pyrophosphate and Amyloidosis

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Diphosphonates; Humans; Prealbumin; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Topics: Age Factors; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The purpose of this study was to examine the diagnostic value of planar. PYP images of 109 consecutive patients with suspected ATTR-CA were retrospectively reviewed. The myocardial PYP uptake was visually graded on a scale of 0 to 3 and quantified with the heart-to-contralateral (H/CL) ratio in accordance with the current expert consensus recommendations. The diagnostic value of planar images for identifying positive PYP SPECT was assessed by a receiver-operating characteristic curve analysis with the area under the curve (AUC). The uptake ratios of the ascending and descending aorta, left atrium, and trapezius muscle divided by the liver uptake were measured on SPECT images and compared to the renal function.. A total of 41 patients (38%) had myocardial PYP uptake on SPECT images. In comparison with the visual scores on 1-h anterior planar images, those on 3-h anterior planar images had lower sensitivity (80.5% vs. 97.6%) and higher specificity (86.8% vs. 55.9%) for identifying positive PYP SPECT. The ROC analysis showed that the combination of visual scores on both 1-h and 3-h anterior planar images had significantly higher AUC values in comparison with 1-h anterior planar images alone (0.90 [95% CI 0.83-0.94] vs. 0.83 [95% CI 0.75-0.88]; P < 0.001), which was comparable to the AUC values on 3-h anterior planar images alone (0.88 [95% CI 0.80-0.92]; P = 0.071). In comparison with visual scores on 1-h or 3-h anterior planar images alone, the combination of visual scores and H/CL ratio did not significantly improve the diagnostic value for identifying positive PYP SPECT (P = 0.73 and P = 0.50, respectively). The uptake ratios of ascending aorta/liver, descending aorta/liver, left atrium/liver, and trapezius muscle/liver were not significantly associated with the serum creatinine level or estimated glomerular filtration rate (P > 0.05 for all).. In the assessment of ATTR-CA using PYP imaging, visual scores on 3-h anterior planar images for identifying positive PYP SPECT had lower sensitivity and higher specificity in comparison with those on 1-h anterior planar images. The diagnostic value of the visual scores on 1-h and 3-h anterior planar images was not improved by adding the H/CL ratio. Blood pool activity of PYP was not significantly associated with renal dysfunction.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Kidney Diseases; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium

Transthyretin (ATTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Diagnosis has dramatically changed with the advent of Technetium-99 m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT). With the ability to diagnose ATTR amyloidosis noninvasively and offer newer therapies, it is increasingly important to identify which patients should be referred for this testing. Relative apical sparing of longitudinal strain on echocardiogram can be potentially used to screen such patients. We sought to describe electrocardiogram (ECG) and echocardiogram (TTE) findings, including relative apical sparing of longitudinal strain, in ATTR amyloidosis patients diagnosed non-invasively with

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Calcinosis; Cardiomyopathies; Diphosphates; Humans; Immunoglobulin Light-chain Amyloidosis; Prealbumin; Radiopharmaceuticals

The optimal heart-to-contralateral chest (H/CL) ratio threshold for non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) using Tc. Using myocardial PYP retention by SPECT as the reference standard, we evaluated the diagnostic performance of different semi-quantitative and quantitative (H/CL chest ratio) planar parameters obtained from 3-hour PYP imaging in a prospectively recruited cohort of minority older adults with heart failure and increased LV wall thickness.. Of 229 patients, 14 were found to have ATTR-CA (6.1%). No PYP uptake (grade 0) was observed in 77% of scans, all grade 3 scans were ATTR-CA, and only 4 of 11 (36%) grade 2 scans were ATTR-CA. An H/CL threshold of ≥ 1.4 maximized specificity (99%) and positive predictive value (93%) but resulted in decreased sensitivity (93%), compared to the ≥ 1.3 threshold which had 100% sensitivity.. Among patients with a low pretest likelihood of ATTR-CA, planar interpretation, while useful to exclude disease, must be interpreted with caution. H/CL ratio threshold of ≥ 1.3 resulted in clinically important misclassifications. These data suggest that quantitative planar imaging thresholds may not be appropriate to apply in low pretest likelihood populations being evaluated for ATTR-CA.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Humans; Prealbumin; Technetium

