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- Title
An optimized imaging protocol for [<sup>99m</sup>Tc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis.
- Authors
Schatka, Imke; Bingel, Anne; Schau, Franziska; Bluemel, Stephanie; Messroghli, Daniel R.; Frumkin, David; Knebel, Fabian; Diekmann, Sonja M.; Elsanhoury, Ahmed; Tschöpe, Carsten; Hahn, Katrin; Amthauer, Holger; Rogasch, Julian M. M.; Wetz, Christoph
- Abstract
Background: In [99mTc]Tc-DPD scintigraphy for myocardial ATTR amyloidosis, planar images 3 hour p.i. and SPECT/CT acquisition in L-mode are recommended. This study investigated if earlier planar images (1 hour p.i.) are beneficial and if SPECT/CT acquisition should be preferred in H-mode (180° detector angle) or L-mode (90°). Methods: In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients (reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i. Results: In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were ≥ 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader's confidence. Conclusions: Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium.
- Subjects
CARDIAC amyloidosis; SINGLE-photon emission computed tomography; RADIONUCLIDE imaging; MYOCARDIAL perfusion imaging; AMYLOIDOSIS; TRANSTHYRETIN
- Publication
Journal of Nuclear Cardiology, 2021, Vol 28, Issue 6, p2483
- ISSN
1071-3581
- Publication type
Article
- DOI
10.1007/s12350-021-02715-6