Role of Nuclear Imaging in Cardiac Amyloidosis Management: Clinical Evidence and Review of Literature

Cardiac amyloidosis (CA) is an infiltrative disease characterized by the extracellular deposition of fibrils, amyloid, in the heart. The vast majority of patients with CA has one of two types between transthyretin amyloid (ATTR) and immunoglobulin light chain associated amyloid (AL), that have different prognosis and therapeutic options. CA is often underdiagnosed. The histological analysis of endomyocardial tissue is the gold standard for the diagnosis, although it has its limitations due to its invasive nature. Nuclear medicine now plays a key role in the early and accurate diagnosis of this disease, and in the ability to distinguish between the two forms. Recent several studies support the potential advantage of bone-seeking radionuclides as a screening technique for the most common types of amyloidosis, in particular ATTR form. This review presents noninvasive modalities to diagnose CA and focuses on the radionuclide imaging techniques (bone-seeking agents scintigraphy, cardiac sympathetic innervation and positron emission tomography studies) available to visualize myocardial amyloid involvement. Furthermore, we report the case of an 83-year old male with a history of prostate cancer, carcinoma of the cecum and kidney cancer, submitted to bone scan to detect bone metastasis, that revealed a myocardial uptake of 99mTC-HMPD suggestive of ATTR CA. An accurate and early diagnosis of CA able to distinguish beyween AL and ATTR CA combined to the improving therapies could improve the survival of patients with this disease.

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Cardiac retention of [11C]HED in genotyped long QT patients: a potential amplifier role for severity of the disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00276.2003 ◽

2003 ◽

Vol 285 (3) ◽

pp. H1286-H1293 ◽

Cited By ~ 19

Author(s):

Alejandro N. Mazzadi ◽

Xavier André-Fouët ◽

Jérôme Duisit ◽

Véronique Gebuhrer ◽

Nicolas Costes ◽

...

Keyword(s):

Sympathetic Innervation ◽

Long Qt ◽

Cardiac Sympathetic Innervation ◽

Relative Retention ◽

Sympathetic Function ◽

Positron Emission ◽

Severity Of The Disease ◽

Sodium And Potassium ◽

Congenital Long Qt Syndrome

Although mutations in cardiac sodium and potassium channel genes are associated with congenital long QT syndrome (LQTS), a “modifier” role of the sympathetic nervous system was proposed to explain the distinct severity of the disease. We evaluated cardiac sympathetic innervation using [11C]hydroxyephedrine ([11C]HED) and positron emission tomography (PET) in genotyped LQTS patients. H215O and [11C]HED PET studies were performed in 11 patients (5 symptomatic) and 8 controls. Perfusion and [11C]HED images were depicted as 36-sector polar maps. Sectorial values of perfusion (H2O%), absolute (HEDRet) and relative retention (HED%Ret) of [11C]HED, and the ratio of HED%Ret to H2O% (HED%Ret/H2O%) were calculated. Normal databases were obtained from controls. Sectorial values below 2SD database values were defined as “outside sectors.” Controls and patients showed similar sectorial perfusion. Sectorial HEDRet did not differ between groups, but means of HED%Ret were lower in three sectors for patients ( P < 0.05). Three sectors from 3 controls had HED%Ret below 2SD, whereas 36 sectors in 9 patients were outside sectors ( P < 0.01). In patients, average HED%Ret/H2O% was lower in 9 sectors ( P < 0.05 vs. controls); 2 outside sectors were found in controls, but 43 outside sectors were found in patients ( P < 0.01), 77% of them in the 5 symptomatic patients. Heterogeneous [11C]HED retention was localized in the septal, anterior, and lateral walls. Most LQTS patients showed a localized and decreased pattern of [11C]HED retention. The larger number of heterogeneous sectors in symptomatic patients suggests that sympathetic function could play an amplifier role for severity of the disease.

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News about the Role of Fluid and Imaging Biomarkers in Neurodegenerative Diseases

Biomedicines ◽

10.3390/biomedicines9030252 ◽

2021 ◽

Vol 9 (3) ◽

pp. 252

Author(s):

Jacopo Meldolesi

Keyword(s):

