Tc-HDP quantitative SPECT/CT in transthyretin cardiac amyloid and the development of a reference interval for myocardial uptake in the non-affected population
Tóm tắt
99mTechnetium-HDP (HDP) bone scans differentiate transthyretin (ATTR) cardiac amyloid from other infiltrative myocardial diseases. These scans are not quantitative and are assessed by comparing myocardial uptake to bone. This study examined whether quantitative HDP SPECT/CT can discriminate individuals with cardiac ATTR from the population without this disease. HDP thoracic xSPECT/CT QUANT (xQUANT) was performed in 29 patients: ATTR cardiac amyloid (n = 6); AL cardiac amyloid (n = 1); other infiltrative myocardial disease (n = 4); no known infiltrative cardiac disease (n = 18). SUVmax measured within volumes of interest for whole heart, ascending aorta blood pool, and specific bones. HDP myocardial uptake calculated as whole heart minus blood pool. The cardiac ATTR group had greater HDP myocardial uptake than those with no known infiltrative disease (p = 0.002). AL and other myocardial diseases had uptake indistinguishable from the group with no known infiltrative cardiac disease. The SUVmaxima were sufficiently similar between individuals without cardiac ATTR that a 99% reference interval for HDP uptake could be calculated, providing an upper limit cut point of SUVmax 1.2. Individuals with cardiac ATTR had SUVmax well above this cut point. Quantitative SPECT/CT can measure HDP myocardial uptake in individuals with normal hearts and those with cardiac ATTR without recourse to comparison with bone. It enables calculation of a reference interval for HDP myocardial uptake in the population without ATTR cardiac amyloid. Using this reference interval single individuals with cardiac ATTR can be accurately discriminated from the non-affected population. This technique uses a NIST traceable calibration source, potentially allowing development of multicentre clinical decision limits. Its role in disease management warrants further assessment.
Tài liệu tham khảo
Andrikopoulou E, Bhambhvani P (2017) Nuclear imaging of cardiac amyloidosis. J Nucl Cardiol. https://doi.org/10.1007/s12350-017-1028-3
Armstrong IS, Hoffmann SA. Activity concentration measurements using a conjugate gradient (Siemens xSPECT) reconstruction algorithm in SPECT/CT. Nucl Med Commun. 2016;37(11):1212–7.
Efron B (1980) The jackknife, the bootstrap and other resampling plans. https://statistics.stanford.edu/sites/default/files/BIO%2063.pdf. Accessed 8 June 2018.
Bai B, Bading J, Conti PS (2013) Tumour quantification in clinical positron emission tomography. Theranostics. 3(10):787–801
Bailey DL, Willowson KP (2014) Quantitative SPECT/CT: SPECT joins PET as a quantitative imaging modality. Eur J Nucl Med Mol Imaging. 41(Suppl 1):S17–S25
Cachovan M, Vija AH, Hornegger J, Kuwert T (2013) Quantification of 99mTc-DPD concentration in the lumbar spine with SPECT/CT. EJNMMI Res. 3(1):45
Cappelli F, Gallini C, Di Mario C, Costanzo EN, Vaggelli L, Tutino F et al (2017) Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis. Journal of Nuclear Cardiology. https://doi.org/10.1007/s12350-017-0922-z
CLSI (2008) Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline - third edition. CLSI Document C28-A3, Wayne, PA, Clinical and Laboratory Standards Institute.
Galat A, Rosso J, Guellich A, Van Der Gucht A, Rappeneau S, Bodez D et al (2015) Usefulness of (99m)Tc-HMDP scintigraphy for the etiologic diagnosis and prognosis of cardiac amyloidosis. Amyloid. 22(4):210–220
Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A et al (2016) Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis. Circulation. 133(24):2404–2412
Glaudemans AW, van Rheenen RW, van den Berg MP, Noordzij W, Koole M, Blokzijl H et al (2014) Bone scintigraphy with (99m)technetium-hydroxymethylene diphosphonate allows early diagnosis of cardiac involvement in patients with transthyretin-derived systemic amyloidosis. Amyloid. 21(1):35–44
Habib G, Bucciarelli-Ducci C, Caforio ALP, Cardim N, Charron P, Cosyns B et al (2017) Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography. Eur Heart J Cardiovasc Imaging. 18(10):1090–1121
Hutt DF, Fontana M, Burniston M, Quigley AM, Petrie A, Ross JC et al (2017) Prognostic utility of the Perugini grading of 99mTc-DPD scintigraphy in transthyretin (ATTR) amyloidosis and its relationship with skeletal muscle and soft tissue amyloid. Eur Heart J Cardiovasc Imaging. 18(12):1344–1350
Kaneta T, Ogawa M, Daisaki H, Nawata S, Yoshida K (2016) Inoue T. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate. Am J Nucl Med Mol Imaging. 6(5):262–268
Maurer MS, Elliott P, Comenzo R, Semigran M, Rapezzi C (2017) Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis. Circulation. 135(14):1357–1377
Morrow DA, Cook NR (2011) Determining decision limits for new biomarkers: clinical and statistical considerations. Clin Chem. 57(1):1–3
Ozarda Y (2016) Reference intervals: current status, recent developments and future considerations. Biochem Med (Zagreb). 26(1):5–16
Perugini E, Guidalotti PL, Salvi F, Cooke RM, Pettinato C, Riva L et al (2005) Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol. 46(6):1076–1084
Vija AH. xSPECT reconstruction method. White Paper Order No A91MI-10462-T1-7600. 2017