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Predictive Value of Tests

Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported.. From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans. Tc-99 m PYP cardiac scan was performed with planar image and single photon emission computed tomography/computed tomography (SPECT/CT) 3 h after administration of Tc-99 m PYP. Perugini grading system was applied to determine positive or negative result of the scan. Heart to contralateral lung (H/CL) ratio as well as the difference of H/CL ratio between first and second Tc-99 m PYP cardiac scans (ΔH/CL ratio) was calculated.. In the five patients participated in this study, three received tafamidis therapy and H/CL ratio was significantly decreased (p = 0.02) after tafamidis therapy. Besides, the ΔH/CL ratio was larger in patients with tafamidis therapy than that in those without tafamidis therapy, albeit not reaching statistical significance (p = 0.2).. A decrease in H/CL ratio was found after tafamidis therapy in patients with ATTR-CA, albeit the magnitude of changes in the H/CL ratio (ΔH/CL ratio) was not significantly different from that of patients without tafamidis therapy. Future study with larger population might be required to further clarify the effect of tafamidis therapy on myocardial uptake of Tc-99 m PYP.. No clinical trial was conducted in our retrospective study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Follow-Up Studies; Humans; Prealbumin; Retrospective Studies; Technetium Tc 99m Pyrophosphate

SPECT improves diagnostic specificity of Technetium-99m pyrophosphate (PYP) scintigraphy. Diagnostic performance of PYP data, reconstructed as either chest or cardio-focal SPECT is not known.. In this quality assurance study, blinded evaluation of PYP SPECT/CT data from 102 Caucasian patients (mean age 76 ± 11 years, 67% men) was performed by two readers. Reader 1 reviewed planar and PYP chest SPECT, while reader 2 reviewed planar and cardio-focal PYP SPECT. Demographic, clinical, and other testing data were obtained from the electronic medical records.. A total of 41 patients (40%) were considered positive based on myocardial uptake on chest PYP SPECT. Of these, 98% of the patients had a Perugini score ≥ 2 on planar imaging. There was good agreement between the two readers for visual score ≥ 2 (k = .88, P < .001) and excellent agreement for myocardial uptake on tomographic imaging (98%, P < .001). Only one study was categorized as false negative by cardio-focal SPECT reconstruction. Non-diffuse myocardial uptake was identified in 22% of those with a positive PYP SPECT.. When read by experienced readers, chest and cardio-focal reconstruction of PYP SPECT have comparable diagnostic performance. A substantial proportion of patients with a positive PYP SPECT have a non-diffuse distribution of PYP. Given the possibility of misclassification of non-diffuse myocardial uptake on cardio-focal reconstruction alone, chest reconstruction of PYP scintigraphy should be strongly considered.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Prealbumin; Quality Assurance, Health Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Technetium-labeled bone-avid radiotracers can be used to diagnose transthyretin cardiac amyloidosis (ATTR-CA). Extracardiac uptake of technetium pyrophosphate (Tc-99m PYP) in this context has not been extensively explored and its significance is not well characterized. We assessed extracardiac Tc-99m PYP uptake in individuals undergoing nuclear scintigraphy and the extent of clinically actionable findings.. The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes Tc-99m PYP imaging to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥ 60 years old with heart failure. We characterized the distribution of extracardiac uptake, including stratification of findings by timing of scan (1 hour vs 3 hours after Tc-99m PYP administration) and noted any additional testing in these subjects.. Of 379 participants, 195 (51%) were male, 306 (81%) Black race, and 120 (32%) Hispanic ethnicity; mean age was 73 years. Extracardiac Tc-99m PYP uptake was found in 42 subjects (11.1%): 21 with renal uptake only, 14 with bone uptake only, 4 with both renal and bone uptake, 2 with breast uptake, and 1 with thyroid uptake. Extracardiac uptake was more common in subjects with Tc-99m PYP scans at 1 hour (23.8%) than at 3 hours (6.2%). Overall, four individuals (1.1%) had clinically actionable findings.. Extracardiac Tc-99m PYP uptake manifested in about 1 in 9 SCAN-MP subjects but was clinically actionable in only 1.1% of cases.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Prealbumin; Prevalence; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radionuclide Imaging

