A case report of an uncommon presentation of 99mtechnetium pyrophosphate scintigraphy in transthyretin cardiac amyloidosis: A potential diagnostic pitfall, pseudo-positive or pseudo-negative?

In this report, we focus on an inconclusive study case as a potential pitfall of 99mTc-PYP scintigraphy and discuss the interpretation of 99mTc-PYP scintigraphy findings with using both planar and SPECT/CT imaging for improvement of diagnostic accuracy for ATTR cardiac amyloidosis.
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research

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Transthyretin (TTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Cardiac amyloidosis remains underappreciated as its diagnosis has been challenging. Recently, Technetium99-m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT) imaging has emerged as a reliable modality to diagnose patients with TTR cardiac amyloidosis. However, there are no clear guidelines regarding which patients should be referred for Tc-PYP imaging.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 104 Source Type: research
Authors: Boutagy NE, Feher A, Alkhalil I, Umoh N, Sinusas AJ Abstract Multimodality cardiovascular imaging is routinely used to assess cardiac function, structure, and physiological parameters to facilitate the diagnosis, characterization, and phenotyping of numerous cardiovascular diseases (CVD), as well as allows for risk stratification and guidance in medical therapy decision-making. Although useful, these imaging strategies are unable to assess the underlying cellular and molecular processes that modulate pathophysiological changes. Over the last decade, there have been great advancements in imaging instrumenta...
Source: Comprehensive Physiology - Category: Physiology Tags: Compr Physiol Source Type: research
This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality. Background TcPYP nuclear scintigraphy is a diagnostic and prognostic tool in ATTR. Echocardiography has identified a pattern of regional variation in longitudinal strain (LS) with a gradient of improved strain from base to apex in ATTR. Methods Consecutive patients with ATTR were evaluated who underwent TcPYP nuclear scintigraphy with planar and attenuation corrected single-photon emission computed tomography (SPECT). Heart-to-contralateral lung (H/CL...
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - Category: Radiology Authors: Tags: Original Research Source Type: research
AbstractBackgroundTechnetium-based bone scintigraphy is rapidly becoming the most common non-invasive imaging tool in the diagnosis of Transthyretin cardiac amyloidosis (ATTR). Skeletal muscle uptake has been described with technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid (TcDPD), and may account for masking of bony uptake. We sought to investigate skeletal muscle uptake of technetium-99m-pyrophosphate (TcPYP) in patients with ATTR.Methods and ResultsThis was a retrospective analysis of 57 patients diagnosed with ATTR who underwent TcPYP scintigraphy. Cardiac uptake was assessed on whole-body planar imaging usin...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
PMID: 29199249 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
AbstractCardiac amyloidosis is a form of restrictive cardiomyopathy resulting in heart failure and potential risk on arrhythmia, due to amyloid infiltration of the nerve conduction system and the myocardial tissue. The prognosis in this progressive disease is poor, probably due the development of cardiac arrhythmias. Early detection of cardiac sympathetic innervation disturbances has become of major clinical interest, because its occurrence and severity limits the choice of treatment. The use of iodine-123 labelled metaiodobenzylguanidine ([I-123]MIBG), a chemical modified analogue of norepinephrine, is well established in...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
Authors: Wall JS, Kennel SJ, Martin EB Abstract Amyloidosis is associated with a number of rare diseases and is characterized by the deposition, in abdominothoracic organs and peripheral nerves, of extracellular protein fibrils, which leads to dysfunction and severe morbidity. Effective clinical evaluation and management of patients with systemic amyloidosis are hampered by the lack of a noninvasive, quantitative method for detecting whole-body amyloid load. We have used a battery of assays including dual-energy SPECT imaging and comparative effectiveness studies in support of translation of a synthetic polybasic p...
Source: Molecular Imaging - Category: Radiology Tags: Mol Imaging Source Type: research
Conclusion: These results showed the potential of NaF-PET/MR to diagnose cardiac amyloidosis and to differentiate ATTR and AL forms, confirming our preliminary published results (Trivieri et al. J Am Coll Cardiol 2016). Research Support: This work was supported by National Institutes of Health (NIH) grants NIH/NHLBI R01HL071021 (to Dr. Fayad) and NIH 5T32HL007824-18 (to Dr. Trivieri), and by British Heart Foundation grants SS/CH/09/002/26360, FS/13/77/30488, SS/CH/09/002/2636, FS/14/78/31020, CH/09/002 (to Dr. Dweck).
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: The ' New Cardiomyopathies: Sarcoid, Amyloid, and Chemotherapy Source Type: research
35Objectives: The current gold standard for diagnosis of amyloid cardiomyopathy (A-CM) is endomyocardial biopsy (EMB). Bone radiotracer based scintigraphy has re-emerged as an effective non-invasive procedure for diagnosing A-CM, specifically transthyretin amyloid cardiomyopathy (ATTR-CM). The purpose of our study was to evaluate the diagnostic accuracy of a new combined single-photon emission computed tomography and computed tomography (SPECT-CT) (3-D imaging) based quantitative method for diagnosing ATTR-CM and compare it with the current standard planar scintigraphy (2-D imaging) method, the heart-to-contralateral side ...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Young Investigator Award Symposium Source Type: research
ConclusionsModification of amyloid-targeting peptides using D-amino acids should be performed cautiously due to the introduction of unexpected secondary pharmacologic effects. Peptides that adopt a helical structure, to align charged amino acid side chains along one face, exhibit specific reactivity with amyloid; however, polybasic peptides with a propensity for β-sheet conformation are also amyloid-reactive and may yield a novel class of amyloid-targeting agents for imaging and therapy.
Source: Molecular Imaging and Biology - Category: Molecular Biology Source Type: research
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