Diagnosis of cardiac amyloid transthyretin (ATTR) amyloidosis by early (soft tissue) phase [99mTc]Tc-DPD whole body scan: comparison with late (bone) phase imaging

Objectives Although expert consensus recommendations suggest 2–3 h as the time interval between bone-seeking radiotracers injection and acquisition, it has been reported that images obtained early after [ 99m Tc]Tc-HMDP administration are sufficient to diagnose cardiac amyloidosis. We evaluated the diagnostic performance of [ 99m Tc]Tc-DPD early phase whole body scan with respect to late phase imaging. Methods We qualitatively and semiquantitatively reviewed [ 99m Tc]Tc-DPD imaging of 53 patients referred for suspect cardiac amyloidosis. Findings of early and late phase images were compared with SPECT results (considered the standard-of-reference) determining sensitivity and specificity for visual analysis of each phase imaging and for each semiquantitative index. Results SPECT imaging was negative for cardiac accumulation in 25 patients and positive in 28. Visual analysis of early phase whole body scan had an extremely significant capability to predict SPECT results; nevertheless, complete agreement was not reached. Visual analysis of late phase imaging showed slightly better results. Semiquantitative analysis of early phase images, namely heart to mediastinum ratio, performed better than semiquantitative analysis of late phase images. Conclusion Visual analysis of [ 99m Tc]Tc-DPD early phase whole body scan is promising in diagnosing cardiac amyloidosis; further studies are needed to confirm our results in different clinical scenarios. Key Points • Visual analysis of early phase planar imaging using [ 99m Tc]Tc-DPD is accurate to diagnose cardiac amyloidosis and may be satisfactory at least in frail patients with high cardiac burden of amyloid fibrils.