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Bone Tracers for Transthyretin Amyloid Cardiomyopathy: Are [ 99m Tc]Tc-DPD and [ 99m Tc]Tc-HMDP Equivalent?
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Bone Tracers for Transthyretin Amyloid Cardiomyopathy: Are [ 99m Tc]Tc-DPD and [ 99m Tc]Tc-HMDP Equivalent?

Julien Dubois, Florentin Kucharczak, Denis Mariano-Goulart et Tom Paunet
Molecular imaging, Vol.25, p.15353508261430506
01/01/2026
PMID: 42124796

Résumé

Aged Aged, 80 and over Amyloid Neuropathies, Familial - diagnostic imaging Bone and Bones - diagnostic imaging Cardiomyopathies - diagnostic imaging Diphosphonates Female Humans Male Middle Aged Organotechnetium Compounds - chemistry Radionuclide Imaging Radiopharmaceuticals Retrospective Studies Technetium Tc 99m Medronate - analogs & derivatives Technetium Tc 99m Medronate - chemistry
The management of transthyretin amyloid cardiomyopathy (ATTR-CM) has revolved around the scintigraphic diagnosis since the introduction of a specific treatment; however, the equivalency of the bone radiotracers remains unclear. This retrospective monocentric observational study compared [ Tc]Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ([ Tc]Tc-DPD) and [ Tc]Tc-hydroxy-methylene diphosphonate ([ Tc]Tc-HMDP) intensity of myocardial uptake compared with background noise for ATTR-CM suspicion. Two hundred and seventy-four patients who underwent planar scintigraphy after intravenous injection of [ Tc]Tc-DPD or [ Tc]Tc-HMDP for ATTR-CM were included. The patients' current visual Perugini grades were retrieved. Regions of interest were measured on the heart (H) and on the contralateral mediastinum (CM), and H/CM ratios were calculated. Although the distribution of quantitative assessments of heart to contralateral mediastinum ratios is wider with [ Tc]Tc-DPD, no difference in Perugini grades was found between [ Tc]Tc-DPD and [ Tc]Tc-HMDP for the diagnosis of ATTR-CM in evocative/non-evocative conditions. There was no difference in ATTR-CM diagnosis between the 2 tracers with a threshold of 1.5 ( -value <0.001 for [ Tc]Tc-HMDP and for [ Tc]Tc-DPD). We show in our local cohort that [ Tc]Tc-DPD and [ Tc]Tc-HMDP for amyloidosis diagnosis are equivalent for ATTR-CM diagnosis based on the Perugini grading scale.

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