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01-12-2021 | Scintigraphy | Original Article

An optimized imaging protocol for [^99mTc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis

Authors: Imke Schatka, MD, Anne Bingel, MD, Franziska Schau, MD, Stephanie Bluemel, MSc, Daniel R. Messroghli, MD, David Frumkin, MD, Fabian Knebel, MD, Sonja M. Diekmann, MD, Ahmed Elsanhoury, PhD, Carsten Tschöpe, MD, Katrin Hahn, MD, Holger Amthauer, MD, Julian M. M. Rogasch, MD, Christoph Wetz, MD

Published in: Journal of Nuclear Cardiology | Issue 6/2021

Abstract

Background

In [^99mTc]Tc-DPD scintigraphy for myocardial ATTR amyloidosis, planar images 3 hour p.i. and SPECT/CT acquisition in L-mode are recommended. This study investigated if earlier planar images (1 hour p.i.) are beneficial and if SPECT/CT acquisition should be preferred in H-mode (180° detector angle) or L-mode (90°).

Methods

In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients (reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i.

Results

In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were ≥ 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader’s confidence.

Conclusions

Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium.

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Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016; 133:2404-12CrossRef

Sperry BW, Vranian MN, Tower-Rader A, Hachamovitch R, Hanna M, Brunken R et al. Regional variation in technetium pyrophosphate uptake in transthyretin cardiac amyloidosis and impact on mortality. JACC Cardiovasc Imaging 2018; 11:234-42CrossRef

Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 2018; 379:1007-16CrossRef

Adams D, Gonzalez-Duarte A, O’Riordan WD, Yang CC, Ueda M, Kristen AV et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis. N Engl J Med 2018; 379:11-21CrossRef

Benson MD, Waddington-Cruz M, Berk JL, Polydefkis M, Dyck PJ, Wang AK et al. Inotersen treatment for patients with hereditary transthyretin amyloidosis. N Engl J Med 2018; 379:22-31CrossRef

ASNC/EANM. ASNC AND EANM CARDIAC AMYLOIDOSIS PRACTICE POINTS (2019)

Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Cardiac Fail 2019; 25:e1-e39CrossRef

Perugini E, Guidalotti PL, Salvi F, Cooke RM, Pettinato C, Riva L et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol 2005; 46:1076-84CrossRef

Castano A, Haq M, Narotsky DL, Goldsmith J, Weinberg RL, Morgenstern R et al. Multicenter study of planar technetium 99m Pyrophosphate cardiac imaging: Predicting survival for patients with ATTR cardiac amyloidosis. JAMA Cardiol 2016; 1:880-89CrossRef

10.

Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 2 of 2-diagnostic criteria and appropriate utilization. J Cardiac Fail 2019; 25:854-65CrossRef

11.

McGraw K, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods 1996; 1:30-46CrossRef

12.

Cicchetti D. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instrument in psychology. Psychol Assess 1994; 6:284-90CrossRef

13.

Bokhari S, Castaño A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. (99m)Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging 2013; 6:195-01CrossRef

14.

Haq M, Pawar S, Berk JL, Miller EJ, Ruberg FL. Can (99m)Tc-pyrophosphate aid in early detection of cardiac involvement in asymptomatic variant TTR amyloidosis? JACC Cardiovasc Imaging 2017; 10:713-14CrossRef

15.

Glaudemans AW, van Rheenen RW, van den Berg MP, Noordzij W, Koole M, Blokzijl H et al. Bone scintigraphy with (99m)technetium-hydroxymethylene diphosphonate allows early diagnosis of cardiac involvement in patients with transthyretin-derived systemic amyloidosis. Amyloid 2014; 21:35-44CrossRef

16.

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; 16:129CrossRef

17.

McAfee JG, Krauss DJ, Subramanian G, Thomas FD, Roskopf M, Ritter C et al. Comparison of 99mTc phosphate and diphosphonate complexes in experimental renal infarcts. Investig Radiol 1983; 18:479-84CrossRef

18.

Scully PR, Morris E, Patel KP, Treibel TA, Burniston M, Klotz E et al. DPD quantification in cardiac amyloidosis: A novel imaging biomarker. JACC Cardiovasc Imaging 2020; 13:1353-63CrossRef

19.

Vija AH, Hawman EG, Engdahl JC. Analysis of a SPECT OSEM reconstruction method with 3D beam modeling and optional attenuation correction: Phantom studies. 2003 IEEE Nuclear Science Symposium Conference Record (IEEE Cat No03CH37515). 2003; 4:2662

20.

Vandenberghe S, D’Asseler Y, Van de Walle R, Kauppinen T, Koole M, Bouwens L et al. Iterative reconstruction algorithms in nuclear medicine. Comput Med Imaging Graph 2001; 25:105-11CrossRef

21.

Kaalep A, Sera T, Rijnsdorp S, Yaqub M, Talsma A, Lodge MA et al. Feasibility of state of the art PET/CT systems performance harmonisation. Eur J Nucl Med Mol Imaging 2018; 45:1344-61CrossRef

22.

