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<p>Transthyretin amyloid cardiomyopathy (ATTR-CM), especially the wild-type form, causes heart failure in elderly patients and is underdiagnosed. Visual assessment using bone-avid tracer scintigraphy is the cornerstone of diagnosis, however, conventional two-dimensional planar scintigraphy using the heart-to-contralateral lung ratio can be inaccurate because rib overlap and extracardiac activity obscure myocardial uptake. To address this limitation, quantitative SPECT/CT using the myocardium-to-blood ratio has been proposed. However, CT acquisition increases radiation exposure, scanning time, and cost. We retrospectively analyzed 90 consecutive patients with and without ATTR-CM (<i>n</i> = 25 and 65, respectively) who underwent <sup>99m</sup>Technetium-hydroxymethylene diphosphonate (<sup>99m</sup>Tc-HMDP) or <sup>99m</sup>Technetium-pyrophosphate (<sup>99m</sup>Tc-PYP) SPECT between June 2021 and April 2025 at Sakakibara Heart Institute (Tokyo, Japan). Using anatomical landmarks identifiable on standard chest radiographs, volumes of interest were placed directly on three-dimensional SPECT images without CT. A three-dimensional cardiac-to-contralateral (C/CL) ratio was calculated. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance for ATTR-CM. The median C/CL ratio was significantly higher in patients with ATTR-CM compared to those without (2.62 [interquartile range, 2.16–2.84] vs. 1.09 [0.96–1.21], <i>P</i> &lt; 0.0001). The area under the curve in the receiver operating characteristic analysis was 1.000 (95% confidence interval: 1.000–1.000, <i>P</i> &lt; 0.0001), with an optimal cutoff value of 1.6 providing near-perfect sensitivity and specificity. Chest X-ray-guided SPECT-only quantitative assessment provides a simple and accessible adjunct to visual interpretation for diagnosing wild-type ATTR-CM, while reducing radiation exposure and facilitating broader clinical application.</p>

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Chest X-ray–guided SPECT-only quantification as an adjunctive approach for wild-type transthyretin amyloid cardiomyopathy

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • Hajime Abe,
  • Nobuo Iguchi,
  • Yasuhiro Suzuki,
  • Yuka Otaki,
  • Mamoru Nanasato,
  • Mitsuaki Isobe

摘要

Transthyretin amyloid cardiomyopathy (ATTR-CM), especially the wild-type form, causes heart failure in elderly patients and is underdiagnosed. Visual assessment using bone-avid tracer scintigraphy is the cornerstone of diagnosis, however, conventional two-dimensional planar scintigraphy using the heart-to-contralateral lung ratio can be inaccurate because rib overlap and extracardiac activity obscure myocardial uptake. To address this limitation, quantitative SPECT/CT using the myocardium-to-blood ratio has been proposed. However, CT acquisition increases radiation exposure, scanning time, and cost. We retrospectively analyzed 90 consecutive patients with and without ATTR-CM (n = 25 and 65, respectively) who underwent 99mTechnetium-hydroxymethylene diphosphonate (99mTc-HMDP) or 99mTechnetium-pyrophosphate (99mTc-PYP) SPECT between June 2021 and April 2025 at Sakakibara Heart Institute (Tokyo, Japan). Using anatomical landmarks identifiable on standard chest radiographs, volumes of interest were placed directly on three-dimensional SPECT images without CT. A three-dimensional cardiac-to-contralateral (C/CL) ratio was calculated. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance for ATTR-CM. The median C/CL ratio was significantly higher in patients with ATTR-CM compared to those without (2.62 [interquartile range, 2.16–2.84] vs. 1.09 [0.96–1.21], P < 0.0001). The area under the curve in the receiver operating characteristic analysis was 1.000 (95% confidence interval: 1.000–1.000, P < 0.0001), with an optimal cutoff value of 1.6 providing near-perfect sensitivity and specificity. Chest X-ray-guided SPECT-only quantitative assessment provides a simple and accessible adjunct to visual interpretation for diagnosing wild-type ATTR-CM, while reducing radiation exposure and facilitating broader clinical application.