Technetium-99mm pyrophosphate (Tc-PYP) scintigraphy is a highly accurate non-invasive method for the diagnosis of transthyretin (ATTR) cardiac amyloidosis. Prognosis for this disease is improved following treatment with the transthyretin (TTR) stabilizer tafamidis. Although tafamidis slows disease progression, its effects on myocardial amyloid and Tc-PYP uptake remain unclear. We present a patient with ATTR cardiac amyloidosis who had a strongly positive initial Tc-PYP scan, with a dramatic decrease in Tc-PYP uptake on repeat scan after 3 years of tafamidis treatment. However, myocardial biopsy showed persistent diffuse amyloid deposits. This case highlights the need for further studies regarding the utility of serial Tc-PYP scans in monitoring the progress of ATTR cardiomyopathy.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Quantitation of myocardial. Consecutive patients who underwent. Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r. CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Stroke Volume; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

There are limited data on the head-to-head comparison of

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Prealbumin; Radiopharmaceuticals; Retrospective Studies

Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.. Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.. Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.. In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Plaque, Amyloid; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99m Tc-pyrophosphate ( 99m Tc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99m Tc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Pleural Effusion; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Clinical algorithms stipulate that transthyretin amyloid cardiomyopathy (ATTR-CM) can be diagnosed noninvasively by technetium-99m pyrophosphate (PYP) imaging when light chain (AL) amyloidosis has been excluded. We sought to define the distribution of light chain abnormalities and final diagnosis of ATTR-CM among patients referred for PYP imaging. We conducted a retrospective cohort study of 378 sequential patients with suspected ATTR-CM, referred for PYP imaging from October 2014 to January 2019. PYP scans were adjudicated as per guidelines. We found that 97 patients (26%) had abnormal plasma cell dyscrasia (PCD) markers, including serum free light chain (FLC) and/or urine/serum immunofixation electrophoresis (IFE). After exclusions for incomplete data or known AL amyloidosis, the final study population with abnormal PCD testing was n = 82. Final adjudication of amyloidosis was determined by multidisciplinary clinical assessment and/or tissue biopsy. The median age of cohort was 75 (68 to 81) years, 88% were men, and 33% were Black. Of the 82 patients, 62 had positive PYP scans (76%) and 20 had negative PYP scans (24%). A total of 64 patients had adjudicated ATTR-CM, confirmed by tissue biopsy in 41 (64%). Of those with confirmed ATTR-CM, 44 (69%) had abnormal FLC ratio between 1.65 and 3.1 and normal IFE. In conclusion, among patients referred for technetium-99m-PYP imaging for suspected ATTR-CM, 26% exhibited abnormalities of PCD markers. An FLC ratio 1.65 to 3.1, with normal IFE was noted in 69% of those with ATTR-CM, suggesting that ATTR-CM can be diagnosed noninvasively without cardiac biopsy in patients with positive PYP scan and similar plasma cell testing results.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Prealbumin; Technetium

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.. В статье суммируется текущий опыт отдела радионуклидной диагностики и позитронно-эмиссионной томографии ФГБУ НМИЦ кардиологии им. акад. Е.И. Чазова в выполнении сцинтиграфии миокарда с 99mTc-пирофосфатом при дифференциальной диагностике типов амилоидоза сердца. Проанализированы возможные причины ложноположительных, сомнительных и недиагностических результатов исследования, предложены способы их устранения, в том числе путем модификации протоколов планарного и томографического исследований и оптимизации диагностического алгоритма амилоидоза сердца в целом.

Topics: Algorithms; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Myocardial Perfusion Imaging; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Comparison of the conventional method and our method showed no significant difference in sensitivity and AUC, while specificity was significantly improved to 97% (p=0.003) of ray-sum axial image and 90% (p=0.01) of ray-sum coronal image, and accuracy was significantly improved to 94% (p=0.02) of ray-sum axial image.. The H/CL calculation method using ray-sum images had higher diagnostic performance than the conventional method, with optimal cutoff of ray-sum axial images 3.07 and ray-sum coronal images 2.77.

