Q00790

Bone-Avid Tracer Cardiac Scintigraphy for Cardiac Amyloidosis

An overview of cardiac amyloidosis, with a summary of bone-avid tracer cardiac scintigraphy, and an approach to accurate interpretation and reporting of technetium 99m bone-avid tracer cardiac findings.

Course ID: Q00790 Category:
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2.75

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$29.00

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 2.75
Procedures: 2.75
Cardiac Procedures: 2.75

Outline

  1. Introduction
  2. Cardiac Amyloidosis
  3. Imaging Evaluation of HFpEF in Older Adults
  4. Noninvasive Diagnosis of ATTR-CA without Biopsy
  5. Mechanism of Nyocardial Uptake of Bone-Avid Tracers in Amyloidosis
  6. 99mTc-PYP/DPD/HMDP Scintigraphy for Risk Assessment in ATTR-CA
  7. 99mTc-PYP/DPD/HMDP Scintigraphy to unravel the prevalence of ATTR-CA in Select at-Risk Cohorts
  8. Novel Targeted Therapies for ATTR-CA
  9. Clicical Vignette
  10. How to Acquire 99mTc-PYP/DPD/HMDP Images
  11. How to Interpret 99mTc-PYP/DPD/HMDP images: A Systematic Aproach
    1. Step 1: Perform Quality Control
    2. Step 2: Confirm the Presence of Rib Uptake as a Check for Appropriate Timing of Scan Acquisition
    3. Step 3: Distinguish Myocardial 99mTc-PYP Uptake from Blood Pool Activity
    4. Step 4: Interpret Myocardial Uptake: Visual Assessment and Grading of 99mTc-PYP Images
    5. Optional Step for Interpretation: Semiquantitative Method of H/CL Ratio at Planar Imaging
    6. Step 5: Exclude a Monoclonal Process with Serum/Urine Immunofixation Electrophoresis and a Serum Free AL Assay in All Patients with Suspected Cardiac Amyloidosis
    7. Step 6: Review for Physiologic Tracer Distribution and Extracardiac Tracer Activity
  12. Challenges with 99mTc-PYP/DPD/HMDP Image Interpretation
    1. False-Positive 99mTc-PYP/DPD/HMDP Scans
      1. High Blood Pool Activity
      2. Recent Acute Myocardial Infarct and Other Myocardial Injuries
    2. False-Negative 99mTc-PYP/DPD/HMDP Scans
  13. Clinical Reporting of 99mTc-PYP/DPD/HMDP Studies
  14. When to Refer for Further Evaluation Including Endomyocardial Biopsy
  15. Future: Quantification of Cardiac Amyloidosis with Use of SPECT and SPECT/CT

Objectives

Upon completion of this course, students will:

  1. understand how amyloidosis affects the myocardiumidentify individuals most susceptible to ATTRwt-CA
  2. understand the specificity and sensitivity associated with cardiac scintigraphy and amyloidosis
  3. identify the bone-avid radiotracer that should be avoided for cardiac amyloid imaging
  4. identify the bone-avid radiotracer previously used for cardiac infarct imaging
  5. describe potential image findings at one hour post Tc-99m PYP injection
  6. list image findings that would indicate sufficient time has past
  7. understand the frequency of ATTR-CA in hospitalized HFpEF patients over age 60 with thickened myocardium
  8. list the current medications available to treat ATTR-CA
  9. understand the recommended and required scintigraphy imaging parameters
  10. identify the only definitive method to confirm radiotracer myocardial uptake
  11. describe organs visualized if 99mTc PYP were injected beyond 6 hours
  12. understand how the Perugini score is utilized
  13. explain how H/CL regions of interest are drawn and placed
  14. explain how myocardial radiotracer can be confirmed
  15. list factors that can negatively impact the H/CL ratio
  16. identify a radiotracer that may be helpful with AL
  17. identify the test that should be considered for AL positive patients
  18. understand the physiologic biodistribution of 99mTc PYP/DPD/HMDP
  19. describe common incidental findings on 99mTc PYP/DPD/HMDP scintigraphy
  20. describe techniques to differentiate blood pool from myocardial activity
  21. describe the myocardial uptake pattern visualized on planar imaging
  22. identify what could be considered in select high suspicion cases when 3-hour cardiac scintigraphy reveals persistent blood pool activity
  23. understand myocardial infarction and cell death physiology
  24. understand recent myocardial infarction and ATTR-CA cardiac scintigraphy
  25. list conditions that can contribute to myocardial uptake with 99mTc PYP
  26. identify the percent sensitivity of 99mTc PYP/DPD/HMDP for ATTR-CA
  27. list types of cardiac amyloidosis associated with false negative outcomes
  28. identify report findings on 99mTc PYP/DPD/HMDP scans that are considered optional
  29. explain management options for 99mTc PYP grade 0 or 1 gene positive patients
  30. list SPECT/CT quantitative software programs