Takahashi Koji, Sasaki Daisuke, Yamashita Mina, Sakaue Tomoki, Enomoto Daijiro, Morioka Hiroe, Uemura Shigeki, Okura Takafumi, Ikeda Shuntaro, Kono Taizo, Hiratsuka Yoshiyasu, Saijo Akira, Yamamura Nobuhisa, Kitazawa Sohei, Yamashita Taro, Ueda Mitsuharu
Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.
Department of Cardiology, Yawatahama City General Hospital, 1-638, Ohira, Yawatahama, Ehime, 796-8502, Japan.
J Nucl Cardiol. 2022 Dec;29(6):3126-3136. doi: 10.1007/s12350-021-02890-6. Epub 2021 Dec 28.
Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.
Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.
Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.
In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.
使用亲骨性示踪剂的放射性核素成像在诊断转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）中起着关键作用，但99m锝焦磷酸盐（PYP）很少能检测到心脏外淀粉样蛋白浸润。我们回顾性研究了ATTR-CA患者腹部皮下脂肪中PYP摄取的频率及其与该组织细针穿刺活检（FNAB）结果的相关性。
静脉注射示踪剂（20mCi）后2小时获得PYP闪烁扫描以胸部为中心的图像，并评估腹部皮下脂肪中PYP摄取的频率。通过刚果红染色评估经腹部皮下脂肪FNAB获取的脂肪涂片的淀粉样蛋白沉积。
纳入24例ATTR-CA患者。10例（41.7%）患者腹部皮下脂肪有一些PYP摄取（PYP阳性组），14例患者没有（PYP阴性组）。PYP阳性组10例患者中有7例（70.0%）经腹部皮下脂肪FNAB检测到淀粉样蛋白沉积，而PYP阴性组14例患者中无一例（0%）检测到，差异有统计学意义。
在ATTR-CA患者中，腹部皮下脂肪中异常的PYP摄取可能反映了经该组织FNAB证实的局部淀粉样蛋白沉积。
