Title:Role of Nuclear Imaging in Cardiac Amyloidosis Management: Clinical Evidence and Review of Literature
Volume: 16
Author(s): Viviana Frantellizzi*, Laura Cosma, Arianna Pani, Mariano Pontico, Miriam Conte, Cristina De Angelis and Giuseppe De Vincentis
Affiliation:
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome,Italy
Keywords:
Cardiac amyloidosis, transthyretin amyloid, MIBG Scan, PET radiotracers, myocardial SPECT, cancer and amyloidosis.
Abstract: Cardiac amyloidosis (CA) is an infiltrative disease characterized by the extracellular
deposition of fibrils, amyloid, in the heart. The vast majority of patients with CA has one of two
types between transthyretin amyloid (ATTR) and immunoglobulin light chain associated amyloid
(AL), that have different prognosis and therapeutic options. CA is often underdiagnosed. The histological
analysis of endomyocardial tissue is the gold standard for the diagnosis, although it has
its limitations due to its invasive nature. Nuclear medicine now plays a key role in the early and
accurate diagnosis of this disease, and in the ability to distinguish between the two forms. Recent
several studies support the potential advantage of bone-seeking radionuclides as a screening technique
for the most common types of amyloidosis, in particular ATTR form. This review presents
noninvasive modalities to diagnose CA and focuses on the radionuclide imaging techniques
(bone-seeking agents scintigraphy, cardiac sympathetic innervation and positron emission tomography
studies) available to visualize myocardial amyloid involvement. Furthermore, we report
the case of an 83-year old male with a history of prostate cancer, carcinoma of the cecum and kidney
cancer, submitted to bone scan to detect bone metastasis, that revealed a myocardial uptake of
99mTC-HMPD suggestive of ATTR CA. An accurate and early diagnosis of CA able to distinguish
beyween AL and ATTR CA combined to the improving therapies could improve the survival
of patients with this disease.
