Sharmila Dorbala1,2,3, Mi-Ae Park4, Sarah Cuddy2,3, Vasvi Singh2, Kyle Sullivan4, Sirwoo Kim4, Rodney H Falk3, Viviany R Taqueti4,2, Hicham Skali2, Ron Blankstein2, Camden Bay4, Marie F Kijewski4, Marcelo F Di Carli4,2. 1. Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts sdorbala@bwh.harvard.edu. 2. CV Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; and. 3. CA Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4. Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
The primary aims of this study were to determine the correlation between absolute quantitative 99mTc-pyrophosphate metrics and traditional measures of cardiac amyloid burden and to measure the intraobserver repeatability of the quantitative metrics. Methods: We studied 72 patients who underwent 99mTc-pyrophosphate SPECT/CT using a novel general-purpose cadmium-zinc-telluride-based SPECT/CT system. The clinical standard for these studies is visual grading (with grades of 0, 1, 2, and 3 indicating myocardial uptake absent, less than rib uptake, equal to rib uptake, or more than rib uptake, respectively). A visual grade of 2 or more was considered positive. For 72 patients, SUVmax, SUVmean, cardiac amyloid activity (CAA; i.e., SUVmean × left ventricular [LV] volume), and percentage injected dose (%ID) were calculated, and visual grading was performed. The correlation was determined between the 4 quantitative metrics or visual grades and the LV mass index (LVMI) (indexed to body surface area on echocardiography, 67 patients). For a subset of 11 patients, the correlation was determined between the visual or quantitative metrics and the extracellular volume (ECV) on cardiac MRI. Normal linear regression was used to compare the standardized association of each of the 4 quantitative metrics with LVMI, as a surrogate for amyloid burden. Receiver-operating-characteristic curve analysis was used to determine the diagnostic accuracy of quantitative metrics, using visual grading as the reference standard. The intraobserver repeatability of generating quantitative metrics was also determined. Results: All 4 quantitative metrics were highly accurate, with an area under the receiver-operating-characteristic curve of more than 0.96 for diagnosis of transthyretin cardiac amyloidosis. SUVmax, SUVmean, CAA, %ID, and visual grade were moderately positively correlated with LVMI (r = 0.485 for %ID) and strongly positively correlated, albeit in a small cohort, with ECV (r = 0.873, SUVmax). Intraobserver repeatability was excellent, with less than a 2% coefficient of variation for SUVmax, %ID, and CAA and 3.8% for SUVmean All 4 quantitative metrics had a standardized effect of more than 0.324 on LVMI; the largest standardized effect was 0.485, for %ID. Conclusion: In this first (to our knowledge) study of 99mTc-pyrophosphate cardiac imaging using a novel cadmium-zinc-telluride SPECT/CT scanner, SUVmax, SUVmean, CAA, and %ID measured by absolute quantitation of 99mTc-pyrophosphate were moderately correlated with LVMI and strongly correlated, albeit in a small cohort, with ECV. The intraobserver repeatability of generating the quantitative metrics was excellent.
The primary aims of this study were to determine the correlation between absolute quantitative 99mTc-pyrophosphate metrics and traditional measures of cardiac amyloid burden and to measure the intraobserver repeatability of the quantitative metrics. Methods: We studied 72 patients who underwent 99mTc-pyrophosphate SPECT/CT using a novel general-purpose cadmium-zinc-telluride-based SPECT/CT system. The clinical standard for these studies is visual grading (with grades of 0, 1, 2, and 3 indicating myocardial uptake absent, less than rib uptake, equal to rib uptake, or more than rib uptake, respectively). A visual grade of 2 or more was considered positive. For 72 patients, SUVmax, SUVmean, cardiac amyloid activity (CAA; i.e., SUVmean × left ventricular [LV] volume), and percentage injected dose (%ID) were calculated, and visual grading was performed. The correlation was determined between the 4 quantitative metrics or visual grades and the LV mass index (LVMI) (indexed to body surface area on echocardiography, 67 patients). For a subset of 11 patients, the correlation was determined between the visual or quantitative metrics and the extracellular volume (ECV) on cardiac MRI. Normal linear regression was used to compare the standardized association of each of the 4 quantitative metrics with LVMI, as a surrogate for amyloid burden. Receiver-operating-characteristic curve analysis was used to determine the diagnostic accuracy of quantitative metrics, using visual grading as the reference standard. The intraobserver repeatability of generating quantitative metrics was also determined. Results: All 4 quantitative metrics were highly accurate, with an area under the receiver-operating-characteristic curve of more than 0.96 for diagnosis of transthyretin cardiac amyloidosis. SUVmax, SUVmean, CAA, %ID, and visual grade were moderately positively correlated with LVMI (r = 0.485 for %ID) and strongly positively correlated, albeit in a small cohort, with ECV (r = 0.873, SUVmax). Intraobserver repeatability was excellent, with less than a 2% coefficient of variation for SUVmax, %ID, and CAA and 3.8% for SUVmean All 4 quantitative metrics had a standardized effect of more than 0.324 on LVMI; the largest standardized effect was 0.485, for %ID. Conclusion: In this first (to our knowledge) study of 99mTc-pyrophosphate cardiac imaging using a novel cadmium-zinc-telluride SPECT/CT scanner, SUVmax, SUVmean, CAA, and %ID measured by absolute quantitation of 99mTc-pyrophosphate were moderately correlated with LVMI and strongly correlated, albeit in a small cohort, with ECV. The intraobserver repeatability of generating the quantitative metrics was excellent.
