Author + information
- Received January 27, 2020
- Revision received March 13, 2020
- Accepted March 18, 2020
- Published online June 1, 2020.
- Paul R. Scully, MBBS, MResa,b,
- Elizabeth Morris, MMathsPhys, MScc,
- Kush P. Patel, MBBS, BSca,b,
- Thomas A. Treibel, PhDa,b,
- Maria Burniston, BSc, PhDc,
- Ernst Klotz, Diply Physd,
- James D. Newton, MBChB, MDe,
- Nikant Sabharwal, DMe,
- Andrew Kelion, DMe,
- Charlotte Manisty, PhDa,b,
- Simon Kennon, MDa,
- Muhiddin Ozkor, MBBS, MDa,
- Michael Mullen, MBBS, MDa,
- Neil Hartman, PhDf,
- Perry M. Elliott, MDa,b,
- Francesca Pugliese, PhDa,g,h,
- Philip N. Hawkins, PhDi,
- James C. Moon, MDa,b and
- Leon J. Menezes, BA, BM BCha,j,k,∗ ()
- aBarts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom
- bInstitute of Cardiovascular Sciences, University College London, London, United Kingdom
- cClinical Physics, St. Bartholomew’s Hospital, London, United Kingdom
- dSiemens Healthineers, Forchheim, Germany
- eJohn Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
- fNuclear Medicine, Abertawe Bro Morgannwg University HB, Swansea, United Kingdom
- gWilliam Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- hNIHR Barts Biomedical Research Centre, London, United Kingdom
- iNational Amyloidosis Centre, University College London, London, United Kingdom
- jInstitute of Nuclear Medicine, University College London, London, United Kingdom
- kNIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Leon J. Menezes, Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Objectives To assess whether single-photon emission computed tomography (SPECT/CT) quantification of bone scintigraphy would improve diagnostic accuracy and offer a means of quantifying amyloid burden.
Background Transthyretin-related cardiac amyloidosis is common and can be diagnosed noninvasively using bone scintigraphy; interpretation, however, relies on planar images. SPECT/CT imaging offers 3-dimensional visualization.
Methods This was a single-center, retrospective analysis of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scans reported using the Perugini grading system (0 = negative; 1 to 3 = increasingly positive). Conventional planar quantification techniques (heart/contralateral lung, and heart/whole-body retention ratios) were performed. Heart, adjacent vertebra, paraspinal muscle and liver peak standardized uptake values (SUVpeak) were recorded from SPECT/CT acquisitions. An SUV retention index was also calculated: (cardiac SUVpeak/vertebral SUVpeak) × paraspinal muscle SUVpeak. In a subgroup of patients, SPECT/CT quantification was compared with myocardial extracellular volume quantification by CT imaging (ECVCT).
Results A total of 100 DPD scans were analyzed (patient age 84 ± 9 years; 52% male): 40 were Perugini grade 0, 12 were grade 1, 41 were grade 2, and 7 were grade 3. Cardiac SUVpeak increased from grade 0 to grade 2; however, it plateaued between grades 2 and 3 (p < 0.001). Paraspinal muscle SUVpeak increased with grade (p < 0.001), whereas vertebral SUVpeak decreased (p < 0.001). The composite parameter of SUV retention index overcame the plateauing of the cardiac SUVpeak and increased across all grades (p < 0.001). Cardiac SUVpeak correlated well (r2 = 0.73; p < 0.001) with ECVCT. Both the cardiac SUVpeak and SUV retention index had excellent diagnostic accuracy (area under the curve [AUC]: 0.999). The heart to contralateral lung ratio performed the best of the planar quantification techniques (AUC: 0.987).
Conclusions SPECT/CT quantification in DPD scintigraphy is possible and outperforms planar quantification techniques. Differentiation of Perugini grade 2 or 3 is confounded by soft tissue uptake, which can be overcome by a composite SUV retention index. This index can help in the diagnosis of cardiac amyloidosis and may offer a means of monitoring response to therapy.
Dr. Scully is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/16/31/32185). Ms. Morris is the recipient of a part time National Institute of Health Research (NIHR) Doctoral Fellowship (NIHR300203); the work presented in this paper does not form part of her fellowship. Dr. Patel is supported by an unrestricted educational grant from Edwards Lifesciences and a British Heart Foundation Clinical research training fellowship grant (FS/19/48/34523). Dr. Treibel is supported by a clinical lecturer grant from the NIHR. Mr. Klotz works for Siemens Healthineers. Dr. Mullen reports consultancy for Abbott Vascular and Edwards Lifesciences; and a research grant from Edwards Lifesciences. Dr. Moon is directly and indirectly supported by the UCLH NIHR Biomedical Research Centre and Biomedical Research Unit at UCLH and Barts, respectively. Dr. Pugliese has received research support from Siemens Healthineers, and this work forms part of the translational research portfolio of the NIHR Cardiovascular Biomedical Research Centre at Barts Heart Centre, which is supported and funded by the NIHR. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received January 27, 2020.
- Revision received March 13, 2020.
- Accepted March 18, 2020.
- 2020 The Authors