Journal Article

Diagnostic value of bone scintigraphy versus cardiovascular magnetic resonance in cardiac amyloidosis

Bietenbeck, Michael, Vehof, Volker, Obergassel, Josefin, Akyol, Nuriye, Yilmaz, Ali, Theofanidou, Maria, Stalling, Philipp, Meier, Claudia

2025

نظرة عامة

Accurate diagnosis of transthyretin amyloidosis cardiomyopathy (ATTR-CM) and its differentiation from light-chain (AL) cardiac amyloidosis (CA) cases (AL-CM) are of paramount importance. Surprisingly, comparative imaging data based on concurrent cardiovascular magnetic resonance (CMR) and bone scintigraphy in the same patients with biopsy-proven diagnosis of CA are still rare. This was a real-world retrospective single-center study based on a local clinical care pipeline and we carefully analyzed clinical, laboratory, CMR, and bone scintigraphy data (and if necessary additional endomyocardial biopsy [EMB] data) in patients with suspected CA. As a major inclusion criterion, we only looked at those patients who underwent both a CMR study and a bone scintigraphy—with a clear-cut imaging finding detected by at least one imaging method. One hundred twenty three patients in whom the final diagnosis was obtained either non-invasively based on combined findings from bone scintigraphy and monoclonal protein studies or invasively based on additional EMB findings were included. A positive CMR result indicating the presence of CA was found in 121 patients—suggesting a CMR sensitivity of 98.4% for the diagnosis of any CA. Bone scintigraphy identified 18 patients with low to moderate uptake (Perugini score = 0–1) and 105 patients with high uptake (Perugini score ≥2)—resulting in a sensitivity for bone scintigraphy of 85.4% for the diagnosis of any CA. There was an agreement (“diagnostic match”) between CMR and bone scintigraphy results in 103 patients (84%) of the total study cohort, while a discrepancy (“diagnostic mismatch”) was observed in 20 patients (16%). In 18 out of these 20 diagnostic mismatch cases, CMR correctly diagnosed the presence of CA despite a negative or inconclusive result on bone scintigraphy (8 with AL-CM, 8 with ATTR-CM, and 2 with EMB-proven but unspecified CA). CMR shows a substantially higher diagnostic yield for the diagnosis of CA compared to bone scintigraphy, if a real-world cohort of patients comprising different subtypes of CA is looked at, since CMR does not only detect ATTR-CM but also depicts other CA subtypes such as AL. In case of a clear-cut positive CMR result unequivocally indicative of CA, there is no incremental diagnostic value of an additionally performed bone scintigraphy. [Display omitted]

• الناشر: Elsevier Inc,Elsevier
• موضوع: Aged / Aged, 80 and over / Amyloid Neuropathies, Familial - diagnostic imaging / Amyloid Neuropathies, Familial - pathology / ATTR / Biopsy / Bone scintigraphy / Cardiac amyloidosis / Cardiomyopathies - diagnostic imaging / Cardiomyopathies - pathology / Cardiovascular / CMR / Diagnosis, Differential / Female / Humans / Immunoglobulin Light-chain Amyloidosis - diagnostic imaging / Immunoglobulin Light-chain Amyloidosis - pathology / Magnetic Resonance Imaging / Magnetic Resonance Imaging, Cine / Male / Middle Aged / Original Research / Predictive Value of Tests / Radiology/Diagnostic Imaging / Radionuclide Imaging / Radiopharmaceuticals - administration & dosage / Reproducibility of Results / Retrospective Studies