Diagnostic Performance and Interpreter Experience of 1-Hour Versus 3-Hour 99m Tc-HMDP Cardiac Amyloid Radionuclide Imaging: A Prospective, Blinded Comparison

作者：Gregorio Tersalvi, Patricia Carey, Armin Garmany, Christopher G. Scott, Jun Zhang, Francisco J. Maldonado, Leandi Krüger, Carrie B. Hruska, Geoffrey B. Johnson, Hayan Jouni, Martin Rodriguez‐Porcel, J. Wells Askew, John P. Bois, Kathleen A. Young, Nandan S. Anavekar, Martha Grogan, Angela Dispenzieri, Panithaya Chareonthaitawee, Andrew Homb, Omar F. AbouEzzeddine · 发表于：Circulation Cardiovascular Imaging · 年份：2025 · DOI：10.1161/circimaging.125.018745 · 被引用次数：3 · 研究领域：Amyloidosis: Diagnosis, Treatment, Outcomes、Cardiac Imaging and Diagnostics、Takotsubo Cardiomyopathy and Associated Phenomena

BACKGROUND: Guidelines recommend 3-hour cardiac amyloid radionuclide imaging (CARI) for transthyretin amyloid cardiomyopathy. Citing rapid blood clearance of 99m Tc-hydroxymethylene-diphosphonate (HMDP) and efficient laboratory throughput, 1-hour imaging is increasingly practiced despite limited supporting evidence. We sought to compare diagnostic performance and interpreter experience of 1-hour versus 3-hour HMDP-CARI. METHODS: Consecutive patients with suspected transthyretin amyloid cardiomyopathy (n=114) underwent both 1-hour and 3-hour HMDP single photon emission computed tomography (CT)/CT. Two cardiologist-radiologist reader teams, blinded to imaging timepoint (1 versus 3 hours), assessed overall interpretation, single photon emission CT–based Perugini grade, interpretation difficulty, interpreter confidence, and need for CT-fused images for anatomic localization. Discordant, equivocal, and difficult cases were arbitrated by a third tie-breaking team. The myocardial-to-blood-pool radiotracer uptake ratio (3-dimensional Score) was measured as a surrogate of contrast resolution. RESULTS: Interinterpreter agreement was high at both time points (κ≥0.81), with more cases requiring arbitration at 3 hours versus 1 hour (22% versus 13%; P =0.049). Overall interpretation and Perugini grades were concordant between time points in 111/114 (97%) and 106/114 (93%) patients, respectively. Three patients (3%) were negative at 1 hour but equivocal at 3 hours, all of which were clinica...