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BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Cardiac Amyloidosis | Research

Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis

Published in: BMC Cardiovascular Disorders | Issue 1/2021

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Abstract

Background

Noninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA). The purpose of this study is to directly compare CMR, SPECT, and PET scans in the diagnosis of CA, and to provide evidence for further scientific research and clinical decision-making.

Methods

PubMed, Embase, and Cochrane Library were searched. Studies used CMR, SPECT and/or PET for the diagnosis of CA were included. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), their respective 95% confidence intervals (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated. Quality assessment of included studies was conducted.

Results

A total of 31 articles were identified for inclusion in this meta-analysis. The pooled sensitivities of CMR, SPECT and PET were 0.84, 0.98 and 0.78, respectively. Their respective overall specificities were 0.87, 0.92 and 0.95. Subgroup analysis demonstrated that 99mTc-HMDP manifested the highest sensitivity (0.99). 99mTc-PYP had the highest specificity (0.95). The AUC values of 99mTc-DPD, 99mTc-PYP, 99mTc-HMDP were 0.89, 0.99, and 0.99, respectively. PET scan with 11C-PIB demonstrated a pooled sensitivity of 0.91 and specificity of 0.97 with an AUC value of 0.98.

Conclusion

Our meta-analysis reveals that SEPCT scans present better diagnostic performance for the identification of CA as compared with other two modalities.
Appendix
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Literature
1.
2.
Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med (Lond). 2018;18(Suppl 2):s30–5.CrossRef
3.
Fontana M, Banypersad SM, Treibel TA, Abdel-Gadir A, Maestrini V, Lane T, Gilbertson JA, Hutt DF, Lachmann HJ, Whelan CJ, et al. Differential myocyte responses in patients with cardiac transthyretin amyloidosis and light-chain amyloidosis: a cardiac MR imaging study. Radiology. 2015;277(2):388–97.PubMedCrossRef
4.
Zhang KW, Stockerl-Goldstein KE, Lenihan DJ. Emerging therapeutics for the treatment of light chain and transthyretin amyloidosis. JACC Basic Transl Sci. 2019;4(3):438–48.PubMedPubMedCentralCrossRef
5.
Bhogal S, Ladia V, Sitwala P, Cook E, Bajaj K, Ramu V, Lavie CJ, Paul TK. Cardiac amyloidosis: an updated review with emphasis on diagnosis and future directions. Curr Probl Cardiol. 2018;43(1):10–34.PubMedCrossRef
6.
Singh V, Falk R, Di Carli MF, Kijewski M, Rapezzi C, Dorbala S. State-of-the-art radionuclide imaging in cardiac transthyretin amyloidosis. J Nucl Cardiol. 2019;26(1):158–73.PubMedCrossRef
7.
8.
Yang M, Arsanjani R, Roarke MC. Advanced nuclear medicine and molecular imaging in the diagnosis of cardiomyopathy. AJR Am J Roentgenol. 2020;215(5):1208–17.PubMedCrossRef
9.
Austin BA, Tang WH, Rodriguez ER, Tan C, Flamm SD, Taylor DO, Starling RC, Desai MY. Delayed hyper-enhancement magnetic resonance imaging provides incremental diagnostic and prognostic utility in suspected cardiac amyloidosis. JACC Cardiovasc Imaging. 2009;2(12):1369–77.PubMedCrossRef
10.
Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I, Sheppard MN, Poole-Wilson PA, Hawkins PN, Pennell DJ. Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation. 2005;111(2):186–93.CrossRefPubMed
11.
Martinez-Naharro A, Treibel TA, Abdel-Gadir A, Bulluck H, Zumbo G, Knight DS, Kotecha T, Francis R, Hutt DF, Rezk T, et al. Magnetic resonance in transthyretin cardiac amyloidosis. J Am Coll Cardiol. 2017;70(4):466–77.PubMedCrossRef
12.
Treglia G, Glaudemans A, Bertagna F, Hazenberg BPC, Erba PA, Giubbini R, Ceriani L, Prior JO, Giovanella L, Slart R. Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging. 2018;45(11):1945–55.PubMedCrossRef
13.
Ramsay SC, Cuscaden C. The current status of quantitative SPECT/CT in the assessment of transthyretin cardiac amyloidosis. J Nucl Cardiol. 2020;27(5):1464–8.PubMedCrossRef
14.
Masri A, Bukhari S, Eisele YS, Soman P. Molecular imaging of cardiac amyloidosis. J Nucl Med. 2020;61(7):965–70.PubMedCrossRef
15.
Dorbala S, Vangala D, Semer J, Strader C, Bruyere JR Jr, Di Carli MF, Moore SC, Falk RH. Imaging cardiac amyloidosis: a pilot study using 18F-florbetapir positron emission tomography. Eur J Nucl Med Mol Imaging. 2014;41(9):1652–62.PubMedCrossRef
16.
Minamimoto R, Awaya T, Iwama K, Hotta M, Nakajima K, Hirai R, Okazaki O, Hiroi Y. Significance of (11)C-PIB PET/CT in cardiac amyloidosis compared with (99m)Tc-aprotinin scintigraphy: a pilot study. J Nucl Cardiol. 2020;27(1):202–9.PubMedCrossRef
17.
Law WP, Wang WY, Moore PT, Mollee PN, Ng AC. Cardiac amyloid imaging with 18F-Florbetaben PET: a pilot study. J Nucl Med. 2016;57(11):1733–9.PubMedCrossRef
18.
Kircher M, Ihne S, Brumberg J, Morbach C, Knop S, Kortüm KM, Störk S, Buck AK, Reiter T, Bauer WR, et al. Detection of cardiac amyloidosis with 18F-Florbetaben-PET/CT in comparison to echocardiography, cardiac MRI and DPD-scintigraphy. Eur J Nucl Med Mol Imaging. 2019;46(7):1407–16.PubMedCrossRef
19.
Zhao L, Tian Z, Fang Q. Diagnostic accuracy of cardiovascular magnetic resonance for patients with suspected cardiac amyloidosis: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2016;16:129.PubMedPubMedCentralCrossRef
20.
Wang TKM, Brizneda MV, Kwon DH, Popovic ZB, Flamm SD, Hanna M, Griffin BP, Xu B. Reference ranges, diagnostic and prognostic utility of native T1 mapping and extracellular volume for cardiac amyloidosis: a meta-analysis. J Magn Reson Imaging: JMRI. 2020;53(5):1458–68.PubMedCrossRef
21.
Pan JA, Kerwin MJ, Salerno M. Native T1 mapping, extracellular volume mapping, and late gadolinium enhancement in cardiac amyloidosis: a meta-analysis. JACC Cardiovasc Imaging. 2020;13(6):1299–310.PubMedPubMedCentralCrossRef
22.
Kim YJ, Ha S, Kim YI. Cardiac amyloidosis imaging with amyloid positron emission tomography: a systematic review and meta-analysis. J Nucl Cardiol. 2020;27(1):123–32.PubMedCrossRef
23.
Kim SH, Kim YS, Kim SJ. Diagnostic performance of PET for detection of cardiac amyloidosis: a systematic review and meta-analysis. J Cardiol. 2020;76(6):618–25.PubMedCrossRef
24.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg (London, England). 2010;8(5):336–41.CrossRef
25.
Reitsma JB, Moons KG, Bossuyt PM, Linnet K. Systematic reviews of studies quantifying the accuracy of diagnostic tests and markers. Clin Chem. 2012;58(11):1534–45.PubMedCrossRef