Topics: Amyloidosis; Diphosphates; Heart; Humans; Radionuclide Imaging; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The imaging protocol and the optimal cut-off points for quantitative assessment of technetium-99m pyrophosphate (Tc-99m PYP) cardiac amyloidosis scintigraphy remain controversial. The aim of this study was to evaluate the concordance between planar and SPECT images, and to investigate the contribution of SPECT/CT to diagnostic precision. All patients referred to our department for Tc-99m PYP cardiac imaging between April 2019 and April 2022 were included in the study. Heart-to-contralateral lung (H/CL) ratios were calculated from anterior planar images at both 1- and 3 h, and visual grading was done in SPECT/CT images at both time points. A total of 141 patients were included in the study (median age 59 years, 54% female). There was a strong positive correlation between H/CL ratios calculated at 1- and 3 h (Pearson's ρ = 0.842, p < 0.001). The highest level of concordance between planar and SPECT/CT images was achieved at a H/CL cut-off point of 1.5 for 1-h images, and 1.4 for 3-h images. SPECT/CT imaging contributed to diagnostic precision in both 1- and 3-h images by reducing the rate of equivocal results from 83% (n = 117) to 25% (n = 35), and from 77% (n = 108) to 27% (n = 38), respectively. Our findings have three implications: (1) planar imaging at both 1- and 3 h could be redundant, (2) a lower H/CL cut-off point for 3-h planar images could improve concordance between planar and SPECT imaging, and (3) SPECT/CT in both 1- and 3 h could improve the diagnostic precision by offering markedly reduced equivocal results.

Topics: Amyloidosis; Diphosphates; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Single Photon Emission Computed Tomography Computed Tomography; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Atrial Fibrillation; Cardiomyopathies; Diphosphates; Heart; Humans; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Humans; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Heart; Heart Murmurs; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Middle Aged; Multimodal Imaging; Prognosis; Systole

Topics: Amyloidosis; Cadmium; Diphosphates; Humans; Prealbumin; Radionuclide Imaging; Tellurium; Zinc

Topics: Amyloidosis; Diphosphates; Floods; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Prealbumin; Radionuclide Imaging

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Neoplasms; Prealbumin; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Humans; Military Personnel; Prealbumin; Technetium

Topics: Amyloidosis; Diphosphates; Humans; Reference Standards

Topics: Amyloidosis; Diphosphates; Echocardiography; Humans; Prealbumin; Prognosis; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Heart; Humans; Prognosis; Technetium

Transthyretin cardiac amyloidosis (also known as ATTR cardiac amyloidosis) is an increasingly recognized cause of heart failure with preserved ejection fraction. In single-center studies, technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging noninvasively detects ATTR cardiac amyloidosis, but the accuracy of this technique in a multicenter study and the association of Tc 99m PYP myocardial uptake with survival are unknown.. To assess Tc 99m PYP cardiac imaging as a diagnostic tool for ATTR cardiac amyloidosis and its association with survival in a multicenter study.. Retrospective cohort study performed at 3 academic specialty centers for cardiac amyloidosis in the United States in which 229 participants were evaluated for cardiac amyloidosis and also underwent Tc 99m PYP cardiac imaging. The date of analysis and final confirmation from the statistician was May 4, 2016.. Tc 99m PYP cardiac imaging for detection of ATTR cardiac amyloidosis.. Retention of Tc 99m PYP in the heart was assessed using both a semiquantitative visual score (range, 0 [no uptake] to 3 [uptake greater than bone]) and a quantitative heart to contralateral (H/CL) ratio. The H/CL ratio was calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc 99m PYP imaging.. Tc 99m PYP imaging of 171 participants (121 with ATTR cardiac amyloidosis and 50 with non-ATTR cardiac amyloidosis [34 with AL amyloidosis and 16 with nonamyloid heart failure with preserved ejection fraction]; 86% male; median [IQR] age, 73 years [65-79 years]) demonstrated 91% sensitivity and 92% specificity for detecting ATTR cardiac amyloidosis with an area under the curve of 0.960 (95% CI, 0.930-0.981). Univariable and multivariable Cox proportional hazards regression analyses among participants with ATTR cardiac amyloidosis showed that an H/CL ratio of 1.6 or greater predicted worse survival (hazard ratio, 3.911 [95% CI, 1.155-13.247]; P = .03 for univariable analysis and 7.913 [95% CI, 1.679-37.296]; P = .01 for multivariable analysis). In Kaplan-Meier analysis over a 5-year follow-up period, survival was significantly worse if the H/CL ratio was 1.6 or greater rather than less than 1.6 (log-rank P = .02).. In this multicenter study, Tc 99m PYP cardiac imaging conferred a high level of sensitivity and specificity for differentiation of patients with ATTR cardiac amyloidosis (irrespective of genotype) from patients with AL cardiac amyloidosis and patients with nonamyloid heart failure with preserved ejection fraction. An H/CL ratio of 1.6 or greater was associated with worse survival among patients with ATTR cardiac amyloidosis. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, Tc 99m PYP may be of diagnostic and prognostic importance.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Heart; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium

