Department of Nuclear Medicine, Medical School, University of Crete, Greece.
Hell J Nucl Med. 2023 Sep-Dec;26(3):172-180. doi: 10.1967/s002449912601. Epub 2023 Dec 14.
The purpose of this study was to evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) standardized uptake value (SUV) metrics in classifying patients with suspected transthyretin cardiac amyloidosis (ATTR-CA) among the different Perugini grades.
One hundred four patients suspected of ATTR-CA underwent planar scintigraphy with bone seeking tracer (Tc pyrophosphate-PYP). Patients were classified according to the Perugini scale, the H/CL, H/Bone and H/Bkg ratios. A subset of 48 patients received additional SPECT/CT. Single photon emission computed tomography/CT SUV quantitative parameters, of the heart, myocardium, lungs, liver, soft tissues, bone, and SUV ratios (SUVmyo, SUVlungs, SUVliver, SUVbone and SUVsoft tissue ratios), were evaluated in order to investigate potential metrics that could more clearly differentiate Perugini grades.
A total of 33.7% of patients were considered grade 0, 34.6% grade 1 and 31.7% grade 2/3. A combination of H/CL >1.33 and H/Bone >0.85 showed the highest sensitivity 100%. Standardized uptake value-based metrics clearly differentiated grade 0 or 1 vs grades 2 or 3, whereas no significant difference was found between grades 0 and 1, or between grades 1 and 2. The combined cut-off values H/CL 1.33 and SUVmyo 2.88 yielded 100% sensitivity and 84.6% specificity in differentiating ATTR-CA positives vs negatives. The metric SUVmyo/SUVliver was the best metric to classify patients with grade 1 as negative (grade 0) or positive (grade 2 or 3).
Single photon emission computed tomography/CT SUV metrics could be complementary to planar scintigraphy in classifying patients among the different Perugini grades. The ratio SUVmyo/SUVliver was the only parameter with high affinity to differentiate patients with grade 1, as grade 0 or grade 2/3 for ATTR-CA.
本研究旨在评估单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）标准摄取值（SUV）指标在不同佩鲁吉尼分级中对疑似转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）患者的分类贡献。
104 例疑似ATTR-CA 的患者接受了骨靶向示踪剂（Tc 焦磷酸盐-PYP）的平面闪烁显像。患者根据佩鲁吉尼分级、H/CL、H/骨和 H/背景比值进行分类。48 例患者接受了额外的 SPECT/CT。评估了心脏、心肌、肺、肝、软组织、骨和 SUV 比值（SUVmyo、SUVlungs、SUVliver、SUVbone 和 SUVsoft tissue ratios）的 SPECT/CT SUV 定量参数，以研究可能更清楚地区分佩鲁吉尼分级的潜在指标。
共有 33.7%的患者被认为是 0 级，34.6%为 1 级，31.7%为 2/3 级。H/CL＞1.33 和 H/骨＞0.85 的组合显示出最高的敏感性 100%。基于 SUV 的指标清楚地区分了 0 级或 1 级与 2 级或 3 级，而 0 级和 1 级之间，或 1 级和 2 级之间没有显著差异。联合截断值 H/CL 1.33 和 SUVmyo 2.88 在区分 ATTR-CA 阳性和阴性方面具有 100%的敏感性和 84.6%的特异性。SUVmyo/SUVliver 是将 1 级患者分类为阴性（0 级）或阳性（2 级或 3 级）的最佳指标。
SPECT/CT SUV 指标可以补充平面闪烁显像，用于对不同佩鲁吉尼分级的患者进行分类。SUVmyo/SUVliver 比值是唯一具有高亲和力的参数，可将 1 级患者与 0 级或 2/3 级 ATTR-CA 患者区分开来。
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