Abstract
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Introduction: Technetium-99m pyrophosphate (Tc-99m PYP) scintigraphy has been demonstrated a useful tool for the non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR). Standard planar heart to mediastinal uptake ratios (H/CL) may be confounded by blood pool activity potentially reducing the diagnostic accuracy of planar imaging. Hypothesis: Combined single-photon emission computed tomography and computed tomography (SPECT-CT) acquisition improves the performance of 99mTc PYP scintigraphy for TTR-CA. SPECT CT can reliably differentiate myocardial uptake from blood pool activity.
Methods: 27 patients with suspected ATTR had Tc-99m PYP planar and SPECT-CT scintigraphy acquired on a digital GE 670 CZT SPECT CT. The SPECT CT acquisition was 360 degree rotational scan, not a 180 degree which is standard of care (SOC), followed by a CT scan of the chest. All images were processed and reviewed by a nuclear medicine physician. The images were scored with a H/CL ratio of ≥ 1.5 at one hour classified as ATTR positive and ratios < 1.5 as ATTR negative per the ASNC guidelines. Additionally, a visual comparison of myocardial uptake relative to bone (rib) uptake was also assessed.
Results: To our knowledge, this is the first reported utilization of a fully digital CZT SPECT CT for the non-invasive diagnosis of ATTR. With this novel technique of 360 degree SPECT CT acquisition reviewers were able to better delineate the cardiac muscle from the LV cavity. Being able to fuse the SPECT and CT gives defined outlines of myocardial and the LV cavity distributions allowing for potentially better diagnosis of this underdiagnosed morbid condition.
Conclusions: Using a novel combined SPECT CT technique produces high quality images and can potentially improve in the diagnosis of ATTR compared standard planar only or planar and 180 degree SPECT techniques.
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