This study describes the results of scintigraphy with 99mTc-labeled methylene-diphosphonate (99mTc-MDP) and pyrophosphate (99mTc-PYP) as a noninvasive test for the distribution of organ involvement in five different types of amyloidosis. Scintigraphy with 99mTc-labeled phosphates appeared to be a sensitive noninvasive screening test for the extent and the distribution of organ involvement in systemic AA and systemic AL amyloidosis as well as in local bronchial amyloid, local dermal amyloid, and familial amyloidotic polyneuropathy. Echocardiography, however, was more sensitive for demonstrating cardiac involvement in systemic amyloidosis than 99mTc-MDP or 99mTc-PYP scintigraphy. 99mTc-MDP images showed a better contrast than 99mTc-PYP images, although there was no difference in the extent or the intensity of soft-tissue uptake.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Connective Tissue; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Amyloidosis is a systemic disease frequently involving the myocardium and leading to functional disturbances of the heart. Amyloidosis can mimic other cardiac diseases. A conclusive clinical diagnosis of cardiac involvement can only be made by a combination of different diagnostic methods. In 7 patients with myocardial amyloidosis we used a combined first-pass and static scintigraphy with technetium-99 m-pyrophosphate. There was only insignificant myocardial uptake of the tracer. The first-pass studies however revealed reduced systolic function in 4/7 patients and impaired diastolic function in 6/7 patients. Therefore, although cardiac amyloid could not be demonstrated in the static scintigraphy due to amyloid fibril amount and composition, myocardial functional abnormalities were seen in the first-pass study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Humans; Technetium; Technetium Tc 99m Pyrophosphate; Ventriculography, First-Pass

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Heart; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The diagnosis of amyloid cardiomyopathy was only based, until the last few years, on the results of invasive techniques. It seems presently that the combined contribution of cardiac sonography and scintigraphy using technetium 99m pyrophosphate, makes, most of the time, this diagnosis possible without need for additional examinations. This notion is illustrated by a typical case-report and data from the literature. Demonstration on the cardiac sonogram of a thickening of the walls-while the context and especially the electrocardiogram are not in favor of a left ventricular hypertrophy--associated with a very particular "hyperechoing" aspect and an abnormal fixation on the scintigram, may be considered specific of this disease.

Topics: Amyloidosis; Diphosphates; Echocardiography; Female; Heart Diseases; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To validate the significance of technetium-99m-pyrophosphate (Tc-99m PYP) myocardial scintigraphy in diagnosing cardiac amyloidosis, 2 patients with familial amyloid polyneuropathy (FAP) and 1 patient with amyloidosis secondary to chronic rheumatic arthritis were studied. All three patients had echocardiographic abnormalities, which were increased wall thickness of the interventricular septum and the left ventricular posterior wall, and granular sparkling appearance in the septum. In 2 patients with FAP, abnormal myocardial uptake of Tc-99m PYP was diffusely detected in Tc-99m PYP SPECT. In the remaining 1 patient with secondary amyloidosis, however, Tc-99m PYP SPECT showed no abnormality, although we had confirmed the presence of myocardial amyloid deposits (type AA amyloid protein) with high amount in the histological examination. Thus, these results indicate that Tc-99m PYP scintigraphy may have a limitation in detecting cardiac involvement in secondary amyloidosis although it is useful in FAP.

Topics: Adult; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

A patient with AA amyloidosis secondary to ankylosing spondylitis showed intense liver uptake of Tc-99m MDP on bone imaging. The biopsy showed hepatic amyloid deposition. A repeat bone scan with Tc-99m MDP 1 year later was negative, although the clinical signs and liver function tests of the patient had not changed. A mechanism might exist, other than the affinity of amyloid to calcium, which would explain the extraosseous uptake of pyrophosphates and diphosphonates in organs and soft tissues affected by systemic amyloidosis.

