Performance of 99Tc m-PYP scintigraphy in differentiation of transthyretin-related cardiac amyloidosis and hypertrophic cardiomyopathy
10.3760/cma.j.cn321828-20240108-00009
- VernacularTitle:99Tc m-PYP SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变与肥厚型心肌病
- Author:
Honghui GUO
1
;
Xinlu ZHANG
;
Xin XIANG
;
Rongchen AN
;
Zhihui FANG
;
Qianchun YE
;
Chuning DONG
;
Xuan YIN
;
Xiaowei MA
;
Yunhua WANG
Author Information
1. 中南大学湘雅二医院核医学科，长沙 410011
- Keywords:
Amyloid neuropathies, familial;
Cardiomyopathy, hypertrophic;
Technetium Tc 99m pyrophosphate;
Radionuclide imaging;
Tomography, emission-computed, single
- From:
Chinese Journal of Nuclear Medicine and Molecular Imaging
2024;44(11):668-672
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of 99Tc m-pyrophosphate (PYP) SPECT imaging for the differential diagnosis of transthyretin-related cardiac amyloidosis (ATTR-CA) and hypertrophic cardiomyopathy (HCM). Methods:Data of patients who were definitively diagnosed with ATTR-CA (35 patients (28 males, 7 females); age 62.5(58.6, 64.3) years) or HCM (14 patients (13 males, 1 female); age 60.5(57.3, 68.7) years) by extracardiac biopsy and echocardiography in the Second Xiangya Hospital of Central South University between June 2020 and March 2023 were retrospectively analyzed. All patients underwent planar and SPECT imaging 1 h after injection of 370-720 MBq 99Tc m-PYP. Visual scoring was performed (0-1 was negative, 2-3 was positive), and heart-to-contralateral lung uptake ratio (H/CL) was calculated based on planar images. The χ2 test was used to compare the difference in visual scores between ATTR-CA and HCM groups, and the diagnostic efficacy of the visual score was calculated. The H/CL differences between ATTR and HCM groups were compared with Mann-Whitney U test, and the ROC curve was used to analyze the efficacy of H/CL for the differential diagnosis of ATTR-CA and HCM. Results:There were 34 patients with visual scores≥2 and 1 patient with visual score<2 in the ATTR-CA group, 6 patients with visual scores =2 and 8 patients with visual scores <2 in HCM group, and there were significant differences between the 2 groups ( χ2=16.20, P<0.001). The diagnostic sensitivity of the visual score was 97.1%(34/35), and the specificity was 8/14. The H/CL in the ATTR-CA group was significantly higher than that in the HCM group (2.08(1.97, 2.20) vs 1.26 (1.17, 1.35), z=-5.09, P<0.001). The ROC curve analysis suggested that the optimal cut-off value was 1.45 (AUC: 0.980, 95% CI: 0.946-1.000; P<0.001); the sensitivity of H/CL differential diagnosis between HCM and ATTR-CA was 97.1%(34/35), and the specificity was 14/14. Conclusion:99Tc m-PYP SPECT imaging is useful in differentiation of ATTR-CA and HCM, and the optimal cut-off value of H/CL for differential diagnosis of these 2 diseases is 1.45.
