The utility of 99mTc-DPD scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience

Moore, Peter T., Burrage, Matthew K. , Mackenzie, Emily, Law, W. Philip, Korczyk, Dariusz and Mollee, Peter (2017) The utility of 99mTc-DPD scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience. Heart, Lung and Circulation, . doi:10.1016/j.hlc.2016.12.017


Author Moore, Peter T.
Burrage, Matthew K.
Mackenzie, Emily
Law, W. Philip
Korczyk, Dariusz
Mollee, Peter
Title The utility of 99mTc-DPD scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience
Formatted title
The utility of 99mTc-DPD scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience
Journal name Heart, Lung and Circulation   Check publisher's open access policy
ISSN 1444-2892
1443-9506
Publication date 2017-02-16
Sub-type Article (original research)
DOI 10.1016/j.hlc.2016.12.017
Open Access Status Not yet assessed
Total pages 8
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Collection year 2018
Language eng
Formatted abstract
Background: The uptake of bone-seeking radiotracers in the amyloid heart is well recognised. 99mTc-DPD has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid in an overseas population, but is not registered for use in Australia. We explored its utility as a diagnostic tool within our population.

Methods: Patients diagnosed with AL and ATTR (wild-type and inherited) cardiac amyloidosis were prospectively recruited from the Princess Alexandra Hospital Amyloidosis Centre. Patients underwent injection with 99mTc-DPD then planar whole body imaging was performed at five minutes post-injection (soft tissue phase) and three hours (bone phase). A myocardial SPECT and low amperage CT were acquired after the late whole-body scan. Scans were analysed by two nuclear imaging specialists. Intensity of cardiac 99mTc-DPD uptake was graded as 0 to 3 in accordance with previous criteria, and semiquantitative analysis was performed using a heart to whole body ratio (H:WB) on the three-hour scan. Patients also underwent electrocardiography and transthoracic echocardiography, and blood samples were taken for troponin I and brain natriuretic peptide levels, to assess for any correlation with DPD uptake.

Results: Twenty-one patients (8 AL and 13 ATTR) completed the study. Median age was 58 and 70 years for AL and ATTR patients respectively, and 19 (90.5%) were male. 99mTc-DPD scintigraphy was positive in 2 (25%) of AL, and 13 (100%) of ATTR patients. Grade of cardiac uptake, and mean H:WB (0.1249 v. 0.0794) was greater in the ATTR cohort (p-value<0.001 and 0.001 respectively). No statistically significant correlation was identified between H:WB and echocardiographic parameters. There was a significant positive correlation between H:WB and the PR interval on ECG (p=0.026).

Conclusions: 99mTc-DPD scintigraphy is highly sensitive for the diagnosis of cardiac ATTR amyloid, but less so for AL amyloid.
Keyword 99mTc-DPD scintigraphy
Bone scan
Cardiac amyloidosis
Nuclear imaging
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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