Topics: Amyloidosis; Diphosphates; Humans; Liver; Liver Diseases; Male; Middle Aged; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Predictive Value of Tests; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

To determine whether technetium-99m-pyrophosphate (Tc-99m-PYP) scanning or two-dimensional echocardiography can detect amyloid heart disease in an earlier stage of familial amyloid polyneuropathy, 15 patients were examined. Although 10 of the 15 patients had no clinical evidence of congestive heart failure, as well as normal ventricular wall thickness and normal values for left ventricular systolic function, five (50%) of them showed mild or moderate myocardial uptake. On the other hand, none had characteristic highly refractile myocardial echoes on the two-dimensional echocardiographic images (p less than 0.01), and values for diastolic function were reduced in four of the five and normal in the remaining one. In 85 control subjects, diffuse positive pyrophosphate scans of the heart were found in four (5%) of them (three with dilated cardiomyopathy and one with sarcoidosis), and highly refractile granular sparkling echoes were observed in nine (11%) (five with hypertrophic cardiomyopathy, three with aortic stenosis, and one with hypereosinophilic syndrome). We conclude that Tc-99m-PYP scanning is a more sensitive and specific method and may have the potential ability to detect amyloid heart disease in the earlier stage of familial amyloid polyneuropathy than two-dimensional echocardiography.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A patient with familial amyloid polyneuropathy and congestive heart failure underwent myocardial imaging using technetium-99m pyrophosphate. Planar scintigraphy showed an intense, diffuse biventricular uptake of the radiotracer. Single-photon emission computed tomography demonstrated an unevenly distributed uptake of the isotope. The greatest activity corresponded to regions with marked echocardiographic changes. Emission tomography may aid in assessing the degree and distribution of the infiltrative lesions in cardiac amyloidosis.

Topics: Aged; Amyloidosis; Diphosphates; Echocardiography; Heart; Humans; Male; Polyneuropathies; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Thirty-four patients with amyloidosis proved by biopsy specimen were studied using technetium Tc 99m pyrophosphate scintigraphy to assess its utility in the diagnosis of amyloid heart involvement. Of 14 patients studied retrospectively, only three had intense uptake judged to be diagnostic of cardiac amyloidosis. In a prospective analysis of 20 patients with amyloidosis, all of whom had evidence of cardiac involvement by two-dimensional echocardiography, 17 had abnormal scans. Fourteen of the 17 scans had only 1+ or 2+ uptake, a finding that also was present in 15 of the 20 control patients (without amyloid heart disease). Only three of the 20 patients with cardiac amyloidosis had intense uptake that was considered unequivocal and diagnostic of amyloidosis. Of the five patients with biopsy specimen proof of endomyocardial amyloidosis, only one had intense uptake and one had no uptake. When intense uptake of technetium Tc 99m pyrophosphate is found in the heart of a patient, amyloidosis is highly likely. The technique, however, is not sufficiently sensitive to warrant routine screening of patients with amyloidosis or cardiomyopathies. Cross-sectional echocardiography is superior to pyrophosphate scintigraphy for recognition of cardiac amyloidosis.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Bone and Bones; Diphosphates; Female; Humans; Liver; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.

Topics: Amyloidosis; Biopsy; Cardiac Catheterization; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Diphosphates; Echocardiography; Endocardium; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Amyloidosis is an important entity in the differential diagnosis of cardiac failure of undetermined etiology. In this case report, the typical pattern of combined systolic and diastolic impairment in amyloid cardiomyopathy was demonstrated by analysis of the cardiac blood pool study. In addition, the patient described had mild uptake of Ga-67 citrate, as well as the characteristically intense myocardial uptake of Tc-99m pyrophosphate. Scintigraphic assessment may be particularly helpful when the diagnosis of amyloidosis is being considered in a patient with unexplained cardiac failure.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart Ventricles; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardium; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To assess the clinical significance of technetium-99m-pyrophosphate (Tc-99m-PYP), -methylene diphosphonate (Tc-99m-MDP) and thallium-201 (Tl-201) myocardial scintigraphy in the diagnosis of cardiac amyloidosis and in the differential diagnosis of cardiac diseases, 12 patients with biopsy-proved systemic amyloidosis (seven with familial amyloid polyneuropathy (FAP) and five with primary amyloidosis) were investigated. The results obtained were as follows: In 10 patients (six with FAP and four with primary amyloidosis) studied by Tc-99m-PYP scintigraphy, two (FAP one, primary amyloidosis one) had diffusely positive myocardial uptake, which was of greater intensity than that of the sternum. Six (four FAP; two primary amyloidosis) also had diffusely positive myocardial uptakes, but the intensity was less than that of the sternum. The remaining two (one FAP; one primary amyloidosis) had only equivocal myocardial uptakes. Two of these patients also had hepatic uptakes and another had both hepatic and thyroid uptakes. The intensity of myocardial uptake of Tc-99m-PYP in patients with echocardiographic left ventricular hypertrophy and/or highly refractile myocardial echoes, so-called granular sparkling appearance (GS) was slightly greater than that in patients with neither myocardial hypertrophy nor GS. FAP had slightly less intensity than primary amyloidosis. In 29 persons with other cardiac diseases and normal subjects examined by Tc-99m-PYP scintigraphy, seven (two dilated cardiomyopathy; two sarcoidosis; three hypertensive heart disease) also had diffusely positive myocardial scans of mild or moderate degree. However, none of them had marked myocardial or other tissue uptakes. Both Tc-99m-PYP and -MDP scintigraphic studies were performed in four patients (three FAP; one primary amyloidosis). In Tc-99m-MDP scintigraphy, diffusely positive myocardial uptakes were observed in two patients with FAP and the remaining two had negative scans. The intensity of Tc-99m-MDP myocardial uptake in each patient was significantly lower than that of Tc-99m-PYP uptake. Tl-201 scintigraphy was carried out in 10 patients (six FAP; four primary amyloidosis). Left ventricular hypertrophy was found in six patients and right ventricular visualization in five. Although electrocardiograms in seven of 10 patients showed QS patterns in the right to mid precordial leads, similar to that seen in antero-septal and extensive anterior myocardial infarctions, neither myocardial perfusion defec

