Campi Cristina, Briani Chiara, Salvalaggio Alessandro, Giraudo Chiara, Cipriani Alberto, Zorzi Alessandro, Zucchetta Pietro, Vettor Roberto, Cecchin Diego
Department of Mathematics, University of Genoa, 16126 Genoa, Italy.
Department of Neurosciences (DNS), University of Padua, 35128 Padua, Italy.
J Cardiovasc Dev Dis. 2023 Apr 22;10(5):184. doi: 10.3390/jcdd10050184.
Bone scintigraphy has emerged as a key tool for non-invasive etiologic diagnosis of transthyretin (ATTR) cardiac amyloidosis (CA). We focused on a new semi-quantification method (on planar imaging) that could complement the qualitative/visual Perugini scoring system, especially when SPET/CT is not available.
We retrospectively/qualitatively evaluated 8674 consecutive, planar 99mTc-biphosphonate scintigraphies (performed for non-cardiac reasons), identifying 68 (0.78%) individuals (mean age 79 ± 7 years, range 62-100 years; female/male ratio 16/52) presenting myocardial uptake. Due to the retrospective nature of the study, no SPET/CT, pathologic or genetic confirmation was obtained. The Perugini scoring system was determined (in patients presenting cardiac uptake) and compared with three newly proposed semi-quantitative indices. We took 349 consecutive bone scintigraphies, qualitatively absent of any cardiac/pulmonary uptake, as "healthy controls" (HC).
The heart-to-thigh ratio (RHT) and lung-to-thigh ratio (RLT) indices were significantly higher in patients than in HCs (p ≤ 0.0001). There were statistically significant differences for RHT in HCs vs. patients with qualitative Perugini scores of 1 or >1 (with p ranging from ≤0.001 to ≤0.0001). ROC curves showed that RHT outperformed the other indices and was more accurate in both male and female groups. Furthermore, in the male population, RHT accurately distinguished HCs and patients with scores of 1 (less likely affected by ATTR) from patients with qualitative scores >1 (more likely affected by ATTR) with an AUC of 99% (sensitivity: 95%; specificity: 97%).
The proposed semi-quantitative RHT index can accurately/semi-quantitatively distinguish between HCs and subjects probably affected by CA (Perugini scores from 1 to 3), and could be particularly useful when no SPET/CT data are available (such as in retrospective studies and data mining). Furthermore, RHT can semi-quantitatively predict, with very high accuracy, subjects in the male population more likely to be affected by ATTR. The present study, although using a very large sample, is however retrospective, monocentric, and therefore the generalizability of the results should be proved by an accurate external validation.
The proposed heart-to-thigh ratio (RHT) can distinguish healthy controls and subjects that are probably affected by cardiac amyloidosis in a simple and more reproducible way, as compared to standard qualitative/visual evaluation.
骨闪烁显像已成为诊断转甲状腺素蛋白（ATTR）心脏淀粉样变（CA）病因的一种关键的非侵入性工具。我们重点关注一种新的半定量方法（基于平面显像），它可以补充定性/视觉佩鲁吉尼评分系统，特别是在无法进行单光子发射计算机断层扫描/计算机断层扫描（SPET/CT）的情况下。
我们回顾性地/定性评估了连续8674例平面99m锝双膦酸盐闪烁显像（因非心脏原因进行），识别出68例（0.78%）出现心肌摄取的个体（平均年龄79±7岁，范围62 - 100岁；女性/男性比例为16/52）。由于该研究的回顾性性质，未获得SPET/CT、病理或基因确认结果。确定了佩鲁吉尼评分系统（在出现心脏摄取的患者中），并与三个新提出的半定量指标进行比较。我们将连续349例定性无任何心脏/肺部摄取的骨闪烁显像作为“健康对照”（HC）。
患者的心脏与大腿比值（RHT）和肺与大腿比值（RLT）指数显著高于健康对照（p≤0.0001）。健康对照与定性佩鲁吉尼评分为1或>1的患者之间的RHT存在统计学显著差异（p范围从≤0.001至≤0.0001）。受试者工作特征曲线显示，RHT优于其他指标，在男性和女性组中都更准确。此外，在男性人群中，RHT能够准确区分健康对照和佩鲁吉尼评分为1（受ATTR影响可能性较小）的患者与定性评分>1（受ATTR影响可能性较大）的患者，曲线下面积（AUC）为99%（敏感性：95%；特异性：97%）。
所提出的半定量RHT指数可以准确地/半定量地区分健康对照和可能受CA影响的受试者（佩鲁吉尼评分从1到3），并且在没有SPET/CT数据时（如在回顾性研究和数据挖掘中）可能特别有用。此外，RHT可以非常高精度地半定量预测男性人群中更可能受ATTR影响 的受试者。本研究虽然使用了非常大的样本，但却是回顾性的、单中心的，因此结果的普遍性应由准确的外部验证来证明。
与标准的定性/视觉评估相比，所提出的心脏与大腿比值（RHT）能够以一种简单且更具可重复性的方式区分健康对照和可能受心脏淀粉样变影响的受试者。
