DPD Quantification in Cardiac Amyloidosis A Novel Imaging Biomarker
DPD Quantification in Cardiac Amyloidosis A Novel Imaging Biomarker
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DOI：
10.1016/j.jcmg.2020.03.020
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发表时间：
2020-06-01
影响因子：
14
通讯作者：
Menezes, Leon J.
中科院分区：
文献类型：
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作者：
Scully, Paul R.;Morris, Elizabeth;Menezes, Leon J.
目的评估单光子发射计算机断层扫描（SPECT/CT）量化骨闪烁成像是否能提高诊断准确性，并提供一种量化淀粉样蛋白负担的方法。经甲状腺素相关的心脏淀粉样变性很常见，可以通过骨显像无创诊断；然而，解释依赖于平面图像。SPECT/CT成像提供三维可视化。方法采用Perugini分级系统（0 =阴性，1 ~ 3 =逐渐阳性）对tc -99m-3,3-二膦-1,2-丙二羧酸（DPD）扫描结果进行单中心回顾性分析。采用常规平面定量技术（心脏/对侧肺，心脏/全身保留比）。通过SPECT/CT采集记录心脏、邻近椎体、棘旁肌和肝脏峰值标准化摄取值（SUVpeak）。同时计算SUV保持指数：（心脏SUVpeak/椎体SUVpeak） x棘旁肌SUVpeak。在一个亚组患者中，将SPECT/CT量化与CT成像心肌细胞外体积量化（ECVCT）进行比较。结果共分析100张DPD扫描（患者年龄84±9岁，52%为男性）：40例为Perugini分级0级，12例为分级1级，41例为分级2级，7例为分级3级。心脏SUVpeak由0级增至2级；然而，它在2级和3级之间趋于平稳（p< 0.001）。棘旁肌SUVpeak随分级而升高（p< 0.001），而椎体SUVpeak则降低（p< 0.001）。SUV保持指数的复合参数克服了心脏SUV峰值的平台期，并在所有等级中均有所增加（p< 0.001）。心脏SUVpeak相关性良好(r(2) = 0.73；p< 0.001)。cardiacSUV（峰值）和SUV retention指数均具有较好的诊断准确率（曲线下面积[AUC]: 0.999）。平面定量技术中心对侧肺比最佳（AUC: 0.987）。结论SPECT/CT定量DPD显像是可行的，且优于平面定量技术。Perugini 2级或3级的区分是由软组织摄取混淆的，这可以通过复合SUV保留指数来克服。该指标有助于心脏淀粉样变的诊断，并可能提供一种监测治疗反应的手段。(c) 2020作者。由爱思唯尔代表美国心脏病学会基金会出版。这是一篇基于CC BY许可（http://creativecommons.org/licenses/by/4.0/）的开放获取文章。
OBJECTIVES To assess whether single-photon emission computed tomography (SPECT/CT) quantification of bone scintigraphy would improve diagnostic accuracy and offer a means of quantifying amyloid burden.BACKGROUND Transthyretin-related cardiac amyloidosis is common and can be diagnosed noninvasively using bone scintigraphy; interpretation, however, relies on planar images. SPECT/CT imaging offers 3-dimensional visualization.METHODS This was a single-center, retrospective analysis of Tc-99m-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scans reported using the Perugini grading system (0 = negative; 1 to 3 = increasingly positive). Conventional planar quantification techniques (heart/contralateral lung, and heart/whole-body retention ratios) were performed. Heart, adjacent vertebra, paraspinal muscle and liver peak standardized uptake values (SUVpeak) were recorded from SPECT/CT acquisitions. An SUV retention index was also calculated: (cardiac SUVpeak/vertebral SUVpeak) x paraspinal muscle SUVpeak. In a subgroup of patients, SPECT/CT quantification was compared with myocardial extracellular volume quantification by CT imaging (ECVCT).RESULTS A total of 100 DPD scans were analyzed (patient age 84 +/- 9 years; 52% male): 40 were Perugini grade 0, 12were grade 1,41were grade 2, and 7were grade 3. Cardiac SUVpeak increased fromgrade0to grade 2; however, it plateaued between grades 2 and 3 (p< 0.001). Paraspinal muscle SUVpeak increased with grade (p< 0.001), whereas vertebral SUVpeak decreased (p < 0.001). The composite parameter of SUV retention index overcame the plateauing of the cardiac SUVpeak and increased across all grades (p< 0.001). Cardiac SUVpeak correlated well (r(2) = 0.73; p< 0.001) with ECVCT. Boththe cardiacSUV(peak) and SUV retention index had excellent diagnostic accuracy (area under the curve [AUC]: 0.999). The heart to contralateral lung ratio performed the best of the planar quantification techniques (AUC: 0.987).CONCLUSIONS SPECT/CT quantification in DPD scintigraphy is possible and outperforms planar quantification techniques. Differentiation of Perugini grade 2 or 3 is confounded by soft tissue uptake, which can be overcome by a composite SUV retention index. This index can help in the diagnosis of cardiac amyloidosis and may offer a means of monitoring response to therapy. (c) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).