Topics: Aged; Amyloidosis; Biopsy; Diagnosis, Differential; Diphosphates; Diphosphonates; Echocardiography; Electrocardiography; Endocardium; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Polyneuropathies; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Thallium

We describe herein the case of a 62-year-old man affected by congestive heart failure of obscure origin, in which the clinical history, the electrocardiographic and echocardiographic findings were compatible with the diagnosis of amyloid cardiomyopathy. Cardiac catheterization disclosed a restrictive physiology. Tc-99m-pyrophosphate myocardial scintiscan was negative despite the markedly increased left ventricular wall thickness on echocardiographic examination. A definite diagnosis was obtained by means of endomyocardial biopsy.

Topics: Amyloidosis; Biopsy; Cardiomyopathies; Diphosphates; Echocardiography; False Negative Reactions; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Twelve patients with familial amyloidosis with polyneuropathy were examined both by cross sectional echocardiography and by technetium-99m pyrophosphate scintigraphy to assess involvement of the heart non-invasively. All 12 patients had echocardiographic abnormalities. The most prominent findings were highly refractile myocardial echoes, thickened heart valves, and increased thickness of the heart walls. Four patients had abnormal myocardial uptake of technetium-99m pyrophosphate. The remaining eight had equivocal or no myocardial uptake and were considered to have normal scintigrams. A certain amount of amyloid is probably required to produce an abnormal scintigram, although lesions with less amyloid can evidently be identified by echocardiography. Neither the duration of polyneuropathy nor its severity showed any relation to the echocardiographic or scintigraphic findings. It is concluded that cross sectional echocardiography is superior to technetium-99m pyrophosphate scintigraphy in detecting cardiac involvement in familial amyloidosis with polyneuropathy and that these results may also be applicable to other forms of amyloidosis.

Topics: Adult; Aged; Amyloidosis; Diphosphates; Echocardiography; Female; Heart; Heart Diseases; Humans; Male; Middle Aged; Nervous System Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Heart; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Amyloidosis; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Amyloid goiter is a rare clinical entity. The diagnosis is rarely made preoperatively because clinical and laboratory findings are nonspecific. We report two cases of amyloid goiter in whom the diagnosis was made preoperatively using Tc-99m pyrophosphate scintigraphy.

Topics: Adult; Aged; Amyloidosis; Diphosphates; Female; Goiter; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thyroidectomy

Topics: Adult; Amyloidosis; Diphosphates; Heart; Heart Diseases; Humans; Middle Aged; Radionuclide Imaging; Serum Amyloid A Protein; Technetium; Technetium Tc 99m Pyrophosphate

