Cardiac amyloidosis detection by early bisphosphonate (99mTc-HMDP) scintigraphy



To determine one or more indexes able to detect the presence of cardiac amyloidosis (CA) from planar scintigraphy images after injection of 99mTc-HMDP tracer and to identify the earliest acquisition time able to ensure an accurate diagnosis of amyloid transthyretin CA.

Methods and Results

A total of 38 patients were included: 18 subjects with a final diagnosis of ATTR-CA and 20 controls. Dynamic planar images of the anterior thorax were acquired, starting at intravenous injection of ≈ 700 MBq of 99mTc-HMDP. From time/activity curves (TAC) of regions of interest such as heart, vascular region, right ribcage, and soft tissues, several indices were considered. From the analysis, it resulted that both TACHeart/Bone(t) and RIheart–bone(t), for t > 6 minutes, well distinguish ATTR-CA patients from controls subjects. This is confirmed by the area under curves (AUC) analysis giving AUC values =.9 at t ≅ 6 minutes and AUC ≅ 1 for t > 10 minutes.


The method proposed allows determining the presence of ATTR-CA, in an inexpensive manner both in terms of examination costs and time spent.

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Immunoglobulin light-chain derived amyloidosis


Transthyretin derived amyloidosis


Area under curves


Cardiac amyloidosis


Hydroxymethylene diphosphonate


Normalized root mean square error


Retention index


Region of interest


Standard error measure


Time/activity curve


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Correspondence to M. F. Santarelli PhD.

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Santarelli, M.F., Genovesi, D., Positano, V. et al. Cardiac amyloidosis detection by early bisphosphonate (99mTc-HMDP) scintigraphy. J. Nucl. Cardiol. (2020).

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  • Cardiac amyloidosis
  • Amyloid transthyretin (ATTR)
  • Early 99mTc-HMDP scintigraphy
  • Dynamic time-activity curves
  • Retention index