technetium-tc-99m-medronate and Cardiomyopathies

Cardiac amyloidosis, once considered untreatable, is now gaining well-deserved attention due to advances in imaging and the recent approval of targeted breakthrough therapies. In this paper, we discuss the role of radionuclide imaging in the evaluation and management of patients with the most common form of amyloidosis-cardiac transthyretin amyloidosis (ATTR). We provide a comprehensive summary of the literature interspersed with our institutional experience as appropriate, to deliver our perspective.

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Bone and Bones; Cardiomyopathies; Heart; Humans; Prealbumin; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The aim of the present manuscript is to review the latest advancements of radionuclide molecular imaging in the diagnosis and prognosis of individuals with cardiac amyloidosis.

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Heart; Humans; Prognosis; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Amyloidosis; Cardiomyopathies; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Bone scans differentiate transthyretin (ATTR) cardiac amyloidosis from light chain amyloidosis and other causes of increased left ventricular (LV) wall thickness. We examined the prevalence and implications of cardiac uptake in the general population.. Patients were included based on having undertaken a bone scan for non-cardiac indications using Technetium 99m hydroxymethylene diphosphonate (HMDP) or Technetium 99m methylene diphosphonate (MDP). Blinded image review was undertaken. Positive was defined as cardiac uptake ≥ rib AND heart/whole body ratio (H/WB) > 0.0388. Echocardiography and clinical records were reviewed.. 6918 patients were included. 15/3472 HMDP scans were positive (14 males, 1 female): none in individuals aged < 65; 1.44% in males and 0.17% in females ≥ 65; 6.15% in males and 1.69% in females ≥ 85. Only 1/3446 MDP scans were positive. All HMDP positive patients had increased septal wall thickness on echocardiography. H/WB correlated positively with LV mass, and negatively with LV ejection fraction. No individual had an explanation other than ATTR for their positive scan.. In this Australian subpopulation, the prevalence of positive bone scans consistent with cardiac ATTR is 0% in individuals aged < 65. Prevalence increased with age, reaching 6.15% in men ≥ 85. The amount of HMDP uptake correlated with echocardiographic features of more advanced cardiac involvement. MDP does not appear useful in ATTR.

Topics: Aged; Aged, 80 and over; Amyloidosis; Australia; Bone and Bones; Cardiomyopathies; Correlation of Data; Diphosphonates; Echocardiography; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Prealbumin; Prevalence; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Amyloidosis; Biomarkers; Biopsy; Bone and Bones; Cardiomyopathies; Heart; Humans; Image Enhancement; Multimodal Imaging; Prealbumin; Radionuclide Imaging; Risk Assessment; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

The aim of this study was to assess the diagnostic accuracy of bone scintigraphy in a large multicenter cohort of patients with cardiac amyloidotic involvement and Phe64Leu transthyretin (TTR) mutation.. Diagnostic accuracy of bone scintigraphy for transthyretin-related cardiac amyloidosis (TTR-CA) is considered extremely high, enabling this technique to be the noninvasive diagnostic standard for TTR-CA. Nevertheless, this approach has not been systematically validated across the entire spectrum of TTR mutations.. A total of 55 patients with Phe64Leu TTR mutation were retrospectively analyzed and evaluated between 1993 and 2018 at 7 specialized Italian tertiary centers. Cardiac involvement was defined as presence of an end-diastolic interventricular septum thickness ≥12 mm, without other possible causes of left ventricular hypertrophy (i.e., arterial hypertension or valvulopathies). A technetium-99m (99mTc)-diphosphonate (DPD) or 99mTc-hydroxyl-methylene-diphosphonate (HMDP) bone scintigraphy was reviewed, and visual scoring was evaluated according to Perugini's method.. Among 26 patients with definite cardiac involvement, 19 underwent 99mTc-DPD or 99mTc-HMDP bone scintigraphy. Of them, 17 (89.5%) patients had low or absent myocardial bone tracer uptake, whereas only 2 (10.5%) showed high-grade myocardial uptake. The sensitivity and the accuracy of bone scintigraphy in detecting TTR-CA were 10.5% and 37%, respectively. Patients with cardiac involvement and low or absent bone tracer uptake were similar to those with high-grade myocardial uptake in terms of age, sex, and electrocardiographic and echocardiographic findings.. The sensitivity of bone scintigraphy (DPD and HMDP) in detecting TTR-CA is extremely low in patients with Phe64Leu TTR mutation, suggesting the need to assess diagnostic accuracy of bone scintigraphy to identify cardiac involvement across a wider spectrum of TTR mutations.

