Huang Yih-Hwen, Lin Yen-Hung, Yen Ruoh-Fang, Hou Charles Jia-Yin, Wang Shan-Ying, Tsai Shih-Chuan, Ho Kung-Chu, Lin Ming-Hsien, Tsao Chin-Ho, Chang Chih-Yung, Huang Jin-Long, Cheng Mei-Fang, Wu Yen-Wen
Department of Nuclear Medicine, National Taiwan University Hospital.
National Taiwan University College of Medicine.
Acta Cardiol Sin. 2021 May;37(3):221-231. doi: 10.6515/ACS.202105_37(3).20210420A.
Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction. Favorable prognosis depends on early diagnosis and correct treatment strategy. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, Tc-labeled bone avid scintigraphy including Tc-pyrophosphate (PYP) scintigraphy may be of diagnostic and prognostic importance. Various international guidelines support the non-biopsy diagnosis of ATTR-CM using Tc-PYP scintigraphy, yet emphasize the gap in standardization of acquisition and imaging analysis protocols, as well as the appropriateness of its clinical use. Therefore, a joint expert consensus has been reached by the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China, to advocate for the application of Tc-PYP scintigraphy in the diagnosis of ATTR-CM. This article aims to highlight the recommendations on image acquisition, qualitative and quantitative assessments of cardiac Tc-PYP uptake, and diagnostic algorithms. We hope the implementation of these recommendations in Taiwan will facilitate the process and enhance the diagnostic rate of ATTR-CM.
转甲状腺素蛋白心脏淀粉样变（ATTR-CM）是射血分数保留的心力衰竭日益被认识到的病因。良好的预后取决于早期诊断和正确的治疗策略。在临床高度怀疑心脏淀粉样变的患者中，包括锝-焦磷酸盐（PYP）闪烁扫描在内的锝标记骨亲和闪烁扫描可能具有诊断和预后意义。各种国际指南支持使用Tc-PYP闪烁扫描对ATTR-CM进行非活检诊断，但强调在采集和影像分析方案的标准化以及其临床应用的适当性方面存在差距。因此，台湾心脏病学会和中华民国核医学会达成了联合专家共识，倡导将Tc-PYP闪烁扫描应用于ATTR-CM的诊断。本文旨在突出关于图像采集、心脏Tc-PYP摄取的定性和定量评估以及诊断算法的建议。我们希望这些建议在台湾的实施将促进这一过程并提高ATTR-CM的诊断率。
