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Comparison of cardio-focal and chest reconstruction of technetium-99m pyrophosphate scintigraphy for diagnosis of transthyretin cardiac amyloidosis: a quality assurance study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

SPECT improves diagnostic specificity of Technetium-99m pyrophosphate (PYP) scintigraphy. Diagnostic performance of PYP data, reconstructed as either chest or cardio-focal SPECT is not known.

Methods

In this quality assurance study, blinded evaluation of PYP SPECT/CT data from 102 Caucasian patients (mean age 76 ± 11 years, 67% men) was performed by two readers. Reader 1 reviewed planar and PYP chest SPECT, while reader 2 reviewed planar and cardio-focal PYP SPECT. Demographic, clinical, and other testing data were obtained from the electronic medical records.

Results

A total of 41 patients (40%) were considered positive based on myocardial uptake on chest PYP SPECT. Of these, 98% of the patients had a Perugini score ≥ 2 on planar imaging. There was good agreement between the two readers for visual score ≥ 2 (k = .88, P < .001) and excellent agreement for myocardial uptake on tomographic imaging (98%, P < .001). Only one study was categorized as false negative by cardio-focal SPECT reconstruction. Non-diffuse myocardial uptake was identified in 22% of those with a positive PYP SPECT.

Conclusion

When read by experienced readers, chest and cardio-focal reconstruction of PYP SPECT have comparable diagnostic performance. A substantial proportion of patients with a positive PYP SPECT have a non-diffuse distribution of PYP. Given the possibility of misclassification of non-diffuse myocardial uptake on cardio-focal reconstruction alone, chest reconstruction of PYP scintigraphy should be strongly considered.

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Abbreviations

CA:

Cardiac amyloidosis

PYP:

Technetium-99m pyrophosphate

ATTR:

Transthyretin amyloidosis

FOV:

Field of view

CZT:

Cadmium-zinc-telluride

LV:

Left ventricular

H/CL:

Heart to contralateral lung

CKD:

Chronic kidney disease

LVEF:

Left ventricular ejection fraction

IVSd:

Interventricular septum thickness in diastole

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Disclosure

Cigdem Akincioglu received research support from Pfizer; Mukunthan Murthy had none; Jonathan Romsa had none to disclose; James Warrington had— none to disclose; Saurabh Malhotra received research support from ASNC/Pfizer Inc., is one of the members in Speakers Bureau for Pfizer Inc. and Alnylam, and is an advisory board member for Pfizer, Alnylam, and BridgeBio.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Medical Imaging, Western University, London, ON, Canada

    Cigdem Akincioglu MD, Jonathan Romsa MD & James Warrington MD, PhD

  2. Department of Internal Medicine, Cook County Health, Chicago, IL, USA

    Mukunthan Murthi MD

  3. Division of Cardiology, Cook County Health, Chicago, IL, USA

    Saurabh Malhotra MD, MPH, FASNC

  4. Division of Cardiology, Rush Medical College, Chicago, IL, USA

    Saurabh Malhotra MD, MPH, FASNC

Authors
  1. Cigdem Akincioglu MD
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  2. Mukunthan Murthi MD
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  3. Jonathan Romsa MD
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  4. James Warrington MD, PhD
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  5. Saurabh Malhotra MD, MPH, FASNC
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Correspondence to Cigdem Akincioglu MD.

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Akincioglu, C., Murthi, M., Romsa, J. et al. Comparison of cardio-focal and chest reconstruction of technetium-99m pyrophosphate scintigraphy for diagnosis of transthyretin cardiac amyloidosis: a quality assurance study. J. Nucl. Cardiol. 30, 2607–2614 (2023). https://doi.org/10.1007/s12350-023-03256-w

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  • DOI: https://doi.org/10.1007/s12350-023-03256-w

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