Efficient 1-Hour Technetium-99 m Pyrophosphate Imaging Protocol for the Diagnosis of Transthyretin Cardiac Amyloidosis
Efficient 1-Hour Technetium-99 m Pyrophosphate Imaging Protocol for the Diagnosis of Transthyretin Cardiac Amyloidosis
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DOI：
10.1161/circimaging.119.010249
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发表时间：
2020-02-01
影响因子：
7.5
通讯作者：
Soman, Prem
中科院分区：
文献类型：
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作者：
Masri, Ahmad;Bukhari, Syed;Soman, Prem
背景：锝-99m焦磷酸盐用于甲状腺素运载蛋白心脏淀粉样变性诊断的方案已经重复使用了1小时和3小时成像时间点.我们研究了成像在1小时与上级效率是否有可比的诊断准确性为3小时imaging.Methods：这是一个登记分析可疑的甲状腺素运载蛋白心脏淀粉样变性患者提到的锝-99 m焦磷酸在一个单一的三级中心从2015年6月至2019年1月。患者在1小时和3小时接受平面和单光子发射计算机断层扫描（SPECT）成像。阳性Tc-99 m焦磷酸盐研究定义为SPECT上存在弥漫性心肌示踪剂摄取。对于平面成像，视觉半定量（等级0-3，>= 2被认为是阳性）和定量心脏对对侧比率（>= 1.5被认为是阳性）被使用。弥漫性心肌摄取60例（25.8%），局部摄取1例（0.4%），无心肌摄取172例（73.8%）。SPECT在1和3小时的结果相同。1小时平面成像的敏感性为98%，特异性为96%。平面0级摄取或心脏与对侧比率= 2.0总是分别与阴性和阳性SPECT相关。对于平面1级和2级摄取以及心脏与对侧比率1.3至1.9，需要SPECT进行诊断。没有轻链心脏淀粉样变性患者有积极的SPECT.Conclusions：一个有效的1小时锝-99 m焦磷酸协议有可比的诊断性能，3小时的协议。
Background:Technetium-99 m pyrophosphate protocols for transthyretin cardiac amyloidosis diagnosis have variably used 1- and 3-hour imaging time points. We investigated whether imaging at 1 hour with superior efficiency had comparable diagnostic accuracy as 3-hour imaging.Methods:This is a registry analysis of patients with suspected transthyretin cardiac amyloidosis referred for technetium-99 m pyrophosphate at a single tertiary center from June 2015 through January 2019. Patients underwent planar and single-photon emission computed tomography (SPECT) imaging at 1 and 3 hours. A positive Tc-99m pyrophosphate study was defined by the presence of diffuse myocardial tracer uptake on SPECT. For planar imaging, visual semiquantitative (grades 0-3, >= 2 considered positive) and quantitative heart to contralateral ratios (>= 1.5 considered positive) were used.Results:Two hundred thirty-three patients (69% men; median age, 77 [69-83] years) underwent the study protocol. There were 60 (25.8%) patients with diffuse myocardial uptake, 1 (0.4%) with regional uptake, and 172 (73.8%) with no myocardial uptake. Results of SPECT were identical at 1 and 3 hours. Planar imaging at 1 hour had 98% sensitivity and 96% specificity. Planar grade 0 uptake or heart to contralateral ratio = 2.0 were always associated with negative and positive SPECT, respectively. For planar grades 1 and 2 uptake and heart to contralateral ratio 1.3 to 1.9, SPECT was needed to make a diagnosis. No patient with light-chain cardiac amyloidosis had positive SPECT.Conclusions:An efficient 1-hour technetium-99 m pyrophosphate protocol had comparable diagnostic performance to a 3-hour protocol.