99mTc-MDP MYOCARDIAL SCINTIGRAPHY IN DIAGNOSIS OF AMYLOID CARDIOMYOPATHY AT FV HOSPITAL, HCM CITY

Nguyen Van Te1,
1 Y học hạt nhân, Bệnh viện FV, TP.HCM

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Tóm tắt

Retrospective study of 99mTc-MDP myocardial scintigraphy for restrictive cardiomyopathy with suspicion of amyloidosis from Feb 2021-Nov 2021 at FV hospital. Total 10 patients (7 male and 3 female patients) of age 37-85 years. Injected dose 15-20 (555-740 MBq), Thorax planar and SPECT/low dose non contrast CT acquisition at 1 hour following tracer injection. Qualitative analysis with Visual score and quantitative H/CL ratio Positive scan is concluded in case of diffuse uptake in myocardium with Visual score 2-3 and H/CL ratio >1.5. The procedure was performed safely with no side effect, no allergic to radiotracer recognized.


Results: Two male patients out of ten are positive for TTR-CA, at age 37 and 67. No myocardial biopsy is indicated for differential diagnosis between AL and TTR-CA. Eight patients are negative scintigraphically not specific for TTR-CA with H/CL <1.5 and Visual score 0.


Conclusion: 99mTc-MDP cardiac scintigraphy is a safe, reliable, noninvasive nuclear imaging applicated for early and differential diagnosis of cardiac amyloidosis replacing to myocardial biopsy. This approach contributes to reveal an undiagnosed disease at not so advanced cardiac involvement and with the progress of recent medical treatment, the survival is increasing. Other bone-avid tracers are encuraged for myocardial imaging depending on their availability

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Tài liệu tham khảo

1. Michelle M.K, Mathew S.M, Amrut V. A, Renee P. B, Patricia P. C, Howard J. E, Ajith P. N, Jose N, Frederick L.R Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association Circulation. 2020;142(1):e7–e22 https://doi.org/10.1161/CIR.0000000000000792
2. Frederick LR, and John L.B, Transthyretin (TTR) Cardiac Amyloidosis Circulation. 2012 ; 126(10): 1286–1300 https://doi.org/10.1161/CIRCULATIONAHA.111.078915
3. Joshua Dower, Danai Dima, Mumtu Lalla, Ayan R Patel, Raymond L Comenzo, Cindy Varga The use of PYP scan for evaluation of ATTR cardiac amyloidosis at a tertiary medical centre May 2022, Br J Cardiol 2022;29:73–6 http://dx.doi.org/10.5837/bjc.2022.019
4. Sabahat Bokhari, Reehan Shahzad, Adam Castaño, Mathew S Maurer. Nuclear imaging modalities for cardiac amyloidosis. Journal of Nuclear Cardiology ,26 October 2013; volume 21, pages 175–184 (2014). ttps://doi. org/10.1007/s12350-013-9803-2
5. Nobuhiro Tahara, Olivier Lairez, Jin Endo, Atsushi Okada, Mitsuharu Ueda, Tomonori Ishii, Yoshinobu Kitano, HahnEy Lee, Eleonora Russo, Toru Kubo. 99mTechnetium-pyrophosphate scintigraphy: a practical guide for early diagnosis of transthyretin amyloid cardiomyopathy. SC Heart Failure2022; 9: 251–262 DOI:10.1002/ehf2.13693. ttps://onlinelibrary.wiley.com/doi/10.1002/ehf2.13693
6. Paeng, J.C., Choi, J.Y. Nuclear Imaging for Cardiac Amyloidosis: Bone Scan, SPECT/CT, and Amyloid-Targeting PET. Nucl Med Mol Imaging 55, 61–70 (2021). https://doi.org/10.1007/s13139-020-00681-4. https://doi. org/10.1007/s13139-020-00681-4
7. M, Jaber WA. The Association of Cardiac Biomarkers, the Intensity of Tc99 Pyrophosphate Uptake, and Survival in Patients Evaluated for Transthyretin Cardiac Amyloidosis in the Early Therapeutics Era. JCF, Volume 28, ISSUE 10, P1509-1518, October 2022. https://doi.org/10.1016/j.cardfail.2022.06.005
8. Maria Beatrice Musumeci, Francesco Cappelli, Domitilla Russo, Giacomo Tini… Low Sensitivity of Bone Scintigraphy in Detecting Phe64Leu Mutation-Related Transthyretin Cardiac Amyloidosis. JACC Cardiovasc Imaging. 2020 Jun;13(6):1314-1321. https://pubmed.ncbi.nlm.nih.gov/31864976