Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy.
Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy.
J Nucl Cardiol. 2021 Feb;28(1):90-99. doi: 10.1007/s12350-019-01643-w. Epub 2019 Feb 14.
99mTc-HMDP scintigraphy has proved its efficacy in non-invasive diagnosis of cardiac amyloidosis (CA) and is currently interpreted according to the Perugini qualitative assessment. Several semi-quantitative indices have been proposed to overcome inherent possible limitations of visual grading. Our aim was to comparatively evaluate six different indices and their diagnostic performance.
We retrospectively reviewed scintigraphy of 76 patients (53 ATTR, 12 AL, 11 LVH) who underwent diagnostic evaluation at our centre. ROC-curve analysis was performed to identify optimal cut-off and relative diagnostic accuracy of six different indices (of which one was proposed for the first time), both in identifying CA patients and in discriminating patients according to their Perugini score.
Heart/Whole-body ratios proved to be the most accurate (100%) in identifying CA patients. Heart/Pelvis ratio (with soft tissue background correction) offered acceptable accuracy (98%), with the largest area under the curve (AUC) (0.98) in discriminating patients with Perugini ≥ 2. Heart/Contralateral Lung ratio confirmed to be exposed to confounding background noise in case of simultaneous lung uptake. Heart/Skull ratio had the worst performance, with six false-negative patients in ATTR identification.
Heart/Whole-body ratios may be robust and effective semi-quantitative indices for the evaluation of CA by means of scintigraphy.
99mTc-HMDP 闪烁显像已被证明可有效用于非侵入性诊断心脏淀粉样变性（CA），目前根据佩鲁吉尼（Perugini）定性评估进行解读。为了克服视觉分级固有的潜在局限性，已经提出了几种半定量指标。我们的目的是比较评估六种不同的指标及其诊断性能。
我们回顾性分析了在我们中心接受诊断评估的 76 例患者（53 例ATTR，12 例 AL，11 例 LVH）的闪烁显像。通过 ROC 曲线分析，确定了六种不同指标（其中一种是首次提出）的最佳截断值和相对诊断准确性，用于识别 CA 患者以及根据 Perugini 评分对患者进行区分。
心脏/全身比值在识别 CA 患者方面是最准确的（100%）。心脏/骨盆比值（具有软组织背景校正）具有可接受的准确性（98%），在区分 Perugini≥2 的患者方面具有最大的曲线下面积（AUC）（0.98）。心脏/对侧肺比值在同时存在肺摄取的情况下，被证实易受到背景噪声的干扰。心脏/颅骨比值的表现最差，在识别ATTR 患者时，有 6 例出现假阴性。
心脏/全身比值可能是闪烁显像评估 CA 的稳健有效的半定量指标。
