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Open Access 13-05-2022 | Computed Tomography | Original Article

Quantitative ^99mTc-DPD-SPECT/CT assessment of cardiac amyloidosis

Authors: Lukas Kessler, MD, Pedro Fragoso Costa, MSc, David Kersting, MD, MSc, Walter Jentzen, PhD, Manuel Weber, MD, Peter Lüdike, MD, Alexander Carpinteiro, MD, Sara Oubari, MD, Tim Hagenacker, MD, Andreas Thimm, MD, Tienush Rassaf, MD, Ken Herrmann, MD, Maria Papathanasiou, MD, Christoph Rischpler, MD

Published in: Journal of Nuclear Cardiology | Issue 1/2023

Abstract

Introduction

Transthyretin (ATTR) amyloidosis is responsible for the majority of cardiac amyloidosis (CA) cases and can be reliably diagnosed with bone scintigraphy and the visual Perugini score. We aimed to implement a quantification method of cardiac amyloid deposits in patients with suspected cardiac amyloidosis and to compare performance to visual scoring.

Methods and materials

136 patients received ^99mTc-DPD-bone scintigraphy including SPECT/CT of the thorax in case of suspicion of cardiac amyloidosis. Imaging phantom studies were performed to determine the scaling factor for standardized uptake value (SUV) quantification from SPECT/CT. Myocardial tracer uptake was quantified in a whole heart volume of interest.

Results

Forty-five patients were diagnosed with CA. A strong relationship between cardiac SUVmax and Perugini score was found (Spearman r 0.75, p < 0.0001). Additionally, tracer uptake in bone decreased with increasing cardiac SUVmax and Perugini score (p < 0.0001). ROC analysis revealed good performance of the SUVmax for the detection of ATTR-CA with AUC of 0.96 ± 0.02 (p < 0.0001) with sensitivity 98.7% and specificity 87.2%.

Conclusion

We demonstrate an accessible and accurate quantitative SPECT approach in CA. Quantitative assessment of the cardiac tracer uptake may improve diagnostic accuracy and risk classification. This method may enable monitoring and assessment of therapy response in patients with ATTR amyloidosis.

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Title: Quantitative 99mTc-DPD-SPECT/CT assessment of cardiac amyloidosis
Authors: Lukas Kessler, MD
Pedro Fragoso Costa, MSc
David Kersting, MD, MSc
Walter Jentzen, PhD
Manuel Weber, MD
Peter Lüdike, MD
Alexander Carpinteiro, MD
Sara Oubari, MD
Tim Hagenacker, MD
Andreas Thimm, MD
Tienush Rassaf, MD
Ken Herrmann, MD
Maria Papathanasiou, MD
Christoph Rischpler, MD
Publication date: 13-05-2022
Publisher: Springer International Publishing
Keywords: Computed Tomography
Computed Tomography
Cardiac Amyloidosis
Scintigraphy
Amyloidosis
Published in: Journal of Nuclear Cardiology / Issue 1/2023
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-022-02960-3

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Quantitative ^99mTc-DPD-SPECT/CT assessment of cardiac amyloidosis

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Methods and materials

Results

Conclusion

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