National patterns in imaging utilization for diagnosis of cardiac amyloidosis: A focus on Tc99m-pyrophosphate scintigraphy

J Nucl Cardiol. 2017 Jun;24(3):1094-1097. doi: 10.1007/s12350-016-0478-3. Epub 2016 Mar 25.

Abstract

Background: Tc99m-pyrophosphate (Tc99m-PYP) scintigraphy has emerged as a diagnostic modality for transthyretin (TTR) cardiac amyloidosis (CA). We sought to examine the variability in test utilization across multiple centers in the US.

Methods: An electronic, web-based survey addressing specifics on Tc-99m PYP imaging was emailed to ASNC members, totaling 2785 recipients. Only one response per institution was allowed.

Results: Responses were collected from 101 centers between July 2 and July 27, 2015. Among the respondents, 24% performed Tc-99m PYP specifically for CA diagnosis. The most commonly used dose was 20 mCi (37%) and most centers (35%) imaged 1 hour after injection. Scans were most often interpreted by cardiologists (60%). Quantification of uptake was performed in 57% of institutions with almost half (43%) utilizing the heart-to-contralateral lung (H/CL) ratio.

Conclusions: This national survey shows relatively low penetrance and high variability in Tc99m-PYP scintigraphy for CA diagnosis highlighting the need for standardization.

Keywords: National survey; Tc99m-pyrophosphate; cardiac amyloidosis.

MeSH terms

  • Amyloid Neuropathies, Familial / diagnostic imaging*
  • Amyloid Neuropathies, Familial / epidemiology*
  • Cardiomyopathies / diagnostic imaging*
  • Cardiomyopathies / epidemiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • Radiopharmaceuticals
  • Technetium Tc 99m Pyrophosphate*
  • United States / epidemiology
  • Utilization Review*

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Pyrophosphate

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related