DETECTION OF CARDIAC TTR AMYLOIDOSIS BY ROUTINE BONE SCINTIGRAPHY: CASE EXAMPLES
Abstract
Background. Bone scintigraphy with bisphosphonates and phosphate complexes labeled with 99mTc, widely used to study focal changes in skeletal bones, allows the diagnosis of transthyretin cardiac amyloidosis. Purpose: to demonstrate the capabilities of scintigraphy in routine examination of skeletal bones in detecting transthyretin cardiac amyloidosis. Material and methods. As clinical observations, we present the results of osteoscintigraphy of three patients who showed increased accumulation of radiopharmaceuticals in the myocardium, which corresponds to cardiac transthyretin amyloidosis (ATTR-СА). Discussion. About ten years ago, criteria for scintigraphic diagnosis of ATTR cardiac amyloidosis were proposed, which have now developed into a full-fledged algorithm. The prevalence of positivity for cardiac amyloidosis on bone scintigraphy was low and depended on which Perugini stages were included (I–III vs II–III). Thus, including Perugini stage I, the incidence was shown to be slightly higher than excluding it. However, a prevalence of 1.5% in the general population over 65 years of age would result in a significant number of patients with АTTRCA. Conclusion. Scintigraphy with 99mTc-labeled phosphate complexes is an effective non-invasive diagnostic method for detecting cardiac transthyretin amyloidosis.
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