A case of cardiac amyloidosis incidentally detected by bone scintigraphy

Document Type : Case report

Authors

1 Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

2 Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan

3 Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

4 Department of Respiratory Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

Abstract

A 73-year-old man with lung cancer underwent bone scintigraphy for disease staging. Diffuse myocardial technetium hydroxymethylene diphosphonate (99mTc-HMDP) uptake was incidentally found. A diagnosis of amyloid transthyretin (ATTR) cardiac amyloidosis was suspected, although the patient had no symptoms at this time. Single-photon emission computed tomography (SPECT) showed particularly strong uptake in the ventricular septum. Cardiac magnetic resonance imaging (CMR) showed widespread subendocardial and partly transmural enhancement of the left ventricular myocardium on delayed postcontrast T1-weighted images. These findings were consistent with ATTR cardiac amyloidosis. 18F-FDG uptake in the left ventricle wall was observed on PET/CT. He was finally diagnosed with ATTR by endomyocardial biopsy. There are two major subtypes of cardiac amyloidosis: ATTR amyloidosis and amyloid light-chain (AL) amyloidosis. Endomyocardial biopsy is the gold standard for diagnosis. Recently, however, several reports have shown that bone scintigraphy using a 99mTc-labelled bone-seeking agent can detect ATTR cardiac amyloidosis and differentiate it from AL amyloidosis. Bone scintigraphy may play an important role in the detection and differentiation of ATTR cardiac amyloidosis.

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References

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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 9, Issue 1
January 2021
Pages 71-75

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