疑似转甲状腺素蛋白（ATTR）心脏淀粉样变性患者99m锝-焦磷酸钠（99mTc-PYP）扫描中定量单光子发射计算机断层扫描得出的标准化摄取值
Quantitative single photon emission computed tomography derived standardized uptake values on 99mTc-PYP scan in patients with suspected ATTR cardiac amyloidosis.
作者信息
Avalon Juan Carlo, Fuqua Jacob, Deskins Seth, Miller Tyler, Conte Justin, Martin Daniel, Marano Gary, Yanamala Naveena, Mills James, Bianco Christopher, Patel Brijesh, Seetharam Karthik, Raylman Raymond, Sengupta Partho P, Hamirani Yasmin S
机构信息
School of Medicine, West Virginia University, Morgantown, WV, USA.
Department of Radiology, West Virginia University, Morgantown, WV, USA.
出版信息
J Nucl Cardiol. 2023 Feb;30(1):127-139. doi: 10.1007/s12350-022-02988-5. Epub 2022 Jun 2.
Technetium-99 pyrophosphate scintigraphy (99mTc-PYP) provides qualitative and semiquantitative diagnosis of ATTR cardiac amyloidosis (ATTR-CA) using the Perugini scoring system and heart/contralateral heart ratio (H/CL) on planar imaging. Standardized uptake values (SUV) with quantitative single photon emission computed tomography (xSPECT/CT) can offer superior diagnostic accuracy and quantification through precise myocardial contouring that enhances assessment of ATTR-CA burden. We examined the correlation of xSPECT/CT SUVs with Perugini score and H/CL ratio. We also assessed SUV correlation with cardiac magnetic resonance (CMR), echocardiographic, and baseline clinical characteristics. Retrospective review of 78 patients with suspected ATTR-CA that underwent 99mTc-PYP scintigraphy with xSPECT/CT. Patients were grouped off Perugini score (Grade 0-1 and Grade 2-3), H/CL ratio (≥ 1.5 and < 1.5). Two cohorts were also created: myocardium SUV > 1.88 and ≤ 1.88 at 1-hour based off an AUC curve with 1.88 showing the greatest sensitivity and specificity. Cardiac SUV retention index was calculated as [SUV myocardium/SUV vertebrae] × SUV paraspinal muscle. Primary outcome was myocardium SUV at 1-hour correlation with Perugini grades, H/CL ratio, CMR, and echocardiographic data. Higher Perugini Grades corresponded with higher myocardium SUV values, especially when comparing Perugini Grade 3 to Grade 2 and 1 (3.03 ± 2.1 vs 0.59 ± 0.97 and 0.09 ± 0.2, P < 0.001). Additionally, patients with H/CL ≥ 1.5 had significantly higher myocardium SUV compared to patients with H/CL ≤ 1.5 (2.92 ± 2.18 vs 0.35 ± 0.60, P < 0.01). Myocardium SUV at 1-hour strongly correlated with ECV (r = 0.91, P = 0.001), pre-contrast T1 map values (r = 0.66, P = 0.037), and left ventricle mass index (r = 0.80, P = 0.002) on CMR. SUVs derived from 99mTc-PYP scintigraphy with xSPECT/CT provides a discriminatory and quantitative method to diagnose and assess ATTR-CA burden. These findings strongly correlate with CMR.
锝-99焦磷酸盐闪烁扫描术（99mTc-PYP）使用佩鲁吉尼评分系统和平面显像上的心脏/对侧心脏比值（H/CL），对转甲状腺素蛋白淀粉样变心肌病（ATTR-CA）进行定性和半定量诊断。定量单光子发射计算机断层扫描（xSPECT/CT）的标准化摄取值（SUV），可通过精确的心肌轮廓勾画提供更高的诊断准确性和定量分析，从而增强对ATTR-CA负荷的评估。我们研究了xSPECT/CT SUV与佩鲁吉尼评分及H/CL比值的相关性。我们还评估了SUV与心脏磁共振（CMR）、超声心动图及基线临床特征的相关性。对78例疑似ATTR-CA且接受了99mTc-PYP闪烁扫描及xSPECT/CT检查的患者进行回顾性分析。患者根据佩鲁吉尼评分（0 - 1级和2 - 3级）、H/CL比值（≥1.5和<1.5）进行分组。还创建了两个队列：根据曲线下面积（AUC）曲线，1小时时心肌SUV>1.88和≤1.88，其中1.88显示出最大的敏感性和特异性。计算心脏SUV滞留指数为[SUV心肌/SUV椎体]×SUV椎旁肌。主要结局是1小时时心肌SUV与佩鲁吉尼分级、H/CL比值、CMR及超声心动图数据的相关性。佩鲁吉尼分级越高，心肌SUV值越高，尤其是将佩鲁吉尼3级与2级和1级比较时（3.03±2.1 vs 0.59±0.97和0.09±0.2，P<0.001）。此外，H/CL≥1.5的患者心肌SUV显著高于H/CL≤1.5的患者（2.92±2.18 vs 0.35±0.60，P<0.01）。1小时时心肌SUV与CMR上的细胞外容积（ECV）（r = 0.91，P = 0.001）、对比剂前T1图值（r = 0.66，P = 0.037）及左心室质量指数（r = 0.80，P = 0.002）密切相关。源自99mTc-PYP闪烁扫描及xSPECT/CT的SUV提供了一种鉴别和定量的方法来诊断和评估ATTR-CA负荷。这些发现与CMR密切相关。
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