"IRGE/PSIR:"
"Delayed three-hour imaging can be performed if there is abnormal biodistribution of tracer (i.e. increased generalised soft tissue uptake) at the one-hour time point. SPECT-CT is useful to differentiate cardiac activity from overlying bone activity, quantify this activity, and distinguish blood pool from myocardial activity. The American Society of Nuclear Cardiology recommends a heart-to-contralateral-lung ratio of ≥1.5 at one hour as classified as ATTR positive and a ratio of"
"PET radionuclides 18F florbetapir and florbetapene target amyloid, but subtype differentiation (ATTR vs AL amyloidosis) is not feasible with these agents; serum/urine protein electrophoresis and free light chain assay remain necessary for subtype differentiation 26. Uptake in left ventricular myocardium is compared to blood and is positive for amyloidosis if the uptake ratio is greater than 1.5 and the retention index is > 0.025 min−1 23,25,26."
"PET radionuclides 18F florbetapir and florbetapene target amyloid, but subtype differentiation (ATTR vs AL amyloidosis) is not feasible with these agents; serum/urine protein electrophoresis and free light chain assay remain necessary for subtype differentiation 26. Uptake in left ventricular myocardium is compared to blood and is positive for amyloidosis if the uptake ratio is greater than 1.5 and the retention index is > 0.025 min−1 23,25,26."
"Cardiac amyloidosis was long considered a rare disease, but prevalence has been increasing globally, largely due to improved noninvasive diagnosis 29-33.Reported prevalence ranges from 5 up to 13% and beyond 33,34. It usually affects the elderly, with subjects usually being 60 years and older at the time of diagnosis. Men are more commonly affected. In the heart, transthyretin-related (ATTR) amyloidosis is more common than AL amyloidosis."
"Cardiac amyloidosis was long considered a rare disease, but prevalence has been increasing globally, largely due to improved noninvasive diagnosis 29-33.Reported prevalence ranges from 5 up to 13% and beyond 33,34. It usually affects the elderly, with subjects usually being 60 years and older at the time of diagnosis. Men are more commonly affected. In the heart, transthyretin-related (ATTR) amyloidosis is more common than AL amyloidosis."
"mass spectrometry: definitive method for classification of the underlying precursor fibril (AL vs. ATTR)"
"mass spectrometry: definitive method for classification of the underlying precursor fibril (AL vs. ATTR)"
"AL amyloidosis: acquired disease"
"transthyretin-related (ATTR) amyloidosis: there are two types of TTR-related amyloidosis:"
"transthyretin-related (ATTR) amyloidosis: there are two types of TTR-related amyloidosis:"
"tricuspid annular plane systolic excursion and RV LS are early indicators of cardiac involvement in patients with systemic AL amyloidosis"
"tricuspid annular plane systolic excursion and RV LS are early indicators of cardiac involvement in patients with systemic AL amyloidosis"
"reduced tricuspid annular plane systolic excursion (TAPSE) despite normal RV end-diastolic dimension"
"native T1 is prolonged even more in AL-amyloidosis than in ATTR-amyloidosis 13-16"
"native T1 is prolonged even more in AL-amyloidosis than in ATTR-amyloidosis 13-16"
"extracellular volume is increased 35, especially in ATTR-amyloidosis, for which it is a prognostic factor 15,16"
"elevated T2 is associated with a worse prognosis in AL-amyloidosis 17"
"IRGE/PSIR:"
"transmural enhancement may be more prevalent in patients with ATTR compared to patients with AL 6"
"transmural enhancement may be more prevalent in patients with ATTR compared to patients with AL 6"
"TI scout sequence: may have some diagnostic utility for the presence of myocardial amyloidosis (in terms of type I, II and III nulling patterns) 24"
"Bone scintigraphy (Tc-99m-DPD/HMDP/PYP) is the primary noninvasive diagnostic test for ATTR subtyping 23,26."
"Tc-99m-DPD, Tc-99m-HMDP (hydroxy methylene diphosphonate) and Tc-99m-PYP (pyrophosphate) 22 have been shown to have high sensitivity and specificity for the diagnosis of transthyretin cardiac amyloidosis (ATTR) 19,20,28."
