Varying levels of small microcalcifications and macrophages in ATTR and AL cardiac amyloidosis: implications for utilizing nuclear medicine studies to subtype amyloidosis
Varying levels of small microcalcifications and macrophages in ATTR and AL cardiac amyloidosis: implications for utilizing nuclear medicine studies to subtype amyloidosis
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DOI：
10.1016/j.carpath.2016.07.001
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发表时间：
2016-09-01
影响因子：
3.7
通讯作者：
Stone, James R.
中科院分区：
文献类型：
--
作者：
Stats, Miriam A.;Stone, James R.
背景：最近，人们对利用核医学研究来无创地鉴别心脏淀粉样变性并对其进行分型产生了很大兴趣。特别是，使用Tc-99 m-3，3-二膦酰基-1，2-丙二羧酸（Tc-99 m-DPD）和Tc-99 m-PYP）的改良骨扫描用于选择性鉴别ATTR淀粉样变性而非AL淀粉样变性患者。ATTR淀粉样变性的这些影像学方式的选择性的形态学基础尚不清楚。方法：为了确定ATTR和AL淀粉样变性中微钙化和/或巨噬细胞的变化是否可能是这些成像方式的选择性的原因，8例ATTR淀粉样变性的肌内膜活检和7例AL淀粉样变性的肌内膜活检用von Kossa钙染色和免疫组织化学染色，结果：与AL淀粉样变性相比，ATTR淀粉样变性病例中存在更大密度的小微钙化（平均值= 16.8 vs.6.5/200 x视野，P = 0.008）。相比之下，与AL淀粉样变性相比，ATTR淀粉样变性中的巨噬细胞较少（平均值= 2.5 vs. 11.7/200 x视野，P = .0004）。各组内微钙化的密度与患者年龄、心脏功能的超声心动图特征或血清钙和肌酸酐水平无关。结论：这些数据表明，微钙化而不是巨噬细胞可能是改良骨扫描对ATTR淀粉样变性的选择性的基础，并表明其他含有微钙化的病理实体也可能导致这些成像方式的阳性扫描。(C)2016 Elsevier Inc. All rights reserved.
Background: Recently, there has been much interest in using nuclear medicine studies to noninvasively identify and subtype cardiac amyloidosis. In particular, modified bone scans using Tc-99m-3,3-diphosphono-1,2-propanodicarboxylic acid (Tc-99m-DPD) and Tc-99m-pyrophosphate (Tc-99m-PYP) are being used to selectively identify patients with ATTR amyloidosis rather than AL amyloidosis. The morphologic basis underlying the selectivity of these imaging modalities for ATTR amyloidosis has been unclear.Methods: To determine if variations in microcalcifications and/or macrophages within ATTR and AL amyloidosis might be responsible for the selectivity for these imaging modalities, 8 endomyocardial biopsies of ATTR amyloidosis and 7 endomyocardial biopsies of AL amyloidosis were stained with von Kossa calcium stains and with immunohistochemistry for the macrophage marker CD68.Results: Compared with AL amyloidosis, there was a greater density of small microcalcifications in cases of ATTR amyloidosis (mean = 16.8 vs. 6.5 per 200 x field, P = .008). In contrast, there were fewer macrophages in ATTR amyloidosis compared with AL amyloidosis (mean = 2.5 vs. 11.7 per 200 x field, P = .0004). The density of microcalcifications within each group was not related to patient age, echocardiographic features of cardiac function, or serum levels of calcium and creatinine.Conclusions: These data suggest that microcalcifications but not macrophages likely underlie the selectivity of modified bone scans for ATTR amyloidosis and suggest that other pathologic entities containing microcalcifications might also result in positive scans with these imaging modalities. (C) 2016 Elsevier Inc. All rights reserved.