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Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard

OBJECTIVES: The purpose of this study was to examine the diagnostic value of planar (99m)Tc-pyrophosphate (PYP) imaging at 1 and 3 h after tracer administration in patients with suspected transthyretin cardiac amyloidosis (ATTR-CA) using SPECT as a reference standard. We also tested whether blood po...

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Autores principales: Saitou, Toshinori, Aikawa, Tadao, Manabe, Osamu, Nagase, Atsushi, Kudo, Tamaki, Oyama-Manabe, Noriko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Nature Singapore 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646466/
https://www.ncbi.nlm.nih.gov/pubmed/36352186
http://dx.doi.org/10.1007/s12149-022-01807-8
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author Saitou, Toshinori
Aikawa, Tadao
Manabe, Osamu
Nagase, Atsushi
Kudo, Tamaki
Oyama-Manabe, Noriko
author_facet Saitou, Toshinori
Aikawa, Tadao
Manabe, Osamu
Nagase, Atsushi
Kudo, Tamaki
Oyama-Manabe, Noriko
author_sort Saitou, Toshinori
collection PubMed
description OBJECTIVES: The purpose of this study was to examine the diagnostic value of planar (99m)Tc-pyrophosphate (PYP) imaging at 1 and 3 h after tracer administration in patients with suspected transthyretin cardiac amyloidosis (ATTR-CA) using SPECT as a reference standard. We also tested whether blood pool activity of PYP is associated with renal dysfunction. METHODS: PYP images of 109 consecutive patients with suspected ATTR-CA were retrospectively reviewed. The myocardial PYP uptake was visually graded on a scale of 0 to 3 and quantified with the heart-to-contralateral (H/CL) ratio in accordance with the current expert consensus recommendations. The diagnostic value of planar images for identifying positive PYP SPECT was assessed by a receiver-operating characteristic curve analysis with the area under the curve (AUC). The uptake ratios of the ascending and descending aorta, left atrium, and trapezius muscle divided by the liver uptake were measured on SPECT images and compared to the renal function. RESULTS: A total of 41 patients (38%) had myocardial PYP uptake on SPECT images. In comparison with the visual scores on 1-h anterior planar images, those on 3-h anterior planar images had lower sensitivity (80.5% vs. 97.6%) and higher specificity (86.8% vs. 55.9%) for identifying positive PYP SPECT. The ROC analysis showed that the combination of visual scores on both 1-h and 3-h anterior planar images had significantly higher AUC values in comparison with 1-h anterior planar images alone (0.90 [95% CI 0.83–0.94] vs. 0.83 [95% CI 0.75–0.88]; P < 0.001), which was comparable to the AUC values on 3-h anterior planar images alone (0.88 [95% CI 0.80–0.92]; P = 0.071). In comparison with visual scores on 1-h or 3-h anterior planar images alone, the combination of visual scores and H/CL ratio did not significantly improve the diagnostic value for identifying positive PYP SPECT (P = 0.73 and P = 0.50, respectively). The uptake ratios of ascending aorta/liver, descending aorta/liver, left atrium/liver, and trapezius muscle/liver were not significantly associated with the serum creatinine level or estimated glomerular filtration rate (P > 0.05 for all). CONCLUSIONS: In the assessment of ATTR-CA using PYP imaging, visual scores on 3-h anterior planar images for identifying positive PYP SPECT had lower sensitivity and higher specificity in comparison with those on 1-h anterior planar images. The diagnostic value of the visual scores on 1-h and 3-h anterior planar images was not improved by adding the H/CL ratio. Blood pool activity of PYP was not significantly associated with renal dysfunction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12149-022-01807-8.
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spelling pubmed-96464662022-11-14 Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard Saitou, Toshinori Aikawa, Tadao Manabe, Osamu Nagase, Atsushi Kudo, Tamaki Oyama-Manabe, Noriko Ann Nucl Med Original Article OBJECTIVES: The purpose of this study was to examine the diagnostic value of planar (99m)Tc-pyrophosphate (PYP) imaging at 1 and 3 h after tracer administration in patients with suspected transthyretin cardiac amyloidosis (ATTR-CA) using SPECT as a reference standard. We also tested whether blood pool activity of PYP is associated with renal dysfunction. METHODS: PYP images of 109 consecutive patients with suspected ATTR-CA were retrospectively reviewed. The myocardial PYP uptake was visually graded on a scale of 0 to 3 and quantified with the heart-to-contralateral (H/CL) ratio in accordance with the current expert consensus recommendations. The diagnostic value of planar images for identifying positive PYP SPECT was assessed by a receiver-operating characteristic curve analysis with the area under the curve (AUC). The uptake ratios of the ascending and descending aorta, left atrium, and trapezius muscle divided by the liver uptake were measured on SPECT images and compared to the renal function. RESULTS: A total of 41 patients (38%) had myocardial PYP uptake on SPECT images. In comparison with the visual scores on 1-h anterior planar images, those on 3-h anterior planar images had lower sensitivity (80.5% vs. 97.6%) and higher specificity (86.8% vs. 55.9%) for identifying positive PYP SPECT. The ROC analysis showed that the combination of visual scores on both 1-h and 3-h anterior planar images had significantly higher AUC values in comparison with 1-h anterior planar images alone (0.90 [95% CI 0.83–0.94] vs. 0.83 [95% CI 0.75–0.88]; P < 0.001), which was comparable to the AUC values on 3-h anterior planar images alone (0.88 [95% CI 0.80–0.92]; P = 0.071). In comparison with visual scores on 1-h or 3-h anterior planar images alone, the combination of visual scores and H/CL ratio did not significantly improve the diagnostic value for identifying positive PYP SPECT (P = 0.73 and P = 0.50, respectively). The uptake ratios of ascending aorta/liver, descending aorta/liver, left atrium/liver, and trapezius muscle/liver were not significantly associated with the serum creatinine level or estimated glomerular filtration rate (P > 0.05 for all). CONCLUSIONS: In the assessment of ATTR-CA using PYP imaging, visual scores on 3-h anterior planar images for identifying positive PYP SPECT had lower sensitivity and higher specificity in comparison with those on 1-h anterior planar images. The diagnostic value of the visual scores on 1-h and 3-h anterior planar images was not improved by adding the H/CL ratio. Blood pool activity of PYP was not significantly associated with renal dysfunction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12149-022-01807-8. Springer Nature Singapore 2022-11-10 2023 /pmc/articles/PMC9646466/ /pubmed/36352186 http://dx.doi.org/10.1007/s12149-022-01807-8 Text en © The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Saitou, Toshinori
Aikawa, Tadao
Manabe, Osamu
Nagase, Atsushi
Kudo, Tamaki
Oyama-Manabe, Noriko
Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title_full Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title_fullStr Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title_full_unstemmed Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title_short Comparison of 1-h with 3-h planar (99m)Tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using SPECT as a reference standard
title_sort comparison of 1-h with 3-h planar (99m)tc-pyrophosphate scintigraphy in patients with suspected transthyretin cardiac amyloidosis using spect as a reference standard
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646466/
https://www.ncbi.nlm.nih.gov/pubmed/36352186
http://dx.doi.org/10.1007/s12149-022-01807-8
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