Topics: Aged; Amyloid Neuropathies, Familial; Bone and Bones; Cardiomyopathies; Diphosphonates; Female; Genetic Predisposition to Disease; Humans; Italy; Male; Middle Aged; Mutation; Prealbumin; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Compounds; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Aged, 80 and over; Amyloid Neuropathies, Familial; Bone Neoplasms; Cardiomyopathies; Genetic Predisposition to Disease; Humans; Incidental Findings; Male; Mutation; Prealbumin; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diagnosis, Differential; Genetic Predisposition to Disease; Humans; Immunoglobulin Light-chain Amyloidosis; Mutation; Prealbumin; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 71-year-old African man without history of cardiac disease was referred to our center for dyspnea. Transthoracic echocardiogram and cardiac MRI were suggestive of cardiac amyloidosis (CA). The diagnosis of the light-chain cardiac amyloidosis (AL-CA) was made after a first endomyocardial biopsy. Accordingly chemotherapy was started. Systematic 99mTc-HMDP scintigraphy showed moderate cardiac uptake (visual score of 2), unusual for AL-CA, and permitted to rectify the diagnosis. Hereditary transthyretin cardiac amyloidosis was confirmed by a second endomyocardial biopsy with a positive Congo-red and anti-transthyretin antibody stainings, mass spectrometry and genetic analysis (Val122Ile mutation).

Topics: Aged; Amyloidosis, Familial; Cardiomyopathies; Diagnosis, Differential; Diagnostic Errors; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To assess the usefulness of bone scintigraphy with (99m)Technetium-hydroxymethylene diphosphonate ((99m)Tc-HDP) for the detection of cardiac involvement in a group of patients with ATTR amyloidosis in different phases of disease, to relate the findings to echocardiography, ECG and cardiac biomarkers, and to evaluate different bone scintigraphic techniques and calculation methods for quantification of the cardiac uptake and for correlation with echocardiographic features and cardiac biomarkers.. Forty-one patients underwent clinical examinations, echocardiography, ECG, measurement of cardiac biomarkers and bone scintigraphy (planar imaging and SPECT-CT) and were subsequently subdivided into three groups: (1) carriers of an amyloidogenic TTR mutation, n = 11, (2) proven ATTR amyloidosis without echocardiographically-defined (mean wall thickness >12 mm) cardiac amyloidosis (AC), n = 19, and (3) ATTR amyloidosis with echocardiographically-defined cardiac amyloidosis, n = 11. Planar and SPECT-CT images were analyzed visually according to a routine scoring system (grade 0-3) and semi-quantitatively by heart-to-whole body (H/WB) and heart-to-skull (H/S) ratio on planar images and by a left ventricle-blood pool ratio on SPECT-CT images.. All patients with ATTR and echocardiographically-defined AC and none of the carriers showed high cardiac uptake on bone scintigraphy. Furthermore, 8 out of 19 patients with ATTR without echocardiographically-defined AC showed high cardiac uptake. Highest correlations were found between H/S ratio on planar bone scintigraphy with troponin T (r = 0.76, p < 0.0001) and H/WB ratio with left ventricular mass index (r = 0.73, p < 0.0001).. Bone scintigraphy with (99m)Tc-HDP may detect cardiac involvement in patients with ATTR amyloidosis prior to echocardiographic evidence of cardiac involvement. Cardiac uptake on bone scintigraphy correlates with severity of cardiac involvement using echocardiography, ECG and cardiac biomarkers. Visual grading and calculation of H/S ratio on planar imaging are the preferred methods to assess cardiac uptake.

Topics: Adult; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Bone and Bones; Cardiomyopathies; Early Diagnosis; Female; Heart Ventricles; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Aged; Amyloidosis, Familial; Cardiomyopathies; Echocardiography; Electrocardiography; Humans; Male; Patient Care Planning; Prealbumin; Radiopharmaceuticals; Sequence Analysis, Protein; Technetium Tc 99m Medronate; Tomography, Emission-Computed; White People

Topics: Adult; Calcinosis; Cardiomyopathies; Connective Tissue Diseases; Humans; Kidney Failure, Chronic; Male; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Technetium Tc 99m Medronate

We present a report and a brief summary of literature focused on a patient with suspected cardiac amyloidosis from transthoracic echocardiography and tc-99m HDP scintigraphy. Imaging demonstrated significantly increased uptake of the bone tracer within the myocardium in comparison to the highest skeletal uptake. Literature described several cases of abnormal myocardial uptake of various imaging tracers in various disease states.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Echocardiography; Female; Humans; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Cardiomyopathies; Female; Heart Septal Defects; Humans; Magnetic Resonance Imaging; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Amyloidosis is characterized by the soft-tissue deposition of amyloid protein. It may occur as a primary disorder but more often is seen as a manifestation of chronic illness. Scattered reports of the affinity of amyloid for bone scanning agents have appeared over many years. Isolated cardiac uptake of Tc-99m HDP is described in a patient with biopsy-proved cardiac amyloidosis on a background of tuberculosis, prostate cancer, and coronary artery disease.

