用于诊断转甲状腺素心脏淀粉样变性病的定量 SPECT/CT 指标：对活检确诊病例的多中心研究

IF 8.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2025-04-24 DOI:10.1007/s00259-025-07294-z

Taku Takaishi, Masaya Kisohara, Ryosuke Horino, Hitomi Kaneko, Naohide Hotta, Kyosuke Mizuno, Takamine Ezaka, Yuto Kitagawa, Sachiko Okochi, Susumu Kobayashi, Masanori Kitase, Shuichi Kitada, Misugi Urano, Akio Hiwatashi

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引用次数: 0

摘要

目的：99mTc-PYP闪烁显像是诊断转甲状腺素蛋白淀粉样心肌病（ATTR-CM）的金标准。常规指标，如心脏与对侧胸部（H/CL）比值和视觉佩鲁吉尼评分，可能会受到生理血池摄取的影响，导致假阳性和额外的患者负担。本研究旨在开发和验证一种广泛适用于ATTR-CM诊断的简单定量指标。方法这项多中心回顾性研究纳入了253名在2021年4月至2024年9月期间接受[99mTc]Tc-PYP SPECT/CT检查的患者。在注射740 MBq[99mTc]Tc-PYP后3小时采集SPECT/CT。通过将左心室侧壁中的平均放射性示踪剂计数除以升主动脉中的平均计数，获得侧壁与主动脉的比值（LW/Ao）。通过心内膜心肌活检确定ATTR-CM诊断。作为统计分析，使用受试者工作特征下面积（AUC）来比较诊断准确性，使用组内相关系数（ICC）来评估评分者之间的一致性。结果在52例有活检结果的患者（31名男性；平均年龄77岁）中，11例被诊断为ATTR-CM。LW/Ao比值的敏感性为100%（11/11），特异性为97.6%（40/41），阳性似然比为41.0。与H/CL比值（AUC）相比，LW/Ao比值显示出更高的AUC（0.99；95%CI:0.99-1.00） = 0.90, p = 0.04) 视觉评分（AUC = 0.87, p < 0.01). LW/Ao比值的ICC非常好（0.91≥0.9）。结论与常规方法相比，定量SPECT/CT指标对ATTR-CM的诊断准确性更高。

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A quantitative SPECT/CT metric for diagnosing transthyretin cardiac amyloidosis: multicenter study on biopsy-confirmed cases

Purpose

99mTechnetium-pyrophosphate ([^99mTc]Tc-PYP) scintigraphy is the gold standard for diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM). Conventional metrics, such as heart-to-contralateral-chest (H/CL) ratio and visual Perugini score, can be influenced by physiological blood pool uptake, leading to false positives and additional patient burdens. This study aimed to develop and validate a simple quantitative metric widely applicable for ATTR-CM diagnosis.

Methods

This multicenter retrospective study enrolled 253 patients who underwent [^99mTc]Tc-PYP SPECT/CT between April 2021 and September 2024. SPECT/CTs were acquired 3 h post-injection of 740 MBq [^99mTc]Tc-PYP. A lateral wall-to-aorta (LW/Ao) ratio was obtained by dividing the average radiotracer count in the lateral wall of the left ventricle by the average count in the ascending aorta. The diagnosis of ATTR-CM diagnosis was determined by endomyocardial biopsy. As statistical analyses, area under receiver operating characteristic (AUC) was used to compare diagnostic accuracy, and intraclass correlation coefficient (ICC) was used to assess inter-rater agreement.

Results

Among 52 patients (31 men; mean age 77) whose biopsy results were available, 11 were diagnosed with ATTR-CM. LW/Ao ratio showed a sensitivity of 100% (11/11), specificity of 97.6% (40/41), and positive likelihood ratio of 41.0. LW/Ao ratio showed higher AUC (0.99; 95% CI: 0.99–1.00) compared to H/CL ratio (AUC = 0.90, p = 0.04) and visual score (AUC = 0.87, p < 0.01). The ICC of LW/Ao ratio was excellent (0.91 ≥ 0.9).

Conclusion

The quantitative SPECT/CT metric demonstrated superior diagnostic accuracy for ATTR-CM compared to conventional methods.

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.