"Planar +/- SPECT-CT scintigraphy is performed one hour post-tracer administration. Images are assessed for the presence of abnormally increased uptake in the myocardium to indicate the presence of ATTR cardiac amyloidosis. Cardiac uptake is evaluated visually and can be scored using the Perugini scale, which compares tracer uptake in the ribs to uptake in the myocardium (if present) 18,21. A grade 2 or 3 pattern of myocardial uptake is strongly suggestive and diagnostic of ATTR amyloidosis, in the absence of a monoclonal protein (negative serum and urine immunofixation and normal serum free light chain ratio."
"Planar +/- SPECT-CT scintigraphy is performed one hour post-tracer administration. Images are assessed for the presence of abnormally increased uptake in the myocardium to indicate the presence of ATTR cardiac amyloidosis. Cardiac uptake is evaluated visually and can be scored using the Perugini scale, which compares tracer uptake in the ribs to uptake in the myocardium (if present) 18,21. A grade 2 or 3 pattern of myocardial uptake is strongly suggestive and diagnostic of ATTR amyloidosis, in the absence of a monoclonal protein (negative serum and urine immunofixation and normal serum free light chain ratio."
"Variable scan uptake is encountered in AL amyloidosis 23."
"Delayed three-hour imaging can be performed if there is abnormal biodistribution of tracer (i.e. increased generalised soft tissue uptake) at the one-hour time point. SPECT-CT is useful to differentiate cardiac activity from overlying bone activity, quantify this activity, and distinguish blood pool from myocardial activity. The American Society of Nuclear Cardiology recommends a heart-to-contralateral-lung ratio of ≥1.5 at one hour as classified as ATTR positive and a ratio of"
"Delayed three-hour imaging can be performed if there is abnormal biodistribution of tracer (i.e. increased generalised soft tissue uptake) at the one-hour time point. SPECT-CT is useful to differentiate cardiac activity from overlying bone activity, quantify this activity, and distinguish blood pool from myocardial activity. The American Society of Nuclear Cardiology recommends a heart-to-contralateral-lung ratio of ≥1.5 at one hour as classified as ATTR positive and a ratio of"
"PET radionuclides 18F florbetapir and florbetapene target amyloid, but subtype differentiation (ATTR vs AL amyloidosis) is not feasible with these agents; serum/urine protein electrophoresis and free light chain assay remain necessary for subtype differentiation 26. Uptake in left ventricular myocardium is compared to blood and is positive for amyloidosis if the uptake ratio is greater than 1.5 and the retention index is > 0.025 min−1 23,25,26."
"PET radionuclides 18F florbetapir and florbetapene target amyloid, but subtype differentiation (ATTR vs AL amyloidosis) is not feasible with these agents; serum/urine protein electrophoresis and free light chain assay remain necessary for subtype differentiation 26. Uptake in left ventricular myocardium is compared to blood and is positive for amyloidosis if the uptake ratio is greater than 1.5 and the retention index is > 0.025 min−1 23,25,26."
"AL amyloidosis"
"noninvasive: by Perugini Grade 2 or 3 uptake on bone scintigraphy, the absence of clonal light chains in blood serum and urine and supportive features on imaging (echocardiography/MRI)"
"mass spectrometry: definitive method for classification of the underlying precursor fibril (AL vs. ATTR)"
"diffuse left ventricular wall thickening (usually, multiple chambers are involved); can be associated with thickening of both atrial walls, in which case, a thickening of >6 mm of the inter-atrial septum or posterior right atrial wall is specific to amyloidosis (this threshold derives from a small early study) 10"
"Nuclear Medicine"
Expected headings
"Echocardiography"
"Nuclear Medicine"
"diffuse left ventricular wall thickening (usually, multiple chambers are involved); can be associated with thickening of both atrial walls, in which case, a thickening of >6 mm of the inter-atrial septum or posterior right atrial wall is specific to amyloidosis (this threshold derives from a small early study) 10"
"PET radionuclides 18F florbetapir and florbetapene target amyloid, but subtype differentiation (ATTR vs AL amyloidosis) is not feasible with these agents; serum/urine protein electrophoresis and free light chain assay remain necessary for subtype differentiation 26. Uptake in left ventricular myocardium is compared to blood and is positive for amyloidosis if the uptake ratio is greater than 1.5 and the retention index is > 0.025 min−1 23,25,26."
"TI scout sequence: may have some diagnostic utility for the presence of myocardial amyloidosis (in terms of type I, II and III nulling patterns) 24"