Zhu Y, Geng C, Huang J, Liu J, Wu N, Xin J et al. Measurement and evaluation of quantitative performance of PET/CT images before a multicenter clinical trial. Sci Rep 2018; 8:9035CrossRef

23.

Mansor S, Pfaehler E, Heijtel D, Lodge MA, Boellaard R, Yaqub M. Impact of PET/CT system, reconstruction protocol, data analysis method, and repositioning on PET/CT precision: An experimental evaluation using an oncology and brain phantom. Med Phys 2017; 44:6413-24CrossRef

24.

Peters SMB, van der Werf NR, Segbers M, van Velden FHP, Wierts R, Blokland K et al. Towards standardization of absolute SPECT/CT quantification: A multi-center and multi-vendor phantom study. EJNMMI Phys 2019; 6:29CrossRef

25.

Peters SMB, Meyer Viol SL, van der Werf NR, de Jong N, van Velden FHP, Meeuwis A et al. Variability in lutetium-177 SPECT quantification between different state-of-the-art SPECT/CT systems. EJNMMI Phys 2020; 7:9CrossRef

26.

Gnesin S, Leite Ferreira P, Malterre J, Laub P, Prior JO, Verdun FR. Phantom validation of Tc-99m absolute quantification in a SPECT/CT commercial device. Comput Math Methods Med 2016; 2016:4360371CrossRef

27.

Rogasch JM, Suleiman S, Hofheinz F, Bluemel S, Lukas M, Amthauer H et al. Reconstructed spatial resolution and contrast recovery with Bayesian penalized likelihood reconstruction (Q.Clear) for FDG-PET compared to time-of-flight (TOF) with point spread function (PSF). EJNMMI Phys 2020; 7:2CrossRef

28.

Vargas HA, Kramer GM, Scott AM, Weickhardt A, Meier AA, Parada N et al. Reproducibility and repeatability of semiquantitative (18)F-fluorodihydrotestosterone uptake metrics in castration-resistant prostate cancer metastases: A prospective multicenter study. J Nucl Med 2018; 59:1516-23CrossRef

29.

Jauw YWS, Bensch F, Brouwers AH, Hoekstra OS, Zijlstra JM, Pieplenbosch S et al. Interobserver reproducibility of tumor uptake quantification with (89)Zr-immuno-PET: A multicenter analysis. Eur J Nucl Med Mol Imaging 2019; 46:1840-49CrossRef

30.

Leijenaar RT, Carvalho S, Velazquez ER, van Elmpt WJ, Parmar C, Hoekstra OS et al. Stability of FDG-PET Radiomics features: An integrated analysis of test-retest and inter-observer variability. Acta Oncol (Stockholm, Sweden) 2013; 52:1391-97CrossRef

31.

Hatt M, Cheze-Le Rest C, Aboagye EO, Kenny LM, Rosso L, Turkheimer FE et al. Reproducibility of 18F-FDG and 3’-deoxy-3’-18F-fluorothymidine PET tumor volume measurements. J Nucl Med 2010; 51:1368-76CrossRef

32.

Nestle U, Kremp S, Schaefer-Schuler A, Sebastian-Welsch C, Hellwig D, Rübe C et al. Comparison of different methods for delineation of 18F-FDG PET-positive tissue for target volume definition in radiotherapy of patients with non-Small cell lung cancer. J Nucl Med 2005; 46:1342-48PubMed

33.

Archimandritis SC, Tsolis AK. Biodistribution of the bone imaging agents99mTc-DHPE and99mTc-MDP in rats. J Radioanal Nucl Chem 1987; 117:35-46CrossRef

34.

Vorne M, Vähätalo S, Lantto T. A clinical comparison of 99mTc-DPD and two 99mTc-MDP agents. Eur J Nucl Med 1983: 8:395-97CrossRef

35.

Mele M, Conte E, Fratello A, Pasculli D, Pieralice M, D’Addabbo A. Computer analysis of Tc-99m DPD and Tc-99m MDP kinetics in humans: Concise communication. J Nucl Med 1983; 24:334-38PubMed

36.

Blume M, Martinez-Möller A, Keil A, Navab N, Rafecas M. Joint reconstruction of image and motion in gated positron emission tomography. IEEE Trans Med Imaging 2010; 29:1892-06CrossRef

37.

Le Meunier L, Slomka PJ, Dey D, Ramesh A, Thomson LE, Hayes SW et al. Motion frozen (18)F-FDG cardiac PET. J Nucl Cardiol 2011; 18:259-66CrossRef

Title: An optimized imaging protocol for [99mTc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis
Authors: Imke Schatka, MD
Anne Bingel, MD
Franziska Schau, MD
Stephanie Bluemel, MSc
Daniel R. Messroghli, MD
David Frumkin, MD
Fabian Knebel, MD
Sonja M. Diekmann, MD
Ahmed Elsanhoury, PhD
Carsten Tschöpe, MD
Katrin Hahn, MD
Holger Amthauer, MD
Julian M. M. Rogasch, MD
Christoph Wetz, MD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Scintigraphy
Amyloidosis
Published in: Journal of Nuclear Cardiology / Issue 6/2021
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-021-02715-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An optimized imaging protocol for [^99mTc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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