26.
Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:Ed000142.PubMed
27.
Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93.PubMedCrossRef
28.
Cuddy S, Dorbala S, Di Carli MF. Imaging of cardiac amyloidosis: will this become a unique application for dual-isotope imaging? J Nucl Cardiol. 2020;27(1):38–40.PubMedCrossRef
29.
Hotta M, Minamimoto R, Awaya T, Hiroe M, Okazaki O, Hiroi Y. Radionuclide imaging of cardiac amyloidosis and sarcoidosis: roles and characteristics of various tracers. Radiographics. 2020;40(7):2029–41.PubMedCrossRef
30.
31.
Donnelly JP, Hanna M. Cardiac amyloidosis: an update on diagnosis and treatment. Clevel Clin J Med. 2017;84(12 Suppl 3):12–26.CrossRef
32.
Siddiqi OK, Ruberg FL. Cardiac amyloidosis: an update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med. 2018;28(1):10–21.PubMedCrossRef
33.
Barbero U, Destefanis P, Pozzi R, Longo F, Piga A. Exercise stress echocardiography with tissue Doppler imaging (TDI) detects early systolic dysfunction in Beta-thalassemia major patients without cardiac iron overload. Mediterr J Hematol Infect Dis. 2012;4(1):12037.CrossRef
34.
Kyriakou P, Mouselimis D, Tsarouchas A, Rigopoulos A, Bakogiannis C, Noutsias M, Vassilikos V. Diagnosis of cardiac amyloidosis: a systematic review on the role of imaging and biomarkers. BMC Cardiovasc Disord. 2018;18(1):221.PubMedPubMedCentralCrossRef
35.
Maurer MS, Ruberg FL, Weinsaft JW. More than meets the eye: time for a new imaging paradigm to test for cardiac amyloidosis. J Card Fail. 2018;24(2):87–9.PubMedCrossRef
36.
Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S, Klingel K, Kandolf R, Sechtem U. Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol. 2008;51(10):1022–30.CrossRefPubMed
37.
Sperry BW, Burgett E, Bybee KA, McGhie AI, O’Keefe JH, Saeed IM, Thompson RC, Bateman TM. Technetium pyrophosphate nuclear scintigraphy for cardiac amyloidosis: Imaging at 1 vs 3 hours and planar vs SPECT/CT. J Nucl Cardiol. 2020;27(5):1802–7.PubMedCrossRef
38.
Malka N, Abulizi M, Kharoubi M, Oghina S, Galat A, Le Bras F, Moktefi A, Guendouz S, Molinier-Frenkel V, Fanen P, et al. Extracardiac soft tissue uptake, evidenced on early (99m)Tc-HMDP SPECT/CT, helps typing cardiac amyloidosis and demonstrates high prognostic value. Eur J Nucl Med Mol Imaging. 2020;47(10):2396–406.PubMedCrossRef
39.
Wollenweber T, Rettl R, Kretschmer-Chott E, Rasul S, Kulterer O, Rainer E, Raidl M, Schaffarich MP, Matschitsch S, Stadler M, et al. In vivo quantification of myocardial amyloid deposits in patients with suspected transthyretin-related amyloidosis (ATTR). J Clin Med. 2020;9(11):3446.PubMedCentralCrossRef
40.
41.
Rosengren S, Skibsted Clemmensen T, Tolbod L, Granstam SO, Eiskjær H, Wikström G, Vedin O, Kero T, Lubberink M, Harms HJ, et al. Diagnostic accuracy of [(11)C]PIB positron emission tomography for detection of cardiac amyloidosis. JACC Cardiovasc Imaging. 2020;13(6):1337–47.PubMedCrossRef
42.
43.
Martinez-Naharro A, Baksi AJ, Hawkins PN, Fontana M. Diagnostic imaging of cardiac amyloidosis. Nat Rev Cardiol. 2020;17(7):413–26.PubMedCrossRef
44.
