Department of Nuclear Medicine and Molecular Imaging .
Amyloid. 2014 Mar;21(1):35-44. doi: 10.3109/13506129.2013.871250. Epub 2014 Jan 23.
To assess the usefulness of bone scintigraphy with (99m)Technetium-hydroxymethylene diphosphonate ((99m)Tc-HDP) for the detection of cardiac involvement in a group of patients with ATTR amyloidosis in different phases of disease, to relate the findings to echocardiography, ECG and cardiac biomarkers, and to evaluate different bone scintigraphic techniques and calculation methods for quantification of the cardiac uptake and for correlation with echocardiographic features and cardiac biomarkers.
Forty-one patients underwent clinical examinations, echocardiography, ECG, measurement of cardiac biomarkers and bone scintigraphy (planar imaging and SPECT-CT) and were subsequently subdivided into three groups: (1) carriers of an amyloidogenic TTR mutation, n = 11, (2) proven ATTR amyloidosis without echocardiographically-defined (mean wall thickness >12 mm) cardiac amyloidosis (AC), n = 19, and (3) ATTR amyloidosis with echocardiographically-defined cardiac amyloidosis, n = 11. Planar and SPECT-CT images were analyzed visually according to a routine scoring system (grade 0-3) and semi-quantitatively by heart-to-whole body (H/WB) and heart-to-skull (H/S) ratio on planar images and by a left ventricle-blood pool ratio on SPECT-CT images.
All patients with ATTR and echocardiographically-defined AC and none of the carriers showed high cardiac uptake on bone scintigraphy. Furthermore, 8 out of 19 patients with ATTR without echocardiographically-defined AC showed high cardiac uptake. Highest correlations were found between H/S ratio on planar bone scintigraphy with troponin T (r = 0.76, p < 0.0001) and H/WB ratio with left ventricular mass index (r = 0.73, p < 0.0001).
Bone scintigraphy with (99m)Tc-HDP may detect cardiac involvement in patients with ATTR amyloidosis prior to echocardiographic evidence of cardiac involvement. Cardiac uptake on bone scintigraphy correlates with severity of cardiac involvement using echocardiography, ECG and cardiac biomarkers. Visual grading and calculation of H/S ratio on planar imaging are the preferred methods to assess cardiac uptake.
评估（99m）Tc-羟甲基二膦酸盐骨闪烁显像术（（99m）Tc-HDP）在不同疾病阶段的转甲状腺素蛋白淀粉样变（ATTR）淀粉样变性患者心脏受累中的应用价值，将检查结果与超声心动图、心电图和心脏标志物相关联，并评估不同的骨闪烁显像技术和定量计算方法，以评估心脏摄取量，并与超声心动图特征和心脏标志物相关联。
41 例患者接受了临床检查、超声心动图、心电图、心脏标志物测量和骨闪烁显像（平面成像和 SPECT-CT），随后分为三组：（1）载有淀粉样变性转甲状腺素蛋白突变的患者，n=11；（2）无超声心动图定义的（平均壁厚度>12mm）心脏淀粉样变性的确诊 ATTR 淀粉样变性患者，n=19；（3）超声心动图定义的心脏淀粉样变性的 ATTR 淀粉样变性患者，n=11。根据常规评分系统（0-3 级）对平面和 SPECT-CT 图像进行视觉分析，并通过平面图像上的心脏与全身（H/WB）和心脏与颅骨（H/S）比值以及 SPECT-CT 图像上的左心室与血池比值进行半定量分析。
所有 ATTR 和超声心动图定义的 AC 患者的心脏摄取均升高，而 19 例无超声心动图定义的 AC 的 ATTR 患者中无一例升高。平面骨闪烁显像的 H/S 比值与肌钙蛋白 T（r=0.76，p<0.0001）和 H/WB 比值与左心室质量指数（r=0.73，p<0.0001）相关性最高。
（99m）Tc-HDP 骨闪烁显像术可能在超声心动图显示心脏受累之前检测到 ATTR 淀粉样变性患者的心脏受累。骨闪烁显像的心脏摄取与超声心动图、心电图和心脏标志物评估的心脏受累严重程度相关。平面成像上的视觉分级和 H/S 比值的计算是评估心脏摄取的首选方法。
