Hara Junko, Ishii Shiro, Kobiyama Honami, Fukushima Kenji, Kawamoto Natsumi, Yamakuni Ryo, Suenaga Hiroki, Muto Yuuki, Sugawara Shigeyasu, Sato Akihiko, Oikawa Masayoshi, Takeishi Yasuchika, Ito Hiroshi
Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Ann Nucl Cardiol. 2024;10(1):23-28. doi: 10.17996/anc.24-00001. Epub 2024 Oct 31.
: This study investigated the feasibility of using a quantitative diagnostic method based on Tc-pyrophosphate scintigraphy (PYP) lateral planar images to differentiate between PYP-positive (myocardial uptake) and false-positive (blood pool uptake) scans. : The study included 93 consecutive patients with suspected transthyretin amyloid cardiomyopathy (ATTR-CM) who underwent PYP between April 2022 and December 2023. Patients were categorized using planar anterior PYP images according to the Perugini visual grading system; patients with grades ≥ 2 were analyzed. Whether the uptake of the ventricle was in the blood pool or the myocardium was confirmed by transaxial single-photon emission tomography (SPECT). The heart-to-mediastinum ratios (H/M ratio) of the left lateral planar images at 1- and 3-h were calculated by placing a circular region of interest in the heart and cephalodorsal side of the heart to determine optimal cut-off values. : Among the PYP images, the study analyzed 15 positives diagnosed as ATTR-CM and 10 false positives. Significant differences were observed in the H/M ratio at 1- and 3-h (both <0.01), with 100% sensitivity and specificity using cut-off values of 1.22 and 1.21 at 1- and 3-h, respectively. The interclass correlation coefficients (2, 1) between the two readers were 0.919 and 0.958 for the 1- and 3-h H/M ratios, respectively. : Lateral planar PYP imaging can exclude PYP false-positive cases caused by blood pools in a simple and quantitative manner using only a 1-h planar image, possibly obviating the need for SPECT imaging.
本研究探讨了基于锝-焦磷酸盐闪烁扫描（PYP）侧位平面图像的定量诊断方法用于区分PYP阳性（心肌摄取）和假阳性（血池摄取）扫描的可行性。本研究纳入了2022年4月至2023年12月期间连续93例疑似转甲状腺素蛋白淀粉样心肌病（ATTR-CM）且接受PYP检查的患者。根据佩鲁吉尼视觉分级系统，使用PYP平面前位图像对患者进行分类；对分级≥2级的患者进行分析。通过断层单光子发射断层扫描（SPECT）确认心室摄取是在血池还是心肌。通过在心脏及其头背侧放置圆形感兴趣区来计算1小时和3小时时左侧位平面图像的心脏与纵隔比值（H/M比值），以确定最佳截断值。在PYP图像中，本研究分析了15例诊断为ATTR-CM的阳性病例和10例假阳性病例。在1小时和3小时时的H/M比值观察到显著差异（均<0.01），1小时和3小时时分别使用截断值1.22和1.21时，敏感性和特异性均为100%。两位阅片者之间1小时和3小时H/M比值的组内相关系数（2,1）分别为0.919和0.958。侧位平面PYP成像仅使用1小时平面图像就能以简单定量的方式排除由血池引起的PYP假阳性病例，可能无需进行SPECT成像。