Neurodegenerative Diseases ◽

Imaging Techniques ◽

Imaging Biomarkers ◽

Positron Emission ◽

Specific Proteins ◽

Great Relevance ◽

The Brain ◽

Positive Point

Biomarkers are molecules that are variable in their origin, nature, and mechanism of action; they are of great relevance in biology and also in medicine because of their specific connection with a single or several diseases. Biomarkers are of two types, which in some cases are operative with each other. Fluid biomarkers, started around 2000, are generated in fluid from specific proteins/peptides and miRNAs accumulated within two extracellular fluids, either the central spinal fluid or blood plasma. The switch of these proteins/peptides and miRNAs, from free to segregated within extracellular vesicles, has induced certain advantages including higher levels within fluids and lower operative expenses. Imaging biomarkers, started around 2004, are identified in vivo upon their binding by radiolabeled molecules subsequently revealed in the brain by positron emission tomography and/or other imaging techniques. A positive point for the latter approach is the quantitation of results, but expenses are much higher. At present, both types of biomarker are being extensively employed to study Alzheimer’s and other neurodegenerative diseases, investigated from the presymptomatic to mature stages. In conclusion, biomarkers have revolutionized scientific and medical research and practice. Diagnosis, which is often inadequate when based on medical criteria only, has been recently improved by the multiplicity and specificity of biomarkers. Analogous results have been obtained for prognosis. In contrast, improvement of therapy has been limited or fully absent, especially for Alzheimer’s in which progress has been inadequate. An urgent need at hand is therefore the progress of a new drug trial design together with patient management in clinical practice.

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Рositron emission tomography in assessment of heart sympathetic nervous system

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2008-14-4-347-355 ◽

2008 ◽

Vol 14 (4) ◽

pp. 347-355

Author(s):

D. Ryzhkova ◽

E. M. Zykov ◽

E. V. Shlyakhto

Keyword(s):

Nervous System ◽

Heart Diseases ◽

Sympathetic Innervation ◽

Cardiovascular Complications ◽

Emission Tomography ◽

Good Tool ◽

Technical Aspects ◽

Cardiac Sympathetic Innervation ◽

Positron Emission ◽

Sympathetic Nervous

This article summarizes data of the studies with the use of positron emission tomography (PET) and devotes technical aspects and clinical application of PET for assessment of the autonomic nervous system of the heart in patients with cardiac diseases. According to the results of experimental and clinical studies PET with radiolabeled сatecholamines and adrenoreceptor ligands provides us with information about alteration of cardiac sympathetic innervation at different steps of neurotransmission. It plays a key role in the progression of various heart diseases such as ischemia, diabetes mellitus, heart failure and noncoronary arrhythmia. Cardiac sympathetic neuronal PET imaging seems to be a good tool for the stratification of the risk of the severe cardiovascular complications.

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Abstract W P333: Seizure as the Presenting Symptom of ICH Patient Characteristics and EEG Utilization

Stroke ◽

10.1161/str.46.suppl_1.wp333 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Kanika Arora ◽

Alyssa Gadpaille ◽

Karen C. Albright ◽

Muhammad Alvi ◽

Ayaz Khawaja ◽

...

Keyword(s):

Substance Abuse ◽

Clinical Evidence ◽

Patient Characteristics ◽

Rhythmic Pattern ◽

Epileptiform Discharges ◽

Number Of Patients ◽

Eeg Data ◽

History Of ◽

Ich Score

Background and Purpose: Seizures are the presenting symptom in a significant number of patients with spontaneous ICH. The role of EEG in the routine evaluation patients, with or without clinical evidence of seizures, is unclear. This study was undertaken to better understand seizures and the use of EEG in patients with ICH. Methods: Retrospective review of consecutive spontaneous ICH patients at our institution from 2008-2013. Patients were considered to have a seizure on presentation if a clinical evidence of a seizure was documented in the medical record; EEG data was not required to confirm seizure on presentation. Demographics, vascular risk factors, ICH score, and EEG findings were assessed. Results: Of 402 spontaneous ICH patients (mean age 63, 42% black, 43% female), 10% presented with seizure. Patients presenting with seizure were younger (mean age 65 vs. 54, p<.001). Compared to patients with ICH presenting without a seizure, blacks presented more frequently with seizure (62% vs. 40%, p=.009). A higher proportion of patients who presented with seizure had a history of alcohol use (50% vs. 27%, p=.008) and substance abuse (23% vs. 10%, p=.025). Patients who presented with seizure more frequently had cortical ICH (54% vs. 32%, p=.007). EEGs were performed more frequently in ICH patients that presented with seizure (66% vs. 19%, p<.001). Among patients with an EEG, epileptiform discharges or rhythmic pattern was more common in patients who presented with seizure (30% vs. 10%, p=.040) and with a cortical ICH (29% vs. 9%, p=.036). There were no significant differences in the proportion of patients that received EEG based on race, history of alcohol abuse, or history of substance abuse. Conclusions: Patients who presented with seizure were younger, black, and a higher proportion had a history of alcohol and substance abuse compared to patients with ICH who did not present with a seizure. Only 66% of those presenting with clinical seizure underwent EEG. Despite the prevalence of subclinical seizures in ICH patients, only 19% of patients who did not present with a seizure underwent EEG. Our study suggests that there may be room for improvement on the part of stroke neurologists in the diagnosis and management seizure of ICH patients.

