Published in:
01-10-2018 | Images that Teach
Cardiac ATTR amyloid nuclear imaging—not all bone scintigraphy radionuclide tracers are created equal
Published in: Journal of Nuclear Cardiology | Issue 5/2018
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A 74-year-old Caucasian man with hypertension and hereditary hemochromatosis presented with new onset atrial fibrillation. An echocardiogram (TTE) showed marked concentric hypertrophy with abnormally low global longitudinal strain (GLS) of − 11.4% and apical sparing. Iron overload cardiomyopathy was ruled out by a cardiac MRI; however, diffuse late gadolinium uptake was suggestive of amyloid deposition. Serum immunofixation and free light chains were negative for AL amyloidosis. Wild-type (senile) transthyretin (ATTR) cardiac amyloidosis (CA) was suspected given patient’s age. A 99mTc-methylene diphosphate (MDP) bone scan was carried out; however, it did not show any cardiac uptake (Figures 1, 2, Panel 1). Repeat imaging was performed using 99mTc-pyrophosphate (PYP), which showed intense tracer uptake diffusely in the myocardium (Figures 1 and 2, Panel 2).
Figure 1
A Planar images of 99mTc-methylene diphosphate (MDP)—215 min following intravenous injection of 22 mCi of 99mTc-MDP, planar scan of the whole body from the vertex to the feet and spot images of the chest, and skull obtained, demonstrated lack of myocardial uptake. B Planar images of 99mTc-pyrophosphate (PYP)—90 min following intravenous injection of 22 mCi of 99mTc-PYP planar scan of the whole body and spot views of the chest were obtained, demonstrated grade 3 myocardial uptake (grater then ribs)
Figure 2
Panel 1 (left): SPECT-CT images in coronal, sagittal, and axial planes of 99mTc-MDP following planar scan demonstrated the lack of myocardial uptake, in comparison with an uptake in the bones. Panel 2 (right): SPECT-CT images with 99mTc-pyrophosphate (PYP) following planar scan with an uptake in bones and diffuse myocardial uptake, more intense in the left ventricle
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