Authors: Sharmila Dorbala; Yukio Ando; Sabahat Bokhari; Angela Dispenzieri; Rodney H Falk; Victor A Ferrari; Marianna Fontana; Olivier Gheysens; Julian D Gillmore; Andor W J M Glaudemans; Mazen A Hanna; Bouke P C Hazenberg; Arnt V Kristen; Raymond Y Kwong; Mathew S Maurer; Giampaolo Merlini; Edward J Miller; James C Moon; Venkatesh L Murthy; C Cristina Quarta; Claudio Rapezzi; Frederick L Ruberg; Sanjiv J Shah; Riemer H J A Slart; Hein J Verberne; Jamieson M Bourque Journal: J Nucl Cardiol Date: 2019-12 Impact factor: 5.952
Authors: Sarah A M Cuddy; Paco E Bravo; Rodney H Falk; Samir El-Sady; Marie Foley Kijewski; Mi-Ae Park; Frederick L Ruberg; Vaishali Sanchorawala; Heather Landau; Andrew J Yee; Giada Bianchi; Marcelo F Di Carli; Su-Chun Cheng; Michael Jerosch-Herold; Raymond Y Kwong; Ronglih Liao; Sharmila Dorbala Journal: JACC Cardiovasc Imaging Date: 2020-05-13
Authors: Adam Castano; Muhammad Haq; David L Narotsky; Jeff Goldsmith; Richard L Weinberg; Rachelle Morgenstern; Ted Pozniakoff; Frederick L Ruberg; Edward J Miller; John L Berk; Angela Dispenzieri; Martha Grogan; Geoffrey Johnson; Sabahat Bokhari; Mathew S Maurer Journal: JAMA Cardiol Date: 2016-11-01 Impact factor: 14.676
Authors: Elizabeth H Dibble; Ana C Lara Alvarez; Minh-Tam Truong; Gustavo Mercier; Earl F Cook; Rathan M Subramaniam Journal: J Nucl Med Date: 2012-04-09 Impact factor: 10.057
Authors: David F Hutt; Marianna Fontana; Maria Burniston; Ann-Marie Quigley; Aviva Petrie; James C Ross; Joanne Page; Ana Martinez-Naharro; Ashutosh D Wechalekar; Helen J Lachmann; Candida C Quarta; Tamer Rezk; Shameem Mahmood; Sajitha Sachchithanantham; Taryn Youngstein; Carol J Whelan; Thirusha Lane; Janet A Gilbertson; Dorota Rowczenio; Philip N Hawkins; Julian D Gillmore Journal: Eur Heart J Cardiovasc Imaging Date: 2017-12-01 Impact factor: 6.875
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: Juan Carlo Avalon; Jacob Fuqua; Seth Deskins; Tyler Miller; Justin Conte; Daniel Martin; Gary Marano; Naveena Yanamala; James Mills; Christopher Bianco; Brijesh Patel; Karthik Seetharam; Raymond Raylman; Partho P Sengupta; Yasmin S Hamirani Journal: J Nucl Cardiol Date: 2022-06-02 Impact factor: 5.952
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: Mouaz H Al-Mallah; Timothy M Bateman; Kelley R Branch; Andrew Crean; Eric L Gingold; Randall C Thompson; Sarah E McKenney; Edward J Miller; Venkatesh L Murthy; Koen Nieman; Todd C Villines; Michael V Yester; Andrew J Einstein; John J Mahmarian Journal: J Nucl Cardiol Date: 2022-09-02 Impact factor: 3.872
Authors: Golnaz Roshankar; Geneva C White; Sebastien Cadet; Nowell M Fine; Denise Chan; James A White; Victor Jimenez-Zepeda; Piotr J Slomka; Robert J H Miller Journal: J Nucl Cardiol Date: 2021-10-03 Impact factor: 3.872
Authors: Pablo Garcia-Pavia; Frank Bengel; Dulce Brito; Thibaud Damy; Franz Duca; Sharmila Dorbala; Jose Nativi-Nicolau; Laura Obici; Claudio Rapezzi; Yoshiki Sekijima; Perry M Elliott Journal: Eur J Heart Fail Date: 2021-05-24 Impact factor: 17.349