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J Am Coll Cardiol, 2008; 51:1509-1510, doi:10.1016/j.jacc.2007.12.038
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Usefulness of 99mTc-DPD Scintigraphy in Cardiac Amyloidosis

Claudio Rapezzi, MD*, Pierluigi Guidalotti, MD, Fabrizio Salvi, MD, Letizia Riva, MD and Enrica Perugini, MD, PhD

* Istituto di Cardiologia, Policlinico S. Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy (Email: claudio.rapezzi{at}unibo.it).

In their useful state-of-the-art paper on the evaluation and management of cardiac amyloidosis, Selvanayagam et al. (1) rightly dedicate much space to noninvasive evaluation but make no mention of a relevant imaging tool: 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy. The authors do discuss radiolabeled serum amyloid P component (SAP) scintigraphy, which can provide valuable information on the distribution and extent of amyloid deposition in the body as a whole, but (as the authors point out) cannot adequately image amyloid in the heart. Unlike the SAP technique, 99mTc-DPD scintigraphy is capable of imaging amyloid deposition in the myocardium of patients with transthyretin-related (TTR) amyloidosis (i.e., hereditary systemic amyloidosis and senile systemic amyloidosis) (2–5). This specific imaging characteristic may facilitate differential diagnosis between TTR and AL cardiac amyloidosis in routine practice—a clinically relevant distinction (5). Because 99mTc-DPD scintigraphy is a standardized technique that uses a widely available tracer, we think that this noninvasive examination should be known to all clinicians involved in the diagnosis and management of systemic amyloidosis.


   References
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 References
 

  1. Selvanayagam JB, Hawkins PN, Biju P, Myerson SG, Neubauer S. Evaluation and management of the cardiac amyloidosis J Am Coll Cardiol 2007;50:2101-2110.[Abstract/Free Full Text]
  2. Janssen S, Piers DA, Van Rijswijk MH, Meijer S, Mandema E. Soft-tissue uptake of 99mTc-diphosphonate and 99mTc-pyrophosphate in amyloidosis Eur J Nucl Med 1990;16:663-670.[CrossRef][ISI][Medline]
  3. De Haro FJ, Castejon I, Besada E, Berrocal JO. Soft-tissue uptake of Tc-99m DPD (dicarboxypropane diphosphonate) in amyloidosis Clin Nucl Med 1996;21:509.[CrossRef][ISI][Medline]
  4. Puille M, Altland K, Linke RP, et al. 99mTc-DPD scintigraphy in transthyretin-related familial amyloidotic polyneuropathy Eur J Nucl Med 2002;29:376-379.[CrossRef][ISI]
  5. Perugini E, Guidalotti PL, Salvi F, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy J Am Coll Cardiol 2005;46:1076-1084.[Abstract/Free Full Text]

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Joseph B. Selvanayagam, Philip N. Hawkins, and Stefan Neubauer
J. Am. Coll. Cardiol. 2008 51: 1510. [Full Text] [PDF]




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