Chiara Gallini1, Francesca Tutino1, Raffaele Martone2, Alfonso Ciaccio1, Egidio Natalino Costanzo1, Giulia Taborchi2, Sofia Morini2, Simone Bartolini2, Silvia Farsetti3, Carlo Di Mario4, Federico Perfetto3, Francesco Cappelli5,6. 1. Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy. 2. Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy. 3. Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy. 4. Interventional Structural Cardiology Division, Department of Heart, Lung and Vessels, Careggi University Hospital, Florence, Italy. 5. Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy. cappellifrancesco@inwind.it. 6. Intensive Cardiac Care Unit, Interventional Structural Cardiology Division, Department of Heart, Lung and Vessels, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. cappellifrancesco@inwind.it.
Abstract
BACKGROUND: 99mTc-HMDP scintigraphy has proved its efficacy in non-invasive diagnosis of cardiac amyloidosis (CA) and is currently interpreted according to the Perugini qualitative assessment. Several semi-quantitative indices have been proposed to overcome inherent possible limitations of visual grading. Our aim was to comparatively evaluate six different indices and their diagnostic performance. METHODS: We retrospectively reviewed scintigraphy of 76 patients (53 ATTR, 12 AL, 11 LVH) who underwent diagnostic evaluation at our centre. ROC-curve analysis was performed to identify optimal cut-off and relative diagnostic accuracy of six different indices (of which one was proposed for the first time), both in identifying CA patients and in discriminating patients according to their Perugini score. RESULTS: Heart/Whole-body ratios proved to be the most accurate (100%) in identifying CA patients. Heart/Pelvis ratio (with soft tissue background correction) offered acceptable accuracy (98%), with the largest area under the curve (AUC) (0.98) in discriminating patients with Perugini ≥ 2. Heart/Contralateral Lung ratio confirmed to be exposed to confounding background noise in case of simultaneous lung uptake. Heart/Skull ratio had the worst performance, with six false-negative patients in ATTR identification. CONCLUSION: Heart/Whole-body ratios may be robust and effective semi-quantitative indices for the evaluation of CA by means of scintigraphy.
BACKGROUND: 99mTc-HMDP scintigraphy has proved its efficacy in non-invasive diagnosis of cardiac amyloidosis (CA) and is currently interpreted according to the Perugini qualitative assessment. Several semi-quantitative indices have been proposed to overcome inherent possible limitations of visual grading. Our aim was to comparatively evaluate six different indices and their diagnostic performance. METHODS: We retrospectively reviewed scintigraphy of 76 patients (53 ATTR, 12 AL, 11 LVH) who underwent diagnostic evaluation at our centre. ROC-curve analysis was performed to identify optimal cut-off and relative diagnostic accuracy of six different indices (of which one was proposed for the first time), both in identifying CA patients and in discriminating patients according to their Perugini score. RESULTS: Heart/Whole-body ratios proved to be the most accurate (100%) in identifying CA patients. Heart/Pelvis ratio (with soft tissue background correction) offered acceptable accuracy (98%), with the largest area under the curve (AUC) (0.98) in discriminating patients with Perugini ≥ 2. Heart/Contralateral Lung ratio confirmed to be exposed to confounding background noise in case of simultaneous lung uptake. Heart/Skull ratio had the worst performance, with six false-negative patients in ATTR identification. CONCLUSION: Heart/Whole-body ratios may be robust and effective semi-quantitative indices for the evaluation of CA by means of scintigraphy.
Authors: Maria Papathanasiou; Christoph Rischpler; Lukas Kessler; Pedro Fragoso Costa; David Kersting; Walter Jentzen; Manuel Weber; Peter Lüdike; Alexander Carpinteiro; Sara Oubari; Tim Hagenacker; Andreas Thimm; Tienush Rassaf; Ken Herrmann Journal: J Nucl Cardiol Date: 2022-05-13 Impact factor: 5.952
Authors: Weijia Li; Dipan Uppal; Yu-Chiang Wang; Xiaobo Xu; Damianos G Kokkinidis; Mark I Travin; James M Tauras Journal: Diagnostics (Basel) Date: 2021-05-30