Abulizi M, Sifaoui I, Wuliya-Gariepy M, Kharoubi M, Israël JM, Emsen B, Bodez D, Monnet A, Didierlaurent D, Tacher V, et al. (18)F-sodium fluoride PET/MRI myocardial imaging in patients with suspected cardiac amyloidosis. J Nucl Cardiol. 2019;28(4):1586–95.PubMedCrossRef
45.
Aquaro GD, Pugliese NR, Perfetto F, Cappelli F, Barison A, Masci PG, Passino C, Emdin M. Myocardial signal intensity decay after gadolinium injection: a fast and effective method for the diagnosis of cardiac amyloidosis. Int J Cardiovasc Imaging. 2014;30(6):1105–15.PubMedCrossRef
46.
Asif T, Gomez J, Singh V, Doukky R, Nedeltcheva A, Malhotra S. Comparison of planar with tomographic pyrophosphate scintigraphy for transthyretin cardiac amyloidosis: Perils and pitfalls. J Nucl Cardiol. 2020;28(1):104–11.PubMedCrossRef
47.
Awaya T, Minamimoto R, Iwama K, Kubota S, Hotta M, Hirai R, Yamamoto M, Okazaki O, Hara H, Hiroi Y, et al. Performance of (99m)Tc-aprotinin scintigraphy for diagnosing light chain (AL) cardiac amyloidosis confirmed by endomyocardial biopsy. J Nucl Cardiol. 2020;27(4):1145–53.PubMedCrossRef
48.
Baggiano A, Boldrini M, Martinez-Naharro A, Kotecha T, Petrie A, Rezk T, Gritti M, Quarta C, Knight DS, Wechalekar AD, et al. Noncontrast magnetic resonance for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging. 2020;13(1 Pt 1):69–80.CrossRefPubMed
49.
Baroni M, Nava S, Quattrocchi G, Milazzo A, Giannattasio C, Roghi A, Pedrotti P. Role of cardiovascular magnetic resonance in suspected cardiac amyloidosis: late gadolinium enhancement pattern as mortality predictor. Neth Heart J. 2018;26(1):34–40.PubMedCrossRef
50.
Bellevre D, Bailliez A, Delelis F, Blaire T, Agostini D, Mouquet F, Maréchaux S, Manrique A. Quantitation of myocardial (99m)Tc-HMDP uptake with new SPECT/CT cadmium zinc telluride (CZT) camera in patients with transthyretin-related cardiac amyloidosis: ready for clinical use? J Nucl Cardiol. 2020;. https://​doi.​org/​10.​1007/​s12350-020-02274-2.CrossRefPubMed
51.
Bhatti S, Watts E, Syed F, Vallurupalli S, Pandey T, Jambekar K, Mazur W, Hakeem A. Clinical and prognostic utility of cardiovascular magnetic resonance imaging in myeloma patients with suspected cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. 2016;17(9):970–7.PubMedCrossRef
52.
Cappelli F, Gallini C, Di Mario C, Costanzo EN, Vaggelli L, Tutino F, Ciaccio A, Bartolini S, Angelotti P, Frusconi S, et al. Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis. J Nucl Cardiol. 2019;26(2):497–504.PubMedCrossRef
53.
Ezawa N, Katoh N, Oguchi K, Yoshinaga T, Yazaki M, Sekijima Y. Visualization of multiple organ amyloid involvement in systemic amyloidosis using (11)C-PiB PET imaging. Eur J Nucl Med Mol Imaging. 2018;45(3):452–61.PubMedCrossRef
54.
Flaherty KR, Morgenstern R, Pozniakoff T, DeLuca A, Castano A, Maurer MS, Bokhari S. (99m)Technetium pyrophosphate scintigraphy with cadmium zinc telluride cameras is a highly sensitive and specific imaging modality to diagnose transthyretin cardiac amyloidosis. J Nucl Cardiol. 2020;27(2):371–80.PubMedCrossRef
55.
Gallini C, Tutino F, Martone R, Ciaccio A, Costanzo EN, Taborchi G, Morini S, Bartolini S, Farsetti S, Di Mario C, et al. Semi-quantitative indices of cardiac uptake in patients with suspected cardiac amyloidosis undergoing 99mTc-HMDP scintigraphy. J Nucl Cardiol. 2019.
