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Research ArticleTeaching Case Studies

Clinical Application of 99mTc-Pyrophosphate Scintigraphy for Diagnosis of Cardiac Amyloidosis: A Case Series

Sami Shoura and Saurabh Malhotra
Journal of Nuclear Medicine Technology June 2023, 51 (2) 125-128; DOI: https://doi.org/10.2967/jnmt.123.265614
Sami Shoura
1Department of Internal Medicine, Cook County Health, Chicago, Illinois;
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Saurabh Malhotra
2Division of Cardiology, Cook County Health, Chicago, Illinois; and
3Division of Cardiology, Rush Medical College, Chicago, Illinois
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    FIGURE 1.

    (A) Electrocardiogram showing atrial fibrillation, inferior myocardial infarction pattern, and low QRS voltage. (B) Transthoracic echocardiogram showing severe left ventricular hypertrophy in parasternal long-axis view. (C) Speckle-tracking strain echocardiogram showing apical-sparing pattern. (D) Contrast-enhanced cardiac MRI showing diffuse gadolinium enhancement in left ventricle. (E) Parametric mapping depicting elevated native myocardial T1 at 1,260 ms and abnormal extracellular volume, at 60%. (F and G) [99mTc]Tc-pyrophosphate scintigraphy, with anterior planar view depicting grade 3 tracer uptake (F), confirmed on cardiofocal SPECT reconstruction (G). Cardiac boundaries are well depicted in short-axis, horizontal long-axis, and vertical long-axis orientations. H/CL = heart–to–contralateral-lung ratio.

  • FIGURE 2.
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    FIGURE 2.

    (A) Electrocardiogram showing sinus rhythm with first-degree atrioventricular block and low QRS voltage in limb leads. (B) Transthoracic echocardiogram showing severe left ventricular hypertrophy in parasternal long-axis view. (C) Speckle-tracking strain echocardiogram showing apical-sparing pattern. (D) Contrast-enhanced cardiac MRI showing diffuse gadolinium enhancement in left ventricle. (E) Parametric mapping depicting elevated native myocardial T1 at 1,194 ms and elevated extracellular volume, at 54%. (F) [99mTc]Tc-pyrophosphate scintigraphy, with anterior planar view depicting grade 1 tracer uptake. (G) Cardiofocal SPECT reconstruction confirming lack of myocardial tracer uptake. H/CL = heart–to–contralateral-lung ratio.

  • FIGURE 3.
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    FIGURE 3.

    (A) Transthoracic echocardiogram showing mild left ventricular hypertrophy in parasternal long-axis view. (B) Speckle-tracking strain echocardiogram showing apical-sparing pattern. (C) [99mTc]Tc-pyrophosphate scintigraphy, with anterior planar view depicting grade 2 tracer uptake. (D) Cardiofocal SPECT reconstruction confirming lack of myocardial tracer uptake. (E) Chest reconstruction identifying significant blood-pool activity in cardiac chambers. Arrow points out mechanical mitral valve. H/CL = heart–to–contralateral-lung ratio; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.

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Journal of Nuclear Medicine Technology: 51 (2)
Journal of Nuclear Medicine Technology
Vol. 51, Issue 2
June 1, 2023
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Clinical Application of 99mTc-Pyrophosphate Scintigraphy for Diagnosis of Cardiac Amyloidosis: A Case Series
Sami Shoura, Saurabh Malhotra
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 125-128; DOI: 10.2967/jnmt.123.265614

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Clinical Application of 99mTc-Pyrophosphate Scintigraphy for Diagnosis of Cardiac Amyloidosis: A Case Series
Sami Shoura, Saurabh Malhotra
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 125-128; DOI: 10.2967/jnmt.123.265614
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Keywords

  • light-chain cardiac amyloidosis
  • transthyretin cardiac amyloidosis
  • 99mTc-pyrophosphate imaging
  • echocardiography
  • MRI
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