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Radiology of the head and neck

10.1093/med/9780199682874.003.0218 ◽

2021 ◽

pp. 973-976

Author(s):

Ivan Zammit-Maempel

Keyword(s):

Head And Neck ◽

Imaging Techniques ◽

Cone Beam Ct ◽

Neck Mass ◽

Positron Emission ◽

Pet Ct ◽

Magnetic Resonance Imaging Mri ◽

Video Fluoroscopy

Various imaging techniques are used in the staging and follow-up of head and neck cancer and evaluating patients presenting with a neck mass. The workhorses in imaging the neck are ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) with positron emission tomography CT (PET-CT) increasingly being requested. Plain radiographs, contrast studies, video fluoroscopy, angiography, and cone beam CT have limited but important roles. This chapter discusses the role of some of these modalities.

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Assessment of Right Ventricular Function: Role of Nuclear Imaging Techniques

Cardiology Clinics ◽

10.1016/s0733-8651(18)30253-4 ◽

1992 ◽

Vol 10 (1) ◽

pp. 23-39 ◽

Cited By ~ 15

Author(s):

Diwakar Jain ◽

Barry L. Zaret

Keyword(s):

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Imaging Techniques ◽

Nuclear Imaging

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New insights into the role of imaging in polymyalgia rheumatica

Rheumatology ◽

10.1093/rheumatology/keaa646 ◽

2020 ◽

Author(s):

Dario Camellino ◽

Christina Duftner ◽

Christian Dejaco

Keyword(s):

Fdg Pet ◽

Clinical Symptoms ◽

Imaging Techniques ◽

Diagnostic Value ◽

Current Data ◽

Acute Phase Reactants ◽

Anatomical Basis ◽

Positron Emission ◽

Diagnostic Values

Abstract PMR is an inflammatory rheumatic disease of elderly people characterized by pain and stiffness in the neck, shoulder and pelvic girdles. No specific diagnostic confirmatory tests exist and clinical symptoms, as well as increased acute phase reactants, are unspecific. The diagnostic value of imaging including ultrasound, MRI and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with/without CT for PMR is increasingly studied. These techniques, particularly FDG-PET/CT, may help to detect underlying GCA in PMR patients with an incomplete response to glucocorticoids and/or recurrent relapses. Recent imaging studies provide novel insights into the anatomical basis of inflammation in PMR, particularly at hip and spine, which may help to distinguish this disease from other mimicking conditions. In this review, we discuss novel insights into the pathoanatomy of PMR, compare the diagnostic values of different imaging techniques and summarize current data on the role of imaging for monitoring and outcome prediction.

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The role of cardiac sympathetic innervation and skin thermoreceptors on cardiac responses during heat stress

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00911.2014 ◽

2015 ◽

Vol 308 (11) ◽

pp. H1336-H1342 ◽

Cited By ~ 9

Author(s):

Manabu Shibasaki ◽

Yasunori Umemoto ◽

Tokio Kinoshita ◽

Ken Kouda ◽

Tomoyuki Ito ◽

...

Keyword(s):

Heat Stress ◽

Diastolic Function ◽

Systolic Function ◽

Sympathetic Innervation ◽

Ventricular Systolic Function ◽

Cardiac Sympathetic Innervation ◽

Cardiac Responses ◽

Cardiac Systolic Function ◽

Stimulation Of

The mechanism(s) for the changes in cardiac function during heat stress remain unknown. This study tested two unique hypotheses. First, sympathetic innervation to the heart is required for increases in cardiac systolic function during heat stress. This was accomplished by comparing responses during heat stress between paraplegics versus tetraplegics, with tetraplegics having reduced/absent cardiac sympathetic innervation. Second, stimulation of skin thermoreceptors contributes to cardiovascular adjustments that occur during heat stress in humans. This was accomplished by comparing responses during leg only heating between paraplegic versus able-bodied individuals. Nine healthy able-bodied, nine paraplegics, and eight tetraplegics participated in this study. Lower body (i.e., nonsensed area for para/tetraplegics) was heated until esophageal temperature had increased by ∼1.0°C. Echocardiographic indexes of diastolic and systolic function were performed before and at the end of heat stress. The heat stress increased cardiac output in all groups, but the magnitude of this increase was attenuated in the tetraplegics relative to the able-bodied (1.3 ± 0.4 vs. 2.3 ± 1.0 l/min; P < 0.05). Diastolic function was maintained in all groups. Indexes of left atrial and ventricular systolic function were enhanced in the able-bodied, but did not change in tetraplegics, while these changes in paraplegics were attenuated relative to the able-bodied. These data suggest that the cardiac sympathetic innervation is required to achieve normal increases in cardiac systolic function during heat stress but not required to maintain diastolic function during this exposure. Second, elevated systolic function during heat stress primarily occurs as a result of increases in internal temperature, although stimulation of skin thermoreceptors may contribute.

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