Myocardial scintigraphy with 99mTc-pyrophosphate in the diagnosis of cardiac amyloidosis: place in the diagnostic algorithm, features of the implementation and interpretation of the study

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Abstract

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.

About the authors

Alexey A. Ansheles

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-2675-3276

д-р мед. наук, ст. науч. сотр. отд. радионуклидной диагностики и позитронно-эмиссионной томографии

Russian Federation, Moscow

Svetlana N. Nasonova

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-0920-7417

канд. мед. наук, ст. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности

Russian Federation, Moscow

Igor V. Zhirov

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-4066-2661

д-р мед. наук, вед. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности

Russian Federation, Moscow

Marina A. Saidova

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-3233-1862

д-р мед. наук, проф., рук. отд. ультразвуковых методов исследования

Russian Federation, Moscow

Olga V. Stukalova

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0001-8377-2388

канд. мед. наук, ст. науч. сотр. отд. томографии

Russian Federation, Moscow

Sergey N. Tereshchenko

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0001-9234-6129

д-р мед. наук, проф., рук. отд. заболеваний миокарда и сердечной недостаточности

Russian Federation, Moscow

Vladimir B. Sergienko

Chazov National Medical Research Center of Cardiology

Email: a.ansheles@gmail.com
ORCID iD: 0000-0002-0487-6902

д-р мед. наук, проф., рук. отд. радионуклидной диагностики и позитронно-эмиссионной томографии

Russian Federation, Moscow

References

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Supplementary files

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2. Fig. 1. Location of the ROI when calculating the H/Cl parameter. This patient has H/Cl=93.6/70.1=1.33.

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3. Fig. 2. Consensus algorithm for non-invasive diagnosis of cardiac amyloidosis. In patients with characteristic features of amyloidosis on echocardiography/MRI, Grade 2/3 on SPECT, and no clonal abnormalities, the diagnosis of ATTR amyloidosis can be considered established without biopsy. Patients with any abnormal serum/urine immunofixation result or the presence of free light chains in the serum should be referred for additional evaluation by a hematologist, preferably an amyloidosis specialist.

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4. Fig. 3. Data of planar scintigraphy, CT, SPECT and SPECT/CT of patient K. In planar examination, accumulation of radiopharmaceuticals in the projection of the heart is noted, however, according to SPECT/CT data, this accumulation refers to the cavities of the ventricle and atria (signal from the blood pool); the inclusion of radiopharmaceuticals in the myocardium is not detected.

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5. Fig. 4. Data from planar scintigraphy, CT, SPECT and SPECT/CT of a patient with verified TTR-amyloidosis. There is a total high-intensity accumulation of 99mTc-PYP in the myocardium ( Grade 3).

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