Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 45; no. 11; pp. 1945 - 1955
• Main Authors: Treglia, Giorgio, Glaudemans, Andor W. J. M., Bertagna, Francesco, Hazenberg, Bouke P. C., Erba, Paola A., Giubbini, Raffaele, Ceriani, Luca, Prior, John O., Giovanella, Luca, Slart, Riemer H. J. A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2018; Springer Nature B.V
• Subjects: Accuracy; Amyloid Neuropathies, Familial - diagnostic imaging; Amyloidosis; Bivariate analysis; Cardiology; Cardiomyopathy; Diagnostic systems; Disease control; Echocardiography; Heart; Heart diseases; Hernias; Humans; Imaging; Medical diagnosis; Medicine; Medicine & Public Health; Meta-analysis; Multivariate Analysis; Nuclear Medicine; Oncology; Original Article; Orthopedics; Patients; Radiology; Radionuclide Imaging - methods; Scintigraphy; Search algorithms; Sensitivity; Sensitivity and Specificity; Skeleton; Systematic review; Technetium; Transthyretin; Amyloid; Cardiac amyloidosis; Bone scintigraphy; Transthyretin; ATTR
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-018-4013-4

Purpose Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR. Methods A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) “amyloid” OR “amyloidosis” AND (b) “TTR” OR “ATTR” OR “transthyretin” AND (c) “scintigraphy” OR “scan” OR “SPECT” OR “SPET” OR “bone” OR “skeletal” OR “skeleton” OR “PYP” OR “DPD” OR “HMDP” OR “MDP” OR “HDP”. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated. Results The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89–95%), specificity 95.4% (95% CI 77–99%), LR+ 7.02 (95% CI 3.42–14.4), LR− 0.09 (95% CI 0.06–0.14), and DOR 81.6 (95% CI 44–153). Mild heterogeneity was found among the selected studies. Conclusion Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.