INTRODUCTION: Assessment of myocardial uptake of Tc-99m-pyrophosphate (Tc-99m PYP) is pivotal in distinguishing transthyretin-associated cardiac amyloidosis (ATTR) from light chain amyloid (AL). It is often difficult to differentiate myocardial uptake from blood pool radioactivity with planar imaging or SPECT. We studied whether simultaneous dual-isotope Tc-99m PYP/Tl-201 SPECT improves assessment of Tc-99m PYP uptake compared to single-isotope SPECT. METHODS: Simultaneous Tc-99m PYP/Tl-201 dual-isotope SPECT was acquired in 112 patients studied for possible cardiac amyloidosis. Visual interpretation was performed by two observers on single-isotope followed by dual-isotope SPECT. Heart-to-contralateral lung ratio (H/CL) of myocardial counts quantified by single-isotope and dual-isotope SPECT was compared between ATTR, AL, and no amyloidosis groups. RESULTS: In 112 patients (39 ATTR and 26 AL patients, and 47 no amyloidosis), a lower proportion of no amyloidosis and AL patients were classified visually as equivocal with dual-isotope SPECT compared to single-isotope SPECT (2% vs 19%, P = 0.02 and 8% vs 35%, P = 0.04, respectively). H/CL measurements with single-isotope and dual-isotope were lower in AL and no amyloidosis patients vs ATTR patients (P < 0.05). Interobserver agreement of visual assessment was improved with dual-isotope SPECT (P = 0.03). AUCs for detection of ATTR by visual assessment and H/CL quantification were higher with dual-isotope (0.94 and 0.95, respectively) compared to single-isotope SPECT (0.84, P = 0.001 and 0.92, P = 0.02). CONCLUSION: Tc-99m PYP/Tl-201 SPECT improves visual differentiation of ATTR and AL amyloidosis compared to single-isotope SPECT. Visual assessment and H/CL quantitation with dual-isotope SPECT provide similar discrimination between patients with ATTR and AL amyloidosis.
INTRODUCTION: Assessment of myocardial uptake of Tc-99m-pyrophosphate (Tc-99mPYP) is pivotal in distinguishing transthyretin-associated cardiac amyloidosis (ATTR) from light chain amyloid (AL). It is often difficult to differentiate myocardial uptake from blood pool radioactivity with planar imaging or SPECT. We studied whether simultaneous dual-isotope Tc-99mPYP/Tl-201 SPECT improves assessment of Tc-99mPYP uptake compared to single-isotope SPECT. METHODS: Simultaneous Tc-99mPYP/Tl-201 dual-isotope SPECT was acquired in 112 patients studied for possible cardiac amyloidosis. Visual interpretation was performed by two observers on single-isotope followed by dual-isotope SPECT. Heart-to-contralateral lung ratio (H/CL) of myocardial counts quantified by single-isotope and dual-isotope SPECT was compared between ATTR, AL, and no amyloidosis groups. RESULTS: In 112 patients (39 ATTR and 26 AL patients, and 47 no amyloidosis), a lower proportion of no amyloidosis and AL patients were classified visually as equivocal with dual-isotope SPECT compared to single-isotope SPECT (2% vs 19%, P = 0.02 and 8% vs 35%, P = 0.04, respectively). H/CL measurements with single-isotope and dual-isotope were lower in AL and no amyloidosispatients vs ATTRpatients (P < 0.05). Interobserver agreement of visual assessment was improved with dual-isotope SPECT (P = 0.03). AUCs for detection of ATTR by visual assessment and H/CL quantification were higher with dual-isotope (0.94 and 0.95, respectively) compared to single-isotope SPECT (0.84, P = 0.001 and 0.92, P = 0.02). CONCLUSION:Tc-99mPYP/Tl-201 SPECT improves visual differentiation of ATTR and AL amyloidosis compared to single-isotope SPECT. Visual assessment and H/CL quantitation with dual-isotope SPECT provide similar discrimination between patients with ATTR and AL amyloidosis.
Authors: Lawreen H Connors; Flora Sam; Martha Skinner; Francesco Salinaro; Fangui Sun; Frederick L Ruberg; John L Berk; David C Seldin Journal: Circulation Date: 2015-12-11 Impact factor: 29.690
Authors: Julian D Gillmore; Mathew S Maurer; Rodney H Falk; Giampaolo Merlini; Thibaud Damy; Angela Dispenzieri; Ashutosh D Wechalekar; John L Berk; Candida C Quarta; Martha Grogan; Helen J Lachmann; Sabahat Bokhari; Adam Castano; Sharmila Dorbala; Geoff B Johnson; Andor W J M Glaudemans; Tamer Rezk; Marianna Fontana; Giovanni Palladini; Paolo Milani; Pierluigi L Guidalotti; Katarina Flatman; Thirusha Lane; Frederick W Vonberg; Carol J Whelan; James C Moon; Frederick L Ruberg; Edward J Miller; David F Hutt; Bouke P Hazenberg; Claudio Rapezzi; Philip N Hawkins Journal: Circulation Date: 2016-04-22 Impact factor: 29.690
Authors: Brett W Sperry; Timothy M Bateman; Esma A Akin; Paco E Bravo; Wengen Chen; Vasken Dilsizian; Fabien Hyafil; Yiu Ming Khor; Robert J H Miller; Riemer H J A Slart; Piotr Slomka; Hein Verberne; Edward J Miller; Chi Liu Journal: J Nucl Cardiol Date: 2022-07-21 Impact factor: 3.872
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