Topics: Aged; Aged, 80 and over; Amyloidosis; Bone and Bones; Cardiomyopathies; Coronary Disease; Heart; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Tissue deposits of amyloid may lead to various clinical symptoms and signs, depending on the site of deposition. In addition, a specific subtype of amyloidosis, AL protein type, is associated with multiple myeloma. Two cases representing contrasting examples of altered radiopharmaceutical biodistribution in myeloma and amyloidosis are presented and discussed, with a bone tracer depicting the heart and a heart tracer depicting the bones.

Topics: Aged; Amyloidosis; Bone and Bones; Bone Neoplasms; Cardiomyopathies; Heart; Humans; Male; Multiple Myeloma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

Two unusual examples of cardiac uptake in elderly patients who had received serial bone scans, one with a "waxing" and the other with a "waning" pattern of myocardial tracer uptake, are presented. An apparent temporal discordance between echocardiographic and scintigraphic findings is noted. Neither of the two patients had clinical, electrocardiographic, or other laboratory evidence of old or new myocardial infarction. Possible causes for the temporal changes are described. Presumptive diagnoses of senile cardiac amyloidosis were made based on clinical findings, noninvasive imaging, and comparison with a historic cohort at the Veterans Administration Medical Center in Houston.

Topics: Aged; Aged, 80 and over; Amyloidosis; Bone and Bones; Cardiomyopathies; Heart; Humans; Male; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors

We assessed the changes in cardiac condition in a patient with cardiac amyloidosis, by means of dual nuclei single photon emission computed tomographic (SPECT) images with technetium-99m-hydroxymethylene diphosphonate (99mTc-HMDP) and thallium-201 (201Tl). Dual SPECT showed a marked increase in myocardial 99mTc-HMDP accumulation along with deterioration of symptoms and signs, while 201Tl scintigraphy remained almost unchanged.

Topics: Aged; Amyloidosis; Cardiomyopathies; Humans; Male; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

SPECT was used to identify a focal accumulation of cardiac calcification using Tc-99m MDP in a patient with an arrhythmia and known metastatic calcification elsewhere.

Topics: Adult; Arrhythmias, Cardiac; Calcinosis; Cardiomyopathies; Humans; Male; Radiography; Technetium Tc 99m Medronate

Clinical, radiographic and scintigraphic abnormalities in primary oxalosis of a 52 years old female are demonstrated. Severe oxalosis-nephropathy and oxalosis-arthropathy/enthesiopathy are shown. For the first time an intense myocardial uptake of 99 m Tc-HDP and 99 m Tc-MDP is described in connection with oxalosis. It is suggested that in the appropriate clinical setting this pattern may be suggestive of oxalosis-cardiomyopathy. Review of literature.

Topics: Arthritis; Bone Diseases; Cardiomyopathies; Diphosphonates; Female; Humans; Hyperoxaluria; Kidney Calculi; Middle Aged; Oxalates; Technetium; Technetium Tc 99m Medronate

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; Cardiomyopathies; Humans; Male; Middle Aged; Myocardium; Peripheral Nervous System Diseases; Radionuclide Imaging; Technetium Tc 99m Medronate

Asymptomatic myocardial disease has been described in relation to longstanding insulin-dependent diabetes mellitus. To detect myocardiopathy in a selected group of 14 patients (aged 21-38 years, duration of diabetes 10-20 years) with insulin-dependent diabetes, we have performed equilibrium gated nuclear angiography with Fourier filtered analysis. These patients had no clinical or echocardiographic signs of cardiac disease. We examined six patients with severe proliferative retinopathy, and eight patients with no signs of retinopathy at fluorescence angiography. The global ejection fraction was within normal limits in all cases. Fourier analysis of scintigraphic data, however, revealed wall motion abnormalities (abnormal amplitude and phase shift) of the left ventricle in all 14 patients, particularly in the anterior and/or septal region. No correlation was found between the degree of wall motion disturbances and prevailing blood glucose or HbA1 concentrations or the presence of retinopathy or autonomic neuropathy. It is concluded that equilibrium gated nuclear angiography in combination with Fourier filtered analysis is a sensitive method of detecting myocardial abnormalities in patients suffering from insulin-dependent diabetes mellitus without cardiac symptoms.

Topics: Adult; Cardiomyopathies; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Female; Fourier Analysis; Heart; Humans; Male; Radionuclide Imaging; Stroke Volume; Technetium Tc 99m Medronate

Topics: Calcinosis; Cardiomyopathies; Diphosphonates; Female; Humans; Hypercalcemia; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate