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Tc-99m HMDP bone scintigraphy for cardiac amyloidosis diagnosis: A false positive case

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Abstract

A 68-year-old man with heart failure (left ventricular ejection fraction = 30%) and normal coronary angiography underwent bone scintigraphy for suspected transthyretin-related cardiac amyloidosis (CA).1 He received 532 MBq (14.3 mCi) Tc-99m hydroxy-methyl-diphosphonate (HMDP) and data were acquired 2 hours after injection. On anterior and posterior whole-body scans (Figure 1 A and B), diffuse cardiac, hepatic, and soft-tissue uptake of the radiotracer was seen, in association with low skeletal uptake. It was established that the patient had recently been hospitalized for heart failure exacerbation and had received an intravenous iron injection, which is a recommended treatment for heart failure.2 In consultation with our hospital’s cardiology team, it was decided to repeat the bone scan at a time when the patient had received no recent iron infusion. Two months after the first bone scan, the patient received 556 MBq (15 mCi) of 99m-Tc HMDP, and no cardiac, hepatic, or soft-tissue uptake was detected (Figure 1C and D).

Introduction

Transthyretin-related cardiac amyloidosis is a common and probably underestimated cause of heart failure in the elderly population.

Tc-99m hydroxy-methyl-diphosphonate scintigraphy is one of the exams that can help clinicians to make the diagnosis.

There is no cause of false positive heart uptake described in the literature.

Section snippets

Case presentation

A 68-year-old man with heart failure (left ventricular ejection fraction = 30%) and normal coronary angiography underwent bone scintigraphy for suspected transthyretin-related cardiac amyloidosis (CA).1 He received 532 MBq (14.3 mCi) Tc-99m hydroxy-methyl-diphosphonate (HMDP) and data were acquired 2 hours after injection. On anterior and posterior whole-body scans (Figure 1A and B), diffuse cardiac, hepatic, and soft-tissue uptake of the radiotracer was seen, in association with low skeletal

Disclosures

Guillaume Lades, Helene Carpenet, Victor Aboyans, and Jacques Monteil have nothing to disclose.

Funding

None declared.

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