Large Pleural Effusion: A Pitfall in the Quantitation of 99mTc-PYP Imaging for ATTR Cardiac Amyloidosis

Wajahat Khatri; Michael Polydefkis; Joban Vaishnav; Elie Saad; Lilja B. Solnes; Steven P. Rowe

doi:10.1097/RLU.0000000000004168

Large Pleural Effusion: A Pitfall in the Quantitation of ^99mTc-PYP Imaging for ATTR Cardiac Amyloidosis

Wajahat Khatri, Michael Polydefkis, Joban Vaishnav, Elie Saad, Lilja B. Solnes, Steven P. Rowe

School of Medicine

Research output: Contribution to journal › Editorial › peer-review

Abstract

Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99mTc-pyrophosphate (99mTc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99mTc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

Original language	English (US)
Pages (from-to)	E594-E595
Journal	Clinical nuclear medicine
Volume	47
Issue number	9
DOIs	https://doi.org/10.1097/RLU.0000000000004168
State	Published - Sep 1 2022

Keywords

ATTR
ATTRv
nuclear cardiology
pyrophosphate

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

Access to Document

10.1097/RLU.0000000000004168

Cite this

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title = "Large Pleural Effusion: A Pitfall in the Quantitation of 99mTc-PYP Imaging for ATTR Cardiac Amyloidosis",

abstract = "Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99mTc-pyrophosphate (99mTc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99mTc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.",

keywords = "ATTR, ATTRv, nuclear cardiology, pyrophosphate",

author = "Wajahat Khatri and Michael Polydefkis and Joban Vaishnav and Elie Saad and Solnes, {Lilja B.} and Rowe, {Steven P.}",

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T1 - Large Pleural Effusion

T2 - A Pitfall in the Quantitation of 99mTc-PYP Imaging for ATTR Cardiac Amyloidosis

AU - Khatri, Wajahat

AU - Polydefkis, Michael

AU - Vaishnav, Joban

AU - Saad, Elie

AU - Solnes, Lilja B.

AU - Rowe, Steven P.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99mTc-pyrophosphate (99mTc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99mTc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

AB - Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99mTc-pyrophosphate (99mTc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99mTc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

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KW - ATTRv

KW - nuclear cardiology

KW - pyrophosphate

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