed to investigate bony metastases in 6 (1 oesophageal cancer and 5 for prostate cancer) and 1 following an orthopaedic procedure. Cardiac uptake was present in 10/37 of the “exclude amyloid” group. In those with cardiac uptake across both groups (17) 94% were male with a mean age of 83 (sd ±6.59) and 41% were from the oncology/musculoskeletal group. Incidental cardiac uptake was seen in 1:200 routine HDP scans. When looking at males >65 specifically the uptake rate increases to (6 out of 701 scans) i.e. 1:117. Assuming there is no increased risk of TTR in patients with prostate or oesophageal cancer, then an estimate of cardiac TTR in the 75,000 males over the age of 65 locally would be approximately 640 men. Conclusions Bone scans account for 41% of all HDP scans with incidental cardiac uptake and therefore represents a significant potential referral source for a cardiac amyloid service. Our data suggests a potential prevalence of cardiac amyloidosis in 1:117 men over 65 with 43% already having heart failure symptoms and signs. Our age and sex specific prevalence suggests cardiac TTR is neither a rare nor unusual diagnosis. We will use our prevalence estimate to ensure our cardiac TTR service is resourced appropriately. We suggest that cardiac amyloid and cardio-oncology services should include pathways incorporating rapid access routes for suitable patients with incidental cardiac uptake on bone scans performed by non-cardiologists. Funding Acknowledgement Type of funding source: None

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Discordant Findings on 18F-NaF and 99mTc-HDP Bone Scans in a Patient With ATTR Cardiac Amyloidosis

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000001933 ◽

2018 ◽

Vol 43 (3) ◽

pp. e89-e92 ◽

Cited By ~ 5

Author(s):

Quinn K.T. Ng ◽

Pooja Sethi ◽

Tara A. Saunders ◽

Miguel Hernandez Pampaloni ◽

Robert R. Flavell

Keyword(s):

Cardiac Amyloidosis ◽

Bone Scans

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Cardiac Amyloidosis Detected by Tc-99m (V) DMSA Myocardial Uptake

Clinical Nuclear Medicine ◽

10.1097/00003072-199419120-00019 ◽

1994 ◽

Vol 19 (12) ◽

pp. 1109-1111 ◽

Cited By ~ 1

Author(s):

CARLO MANNI ◽

GIUSEPPE SANGIORGI ◽

SERGIO BOEMI ◽

DOMENICO DE NARDO ◽

CESIDIO CIPRIANI ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Myocardial Uptake

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Quantification of myocardial 99mTc-labeled bisphosphonate uptake with cadmium zinc telluride camera in patients with transthyretin-related cardiac amyloidosis

EJNMMI Research ◽

10.1186/s13550-019-0584-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Alain Manrique ◽

David Dudoignon ◽

Stéphanie Brun ◽

Catherine N’Ganoa ◽

Emmanuelle Cassol ◽

...

Keyword(s):

Quantitative Analysis ◽

Cardiac Amyloidosis ◽

Mean Value ◽

Whole Body ◽

Myocardial Uptake ◽

Whole Body Scan ◽

Body Scan ◽

Transthyretin Amyloidosis ◽

Septal Thickness ◽

Czt Spect

Abstract Purpose We aimed to compare different methods for semi-quantitative analysis of cardiac retention of bone tracers in patients with cardiac transthyretin amyloidosis (ATTR). Methods Data from 67 patients with ATTR who underwent both conventional whole-body scan and a CZT myocardial SPECT (DSPECT, Spectrum Dynamics) 3 h after injection of 99mTc-labeled bone tracer were analyzed. Visual scoring of cardiac retention was performed on whole-body scan according to Perugini 4-point grading system from 0 (no uptake) to 3 (strong cardiac uptake with mild/absent bone uptake). A planar heart-to-background (H:B) ratio was calculated using whole-body scan (wb-H:B). CZT SPECT was quantified using three methods: planar H:B ratio calculated from anterior reprojection (ant-H:B), left anterior oblique reprojection (LAO-H:B), and 3D-H:B ratio calculated from transaxial slices as mean counts in a VOI encompassing the heart divided by background VOI in the contralateral lung. Interventricular septal thickness was obtained using echocardiography. Results H:Bs obtained from planar and reprojected data were not statistically different (wb-H:B, 2.05 ± 0.64, ant-H:B, 1.97 ± 0.61, LAO-H:B, 2.06 ± 0.64, all p = ns). However, 3D-H:B was increased compared to planar H:Bs (3D-H:B, 4.06 ± 1.77, all p < 0.0001 vs. wb-H:B, ant-H:B, and LAO-H:B). Bland-Altman plots demonstrated that the difference between 3D and planar H:Bs increased with the mean value of myocardial uptake. 3D-H:B was best correlated to septal thickness (r = 0.45, p < 0.001). Finally, abnormal right ventricular uptake was associated with higher values of cardiac retention. Conclusion 3D semi-quantitative analysis of CZT SPECT optimized the assessment of 99mTc-labeled bone tracer myocardial uptake in patients with cardiac amyloidosis.

