European journal of nuclear medicine and molecular imaging · 2025
Additive diagnostic value of thoracic SPECT/CT imaging in perugini grade 1 patients who underwent bone scintigraphy.
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Poledniczek Michael, Rettl René, Kronberger Christina, Schmid Lena Marie, Ermolaev Nikita, Duca Franz, Nitsche Christian, Binder Christina, Camuz Ligios Luciana, Eslami Mahshid, Binder Patrick, Spielvogel Clemens P, Badr Eslam Roza, Beitzke Dietrich, Kastner Johannes, Bergler-Klein Jutta, Kammerlander Andreas A, Hengstenberg Christian, Hacker Marcus, Calabretta Raffaella
Аннотация
PURPOSE: Left ventricular (LV) myocardial uptake of 99mTechnetium-labeled tracers is assessed to diagnose transthyretin amyloid cardiomyopathy (ATTR-CM). The degree of uptake is visually graded using planar images utilising the Perugini score. Today, non-invasive diagnosis of ATTR-CM is broadly established in practice; however, in patients with mild tracer uptake (Perugini grade 1), no definite diagnosis can be made without endomyocardial biopsy.
METHODS: Within the scope of a prospective cardiac amyloidosis registry at the Medical University of Vienna, all patients who underwent bone scintigraphy graded as Perugini grade 1 with additional SPECT/CT imaging performed between September 2014 and May 2025 were retrospectively analysed.
RESULTS: 41 patients (70.8 years, IQR: 64.9-78.8, 41.5% female) were included. The majority (n = 32, 78.0%) of scans were ordered for a suspicion of ATTR-CM. On SPECT/CT images, true LV tracer uptake was confirmed in 4 (9.8%) patients, and 1 (2.4%) patient presented with focal myocardial uptake. In all other patients, tracer uptake was not within the myocardial tissue but rather blood-pool uptake. In follow-up [99mTc]-DPD scintigraphy, myocardial tracer uptake eventually progressed to Perugini grade 2 in 3 patients who previously demonstrated mild LV myocardial tracer uptake. In contrast, those with diffuse LV uptake did not show any signs of progression in follow-up SPECT/CT imaging.
CONCLUSION: SPECT/CT is mandatory in patients with mild mediastinal tracer uptake interpreted as Perugini grade 1. Among patients with Perugini grade 1 and confirmed [99mTc]-DPD LV uptake on SPECT/CT images, progression to Perugini grade 2 was observed in all individuals who underwent nuclear medicine imaging follow-up.
METHODS: Within the scope of a prospective cardiac amyloidosis registry at the Medical University of Vienna, all patients who underwent bone scintigraphy graded as Perugini grade 1 with additional SPECT/CT imaging performed between September 2014 and May 2025 were retrospectively analysed.
RESULTS: 41 patients (70.8 years, IQR: 64.9-78.8, 41.5% female) were included. The majority (n = 32, 78.0%) of scans were ordered for a suspicion of ATTR-CM. On SPECT/CT images, true LV tracer uptake was confirmed in 4 (9.8%) patients, and 1 (2.4%) patient presented with focal myocardial uptake. In all other patients, tracer uptake was not within the myocardial tissue but rather blood-pool uptake. In follow-up [99mTc]-DPD scintigraphy, myocardial tracer uptake eventually progressed to Perugini grade 2 in 3 patients who previously demonstrated mild LV myocardial tracer uptake. In contrast, those with diffuse LV uptake did not show any signs of progression in follow-up SPECT/CT imaging.
CONCLUSION: SPECT/CT is mandatory in patients with mild mediastinal tracer uptake interpreted as Perugini grade 1. Among patients with Perugini grade 1 and confirmed [99mTc]-DPD LV uptake on SPECT/CT images, progression to Perugini grade 2 was observed in all individuals who underwent nuclear medicine imaging follow-up.