Francesco Cappelli1, Chiara Gallini2, Egidio Natalino Costanzo2, Francesca Tutino2, Alfonso Ciaccio2, Luca Vaggelli2, Simone Bartolini3, Sofia Morini3, Raffaele Martone3, Paola Angelotti4, Sabrina Frusconi4, Carlo Di Mario3, Federico Perfetto4. 1. Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Interventional Structural Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. Electronic address: cappellifrancesco@inwind.it. 2. Nuclear Medicine Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. 3. Interventional Structural Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. 4. Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
Abstract
BACKGROUND: Full body scintigraphy using bone tracers plays an important role in defining the type of amyloidosis and in diagnosing the heart involvement (cardiac amyloidosis, CA). No study has been conducted to explore lung retention (LR) in CA and its correlation to heart retention (HR).We evaluated LR in patients undergoing 99mTc-HMDP scintigraphy during evaluation for suspected CA. METHODS AND RESULTS: We enrolled 93 suspected CA patients. Patients underwent a complete diagnostic work up. After diagnostic process 82 patients resulted affected by certain CA (20 AL and 62 TTR), while 11 subjects showed left ventricular hypertrophy (LVH) not caused by CA. 99mTc-HMDP cardiac uptake was evaluated using the Perugini visual score while the modified Janssen score was used for LR estimation (grade 0 no uptake, grade 1 less than ribs, grade 2 more than ribs). RESULTS: 99mTc-HMDP LR was observed in 1/20 AL patient (5%), while 36/62 (58%) TTR patients showed LR with 29 grade 1 (47%) and 7 grade 2 (11%). No LR was observed in patients with LVH and no CA. LR was not evident in patients without HR, present in 1/3 (33%) of the patients with Perugini 1 HR and 11/24 (46%) and 26/36 (72%) of the patients showing respectively a Perugini 2 and a Perugini 3. CONCLUSION: 99mTc-HMDP scintigraphy shows LR in about 60% of TTR subjects, related to the grade of HR. In AL amyloidosis LR is less frequent than in TTR amyloidosis suggesting an aetiological tropism that seems comparable to the already known TTR related cardiac tropism.
BACKGROUND: Full body scintigraphy using bone tracers plays an important role in defining the type of amyloidosis and in diagnosing the heart involvement (cardiac amyloidosis, CA). No study has been conducted to explore lung retention (LR) in CA and its correlation to heart retention (HR).We evaluated LR in patients undergoing 99mTc-HMDP scintigraphy during evaluation for suspected CA. METHODS AND RESULTS: We enrolled 93 suspected CA patients. Patients underwent a complete diagnostic work up. After diagnostic process 82 patients resulted affected by certain CA (20 AL and 62 TTR), while 11 subjects showed left ventricular hypertrophy (LVH) not caused by CA. 99mTc-HMDP cardiac uptake was evaluated using the Perugini visual score while the modified Janssen score was used for LR estimation (grade 0 no uptake, grade 1 less than ribs, grade 2 more than ribs). RESULTS: 99mTc-HMDP LR was observed in 1/20 ALpatient (5%), while 36/62 (58%) TTRpatients showed LR with 29 grade 1 (47%) and 7 grade 2 (11%). No LR was observed in patients with LVH and no CA. LR was not evident in patients without HR, present in 1/3 (33%) of the patients with Perugini 1 HR and 11/24 (46%) and 26/36 (72%) of the patients showing respectively a Perugini 2 and a Perugini 3. CONCLUSION: 99mTc-HMDP scintigraphy shows LR in about 60% of TTR subjects, related to the grade of HR. In AL amyloidosis LR is less frequent than in TTRamyloidosis suggesting an aetiological tropism that seems comparable to the already known TTR related cardiac tropism.