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Diagnostic Performance and Interpreter Experience of 1-Hour Versus 3-Hour (99m)Tc-HMDP Cardiac Amyloid Radionuclide Imaging: A Prospective, Blinded Comparison #MMPMID41355666
Tersalvi G; Carey P; Garmany A; Scott CG; Zhang J; Maldonado FJ; Kruger LF; Hruska CB; Johnson GB; Jouni H; Rodriguez-Porcel MG; Askew JW; Bois JP; Young KA; Anavekar NS; Grogan M; Dispenzieri A; Chareonthaitawee P; Homb AC; AbouEzzeddine OF
Circ Cardiovasc Imaging 2025[Dec]; ? (?): e018745 PMID41355666show ga
BACKGROUND: Guidelines recommend 3-hour cardiac amyloid radionuclide imaging (CARI) for transthyretin amyloid cardiomyopathy. Citing rapid blood clearance of (99m)Tc-hydroxymethylene-diphosphonate and efficient laboratory throughput, 1-hour imaging is increasingly practised despite limited supporting evidence. We sought to compare diagnostic performance and interpreter experience of 1-hour versus 3-hour (99m)Tc-hydroxymethylene-diphosphonate cardiac amyloid radionuclide imaging. METHODS: Consecutive patients with suspected transthyretin amyloid cardiomyopathy (n=114) underwent both 1-hour and 3-hour (99m)Tc-hydroxymethylene-diphosphonate single photon emission computed tomography (CT)/CT. Two cardiologist-radiologist reader teams, blinded to imaging timepoint (1 versus 3 hours), assessed overall interpretation, single photon emission CT-based Perugini grade, interpretation difficulty, interpreter confidence, and need for CT-fused images for anatomic localization. Discordant, equivocal, and difficult cases were arbitrated by a third tie-breaking team. The myocardial-to-blood-pool radiotracer uptake ratio (3-dimensional Score) was measured as a surrogate of contrast resolution. RESULTS: Interinterpreter agreement was high at both time points (kappa>/=0.81), with more cases requiring arbitration at 3 hours versus 1 hour (22% versus 13%; P=0.049). Overall interpretation and Perugini grades were concordant between time points in 111/114 (97%) and 106/114 (93%) patients, respectively. Three patients (3%) were negative at 1 hour but equivocal at 3 hours, all of which were clinically ruled out for transthyretin amyloid cardiomyopathy. Interpreter confidence was comparable at both timepoints (97% versus 95%; P=0.317). Compared with 3-hour imaging, contrast resolution was inferior (lower 3-dimensional score, P<0.001) and CT fusion was more frequently needed (57% versus 31%, P<0.001) at 1-hour imaging. CONCLUSIONS: In a prospective, blinded comparison of 1-hour versus 3-hour (99m)Tc-hydroxymethylene-diphosphonate cardiac amyloid radionuclide imaging, diagnostic performance and interpreter experience were similar, with readers requesting CT fusion more frequently at 1 hour to optimize myocardial-to-blood pool discrimination.
Circ+Cardiovasc+Imaging 2025 ; ? (?): e018745