This report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To determine the value of technetium-99m-pyrophosphate myocardial scintigraphy in the diagnosis of amyloid heart disease this procedure was prospectively performed in 20 consecutive patients with biopsy-proven primary amyloidosis. Eleven patients had echocardiographic abnormalities compatible with amyloid cardiomyopathy, 9 of whom had congestive heart failure. Diffuse myocardial pyrophosphate uptake was of equal or greater intensity than that of the ribs in 9 of the 11 patients with echocardiograms suggestive of amyloidosis, but in only 2 of the 9 with normal echocardiograms, despite abnormal electrocardiograms (p less than 0.01). Increased wall thickness measured by M-mode echocardiography correlated with myocardial pyrophosphate uptake (r = 0.68, p less than 0.01). None of 10 control patients with nonamyloid, nonischemic heart disease had a strongly positive myocardial pyrophosphate uptake. Thus, myocardial technetium-99m-pyrophosphate scanning is a sensitive and specific test for the diagnosis of cardiac amyloidosis in patients with congestive heart failure of obscure origin. It does not appear to be of value for the early detection of cardiac involvement in patients with known primary amyloidosis without echocardiographic abnormalities.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A prospective, comparative study was made of the efficacy of technetium-99m pyrophosphate (Tc PYP) and technetium-99m methylene diphosphonate (Tc MDP) in detecting soft-tissue amyloidosis. Tc PYP and Tc MDP scans were obtained within ten-day intervals in seven patients with histologically proven amyloidosis. Tc PYP was a better scanning agent for soft-tissue amyloidosis in all patients. Cardiac and hepatic involvement were proved by autopsy in one patient. Involvement of the heart was confirmed by echocardiography in five patients. The potential use of Tc PYP scanning as a screening test for soft-tissue amyloidosis is discussed.

Topics: Adult; Aged; Amyloidosis; Biopsy; Diphosphates; Diphosphonates; Echocardiography; Female; Heart Diseases; Humans; Liver Diseases; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Ten consecutive patients with tissue-proven amyloidosis, seven of whom presented with congestive heart failure, were found to exhibit intense diffuse uptake of technetium-99m-pyrophosphate (Tc-99m-PYP) on cardiac radionuclide imaging. The patients exhibited echocardiographic and systolic time interval abnormalities suggesting combined restrictive and congestive cardiomyopathic changes. On M-mode echocardiograms, there was symmetrically increased thickness of the interventricular septum and left ventricular (LV) posterior wall in diastole (10 of 10), decreased fractional shortening of the LV minor axis diameter in systole (eight of nine), and decreased percent thickening of the LV minor axis diameter in systole (eight of nine) and LV posterior wall (10 of 10) in systole. Three patients demonstrated enlarged LV end-diastolic diameter. All 10 patients had abnormal PEP/LVET and eight had shortened LVETI. When combined with noninvasive tests of LV performance, positive myocardial pyrophosphate (PYP) scanning provides a new and useful adjunct in the diagnosis of amyloid heart disease.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Systole; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Electrocardiography; Heart Ventricles; Humans; Male; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Diphosphates; Heart Failure; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Calcium; Diphosphates; Humans; Male; Muscles; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Intense, diffuse localization of Tc-99m-pyrophosphate was demonstrated in the right and left ventricles of a patient with biopsy-proved amyloidosis and severe congestive heart failure. This finding is strong presumptive evidence of myocardial infiltration by amyloid in the presence of biopsy-proven amyloidosis elsewhere in the body.

Topics: Adult; Amyloidosis; Bone and Bones; Diphosphates; Echocardiography; Heart Diseases; Heart Failure; Heart Ventricles; Humans; Hypertrophy; Male; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Technetium-99m sulfur colloid (SC) and Technetium-99m pyrophosphate (PYP) scintigrams in a patient with idiopathic systemic amyloidosis were abnormal. Hepatic SC distribution was nonhomogeneous. Spleen showed reduced SC uptake and a large focal defect at its upper pole. Splenic localization of PYP was seen on a bone scan. On histologic examination the abnormal scintigraphic sites showed heavy amyloid deposition. Splenic localization of skeletal radiotracer due to amyloidosis has not been previously reported.

Topics: Amyloidosis; Colloids; Diphosphates; Humans; Liver; Male; Middle Aged; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid

A material of 15 cases of histologically examined pyrophosphate arthritis (hip-joint: 7 cases, knee joint: 8 cases) is presented. Amyloid deposits were found in 14 cases and chondromatosis in the subsynovial connective tissue of all the cases. The significance of this high, not previously reported, coincidence is discussed, together with various pathogenetic possibilities, as related to the theories of the genesis of amyloid substance.

Topics: Aged; Amyloid; Amyloidosis; Arthritis; Calcium Pyrophosphate; Connective Tissue; Crystallization; Diphosphates; Female; Hip Joint; Humans; Knee Joint; Male; Microscopy, Polarization; Middle Aged; Synovial Membrane