[99mTc]Tc-hydroxydiphosphonate uptake in soft tissue is associated with amyloid load in subcutaneous abdominal fat tissue and mortality in wild-type transthyretin amyloidosis patients,European Journal of Nuclear Medicine and Molecular Imaging

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[99mTc]Tc-hydroxydiphosphonate uptake in soft tissue is associated with amyloid load in subcutaneous abdominal fat tissue and mortality in wild-type transthyretin amyloidosis patients
European Journal of Nuclear Medicine and Molecular Imaging ( IF 8.6 ) Pub Date : 2024-08-08 , DOI: 10.1007/s00259-024-06865-w
Hendrea Sanne Aletta Tingen ₁ , Dion Groothof ₂ , Alwin Tubben ₃ , Johan Bijzet ₄ , Ewout J Houwerzijl ₂ , Friso L H Muntinghe ₂ , Paul A van der Zwaag ₅ , Peter van der Meer ₃ , Bouke P C Hazenberg ₆ , Riemer H J A Slart _{1,

7} , Hans L A Nienhuis ₂

Affiliation

Purpose

Bone scintigraphy is key to non-invasively diagnosing wild-type transthyretin (ATTRwt) amyloidosis, and is mainly used to assess cardiac radiotracer uptake. However, extracardiac radiotracer uptake is also observed. We investigated whether intensity of soft tissue radiotracer uptake is associated with amyloid load in subcutaneous abdominal fat tissue and with mortality.

Methods

This prospective cohort study included 94 ATTRwt amyloidosis patients and 26 amyloid-negative heart failure controls who underwent whole-body [^99mTc]Tc-hydroxydiphosphonate scintigraphy. Site-to-background ratios were calculated for heart, elbows, subcutaneous tissue, shoulders and wrists on anterior planar bone scintigraphy images using rib and whole-body radiotracer uptake as background. Fat tissue aspirates were stained with Congo red to grade amyloid load. Site-to-rib ratios were compared between ATTRwt amyloidosis patients and controls, and associations of site-to-background ratio with Congo red score and all-cause mortality were studied.

Results

ATTRwt amyloidosis patients had higher soft tissue-to-rib, heart-to-rib and heart-to-whole body ratios compared with controls. The intensity of soft tissue uptake was positively associated with amyloid load in fat tissue in ATTRwt amyloidosis patients. Estimated glomerular filtration rate, N-terminal brain natriuretic propeptide, high-sensitivity cardiac troponin T (hs-cTnT), and the prognostic Mayo and NAC staging system were associated with all-cause mortality in univariable models. Soft tissue/rib ratio, hs-cTnT and the prognostic staging systems were the only two variables that were independently associated withall-cause mortality.

Conclusion

Soft tissue radiotracer uptake on bone scintigraphy in ATTRwt amyloidosis patients is positively associated with amyloid load in abdominal fat tissue and is independently associated with mortality.

中文翻译：

[99mTc]Tc-羟基二膦酸盐在软组织中的摄取与皮下腹部脂肪组织中的淀粉样蛋白负荷以及野生型转甲状腺素蛋白淀粉样变性患者的死亡率相关

目的

骨闪烁扫描是非侵入性诊断野生型运甲状腺素蛋白 (ATTRwt) 淀粉样变性的关键，主要用于评估心脏放射性示踪剂的摄取。然而，也观察到心外放射性示踪剂的摄取。我们研究了软组织放射性示踪剂摄取强度是否与皮下腹部脂肪组织中的淀粉样蛋白负荷以及死亡率相关。

方法

这项前瞻性队列研究包括 94 名 ATTRwt 淀粉样变性患者和 26 名淀粉样蛋白阴性心力衰竭对照者，他们接受了全身 [ ^99m Tc]Tc-羟基二膦酸盐闪烁扫描。使用肋骨和全身放射性示踪剂摄取作为背景，计算前平面骨闪烁扫描图像上心脏、肘部、皮下组织、肩部和腕部的位点与背景比。脂肪组织抽吸物用刚果红染色以分级淀粉样蛋白负荷。比较了 ATTRwt 淀粉样变性患者和对照之间的位点与肋骨比率，并研究了位点与背景比率与刚果红评分和全因死亡率的关联。

结果

与对照组相比，ATTRwt 淀粉样变性患者的软组织与肋骨、心脏与肋骨以及心脏与全身的比率较高。 ATTRwt 淀粉样变性患者的软组织摄取强度与脂肪组织中的淀粉样蛋白负荷呈正相关。在单变量模型中，估计肾小球滤过率、N 端脑钠尿前肽、高敏心肌肌钙蛋白 T (hs-cTnT) 以及预后 Mayo 和 NAC 分期系统与单变量模型中的全因死亡率相关。软组织/肋骨比率、hs-cTnT 和预后分期系统是唯一与全因死亡率独立相关的两个变量。