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Role of Nuclear Imaging in Cardiac Amyloidosis Management: Clinical Evidence and Review of literature

Author(s):

Viviana Frantellizzi*, Laura Cosma, Arianna Pani, Mariano Pontico, Miriam Conte, Cristina De Angelis and Giuseppe De Vincentis  

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 have one of two types: transthyretin amyloid (ATTR) and immunoglobulin light chain associated amyloid (AL), that have different prognosis and therapeutic options. CA is often underdiagnosed and even if histological analysis of endomyocardial tissue is the gold standard for the diagnosis, it has its limitation because it is an invasive technique. Nuclear medicine now plays a key role on the early and accurate diagnosis of this disease, including the peculiar 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 an 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. Early diagnosis of CA has important clinical, therapeutic and prognostic implications and, with improving therapies, an accurate diagnosis, including the ability to distinguish between AL CA an ATTR CA, is becoming a paramount and could improve survival of patients with this disease.

Keywords:

Cardiac Amyloidosis, Transthyretin Amyloid, MIBG Scan, PET Radiotracers, Myocardial SPECT, Cancer And Amyloidosis

Affiliation:

Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Ph.D. Program in Morphogenesis & Tissue Engineering, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome



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