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Early-phase myocardial uptake intensity of 99mTc-HMDP vs 99mTc-DPD in patients with hereditary transthyretin-related cardiac amyloidosis

Journal of Nuclear Cardiology ◽

10.1007/s12350-016-0707-9 ◽

2016 ◽

Vol 25 (1) ◽

pp. 217-222 ◽

Cited By ~ 15

Author(s):

Mukedaisi Abulizi ◽

Anne-Ségolène Cottereau ◽

Aziz Guellich ◽

Stéphanie Vandeventer ◽

Arnault Galat ◽

...

Keyword(s):

Early Phase ◽

Cardiac Amyloidosis ◽

Myocardial Uptake

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Positive Myocardial Uptake of Bone Scintigraphic Agents Associated with Cardiac Amyloidosis: Frequency of Positive Uptake Data Based on Daily Clinical Practice

Annals of Nuclear Cardiology ◽

10.17996/anc.20-00121 ◽

2020 ◽

Vol 6 (1) ◽

pp. 27-32

Author(s):

Shigeru Fukuzawa ◽

Shinichi Okino ◽

Hikaru Ishiwaki ◽

Yo Iwata ◽

Takashi Uchiyama ◽

...

Keyword(s):

Clinical Practice ◽

Cardiac Amyloidosis ◽

Daily Clinical Practice ◽

Myocardial Uptake ◽

Uptake Data

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373 Utility of the early phase of DPD scintigraphy in the diagnosis of correlated TT-R cardiac amyloidosis

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.050 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Tiziano Graziani ◽

Carla Cidda ◽

Walter Serra ◽

Maria Mattioli ◽

A. Sammartano ◽

...

Keyword(s):

Early Phase ◽

Cardiac Amyloidosis ◽

Tracer Uptake ◽

Specific Pattern ◽

Myocardial Uptake ◽

Tracer Injection ◽

Cardiac Region ◽

Planar Images ◽

Heart To Mediastinum Ratio ◽

Predictive Role

Abstract Aims The importance of cardiac scan with phosphonate-based radiotracers in the diagnosis of cardiac amyloidosis is now well established. Standard imaging is performed 3 h after tracer injection with a planar view on the cardiac region. This study sought to evaluate the predictive role of early-phase myocardial uptake (10 min after injection) of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) compared compared with standard late acquisition, in patients with suspected hereditary transthyretin-related cardiac amyloidosis (TTR-CA). Methods and results Fifty five patients with suspected of TTR-CA with typical aspects of the relative apical sparing at two-dimensional speckle-tracking echocardiography, reported as a specific pattern for cardiac amyloidosis, were enrolled after having signed informed written consent. They have been subjected to a 99mTc-DPD cardiac scintigraphy with planar acquisition at 10 min and 3 h after tracer injection (13 Mbq/Kg). Patients with cardiac uptake on the planar images concluded the examination with a SPECT-CT (cardiac protocol) to assess the affected myocardial segments. On planar images the heart-to-mediastinum-ratio was measured. Subsequently, the diagnosis of amyloidosis has to be confirmed with morphologic examinations such as biopsy and genetic tests. Of the enrolled patients with clinical and echocardiographic aspect of TTR-CA, 22 were positive for cardiac amyloidosis. All of them showed tracer uptake in both early and late images. In patients with positive results, the early-phase showed a Heart-to-mediastinum-ratio >1.2. SPECT/CT showed involvement of almost two myocardial segments: in all patients the ventricular septum showed significant tracer uptake. Conclusions Our small group of patients showed that 99mTc-DPD myocardial uptake intensity on early-phase scintigraphy can be used to anticipate the results of late images in diagnosis of TTR cardiac amyloidosis.

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Does the etiology of cardiac amyloidosis determine the myocardial uptake of [18F]-NaF PET/CT?

Journal of Nuclear Cardiology ◽

10.1007/s12350-016-0457-8 ◽

2016 ◽

Vol 24 (2) ◽

pp. 746-749 ◽

Cited By ~ 18

Author(s):

Christian Gagliardi ◽

Elena Tabacchi ◽

Rachele Bonfiglioli ◽

Stefania Diodato ◽

Cristina Nanni ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Myocardial Uptake ◽

Pet Ct

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Grade 3 myocardial uptake in 99mtechnetium-pyrophosphate scintigraphy in light chain cardiac amyloidosis

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab321 ◽

2021 ◽

Author(s):

Atsushi Okada ◽

Emi Tateishi ◽

Keiko Ohta-Ogo ◽

Chisato Izumi

Keyword(s):

Light Chain ◽

Cardiac Amyloidosis ◽

Myocardial Uptake ◽

Monoclonal Protein ◽

Grade 3

Abstract We report grade 3 myocardial uptake in 99mtechnetium-pyrophosphate (99mTc-PYP) scintigraphy in a case of light-chain cardiac amyloidosis (CA), which emphasizes the importance of screening for monoclonal protein even in typical 99mTc-PYP findings of transthyretin CA.

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