Usefulness and limitations of 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy

Claudio Rapezzi, Candida Cristina Quarta, Pier Luigi Guidalotti, Simone Longhi, Cinzia Pettinato, Ornella Leone, Alessandra Ferlini, Fabrizio Salvi, Pamela Gallo, Christian Gagliardi, Angelo Branzi

Research output: Contribution to journalArticle

Abstract

Purpose We previously reported in a small series of patients that 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid ( 99mTc-DPD) scintigraphy tested positive in transthyretin-related (TTR) (both mutant and wild-type) but not in primary (AL) amyloidotic cardiomyopathy (AC). We extended our study to a larger cohort of patients with AC. Methods We evaluated (1) 45 patients with TTR-related AC (28 mutant and 17 wild-type), (2) 34 with AL-related AC and (3) 15 non-affected controls. Myocardial uptake of 99mTc-DPD (740 MBq i.v.) was semiquantitatively and visually assessed at 5 min and at 3 h. Results Heart retention (HR) and heart to whole-body retention ratio (H/WB) of late 99mTc-DPD uptake were higher among TTR-related AC (HR 7.8%; H/WB 10.4) compared with both unaffected controls (HR 3.5%; H/WB 5.7; p<0.0001) and AL-related AC (HR 4.0%; H/WB 6.1; p<0.0001). For the diagnosis of TTR-related AC, positive and negative predictive accuracy of visual scoring of cardiac retention were: 80 and 100% (visual score ≥1); 88 and 100% (visual score ≥2); and 100 and 68% (visual score = 3). At adjusted linear regression analysis, TTR aetiology turned out to be the only positive predictor of increasing 99mTc-DPD uptake in terms of both HR [β 2.5, 95% confidence interval (CI) 1.5-3.5; p99mTc-DPD scintigraphy was confirmed to be useful for differentiating TTR from AL-related AC, diagnostic accuracy was lower than previously reported due to a mild degree of tracer uptake in about one third of AL patients. 99mTc-DPD scintigraphy can provide an accurate differential diagnosis in cases of absent or intense uptake evaluated by visual score.

Original languageEnglish
Pages (from-to)470-478
Number of pages9
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume38
Issue number3
DOIs
Publication statusPublished - Mar 2011

Keywords

  • Tc-DPD scintigraphy
  • Accuracy
  • Amyloid
  • Cardiomyopathy
  • Differential diagnosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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