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Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis

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Abstract

Purpose

Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR.

Methods

A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) “amyloid” OR “amyloidosis” AND (b) “TTR” OR “ATTR” OR “transthyretin” AND (c) “scintigraphy” OR “scan” OR “SPECT” OR “SPET” OR “bone” OR “skeletal” OR “skeleton” OR “PYP” OR “DPD” OR “HMDP” OR “MDP” OR “HDP”. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated.

Results

The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89–95%), specificity 95.4% (95% CI 77–99%), LR+ 7.02 (95% CI 3.42–14.4), LR− 0.09 (95% CI 0.06–0.14), and DOR 81.6 (95% CI 44–153). Mild heterogeneity was found among the selected studies.

Conclusion

Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.

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Authors and Affiliations

  1. Clinic of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland

    Giorgio Treglia, Luca Ceriani & Luca Giovanella

  2. Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  3. Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  4. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland

    Giorgio Treglia & John O. Prior

  5. Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W. J. M. Glaudemans & Riemer H. J. A. Slart

  6. Department of Nuclear Medicine, Spedali Civili of Brescia and University of Brescia, Brescia, Italy

    Francesco Bertagna & Raffaele Giubbini

  7. Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Bouke P. C. Hazenberg

  8. Department of Nuclear Medicine, University of Pisa, Pisa, Italy

    Paola A. Erba

  9. Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands

    Riemer H. J. A. Slart

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  1. Giorgio Treglia
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Correspondence to Giorgio Treglia.

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Treglia, G., Glaudemans, A.W.J.M., Bertagna, F. et al. Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 45, 1945–1955 (2018). https://doi.org/10.1007/s00259-018-4013-4

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