56.
Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, Wechalekar AD, Berk JL, Quarta CC, Grogan M, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133(24):2404–12.PubMedCrossRef
57.
Karamitsos TD, Piechnik SK, Banypersad SM, Fontana M, Ntusi NB, Ferreira VM, Whelan CJ, Myerson SG, Robson MD, Hawkins PN, et al. Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging. 2013;6(4):488–97.CrossRefPubMed
58.
Kircher M, Ihne S, Brumberg J, Morbach C, Knop S, Kortüm KM, Störk S, Buck AK, Reiter T, Bauer WR, et al. Detection of cardiac amyloidosis with (18)F-Florbetaben-PET/CT in comparison to echocardiography, cardiac MRI and DPD-scintigraphy. Eur J Nucl Med Mol Imaging. 2019;46(7):1407–16.PubMedCrossRef
59.
Lee SP, Lee ES, Choi H, Im HJ, Koh Y, Lee MH, Kwon JH, Paeng JC, Kim HK, Cheon GJ, et al. 11C-Pittsburgh B PET imaging in cardiac amyloidosis. JACC Cardiovasc Imaging. 2015;8(1):50–9.PubMedCrossRef
60.
Martineau P, Finnerty V, Giraldeau G, Authier S, Harel F, Pelletier-Galarneau M. Examining the sensitivity of 18F-NaF PET for the imaging of cardiac amyloidosis. J Nucl Cardiol. 2019;28(1):209–18.PubMedCrossRef
61.
Masri A, Bukhari S, Ahmad S, Nieves R, Eisele YS, Follansbee W, Brownell A, Wong TC, Schelbert E, Soman P. Efficient 1-hour technetium-99 m pyrophosphate imaging protocol for the diagnosis of transthyretin cardiac amyloidosis. Circ Cardiovasc Imaging. 2020;13(2):e010249.PubMedPubMedCentralCrossRef
62.
Moore PT, Burrage MK, Mackenzie E, Law WP, Korczyk D, Mollee P. The utility of (99m)Tc-DPD scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience. Heart Lung Circ. 2017;26(11):1183–90.PubMedCrossRef
63.
Papantoniou V, Valsamaki P, Kastritis S, Tsiouris S, Delichas Z, Papantoniou Y, Tsiouma M, Athanasoulis T, Fotopoulos A, Dimopoulos MA. Imaging of cardiac amyloidosis by (99m)Tc-PYP scintigraphy. Hell J Nucl Med. 2015;18(Suppl 1):42–50.PubMed
64.
Poterucha TJ, Elias P, Bokhari S, Einstein AJ, DeLuca A, Kinkhabwala M, Johnson LL, Flaherty KR, Saith SE, Griffin JM, et al. Diagnosing transthyretin cardiac amyloidosis by technetium 99m pyrophosphate: a test in evolution. JACC Cardiovasc Imaging. 2020;14(6):1221–31.PubMedCrossRefPubMedCentral
65.
Rapezzi C, Quarta CC, Guidalotti PL, Pettinato C, Fanti S, Leone O, Ferlini A, Longhi S, Lorenzini M, Reggiani LB, et al. Role of (99m)Tc-DPD scintigraphy in diagnosis and prognosis of hereditary transthyretin-related cardiac amyloidosis. JACC Cardiovasc Imaging. 2011;4(6):659–70.PubMedCrossRef
66.
Régis C, Harel F, Martineau P, Grégoire J, Abikhzer G, Juneau D, Pelletier-Galarneau M. Tc-99m-pyrophosphate scintigraphy for the diagnosis of ATTR cardiac amyloidosis: comparison of quantitative and semi-quantitative approaches. J Nucl Cardiol. 2020;27(5):1808–15.PubMedCrossRef
67.
White JA, Kim HW, Shah D, Fine N, Kim KY, Wendell DC, Al-Jaroudi W, Parker M, Patel M, Gwadry-Sridhar F, et al. CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging. 2014;7(2):143–56.PubMedPubMedCentralCrossRef
Metadata
Title
Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis
Publication date
01-12-2021
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02292-z

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