Evidence map›Paper›PMID 42909580›Full record

ArticleEuropean journal of nuclear medicine and molecular imaging2026

The role of extracardiac radiotracer biodistribution in the evaluation of cardiac amyloidosis: a retrospective multicenter study on [99mTc]Tc-DPD and [99mTc]Tc-HMDP.

Andrea Di Giorgio, Giacomo Battisti, Norma Bonazzi, Sonia Elisa Prisco, Maria Starace, Simone Longhi, Stefano Fanti, Valentina Berti, Francesco Cappelli, Rachele Bonfiglioli

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Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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10 authors.

Andrea Di GiorgioNuclear medicine, Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy. andrea.digiorgio2@studio.unibo.it.ORCID http://orcid.org/0009-0006-3973-4409
Giacomo BattistiDepartment of Nuclear Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Norma BonazziDepartment of Nuclear Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Sonia Elisa PriscoNuclear Medicine Unit, Hospital Care Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
Maria StaraceNuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Simone LonghiCardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Stefano FantiNuclear medicine, Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy.
Valentina BertiNuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Francesco CappelliTuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
Rachele BonfiglioliNuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBone scintigraphy using [99mTc]Tc-DPD or [99mTc]Tc-HMDP is a non-invasive cornerstone for diagnosing transthyretin cardiac amyloidosis (ATTR-CA). However, their interchangeability and the clinical relevance of systemic extracardiac uptake (ExtCU) remain poorly defined.

aimTo systematically compare the diagnostic performance and whole-body biodistribution profiles of [99mTc]Tc-DPD and [99mTc]Tc-HMDP in patients with suspected cardiac amyloidosis (CA).

methodsWe retrospectively evaluated a multicenter cohort of patients investigated for suspected CA who underwent late planar whole-body scintigraphy and targeted SPECT/CT with either radiotracer as part of their diagnostic workup. Inclusion required a final, confirmed diagnosis of ATTRwt, ATTRv, or AL amyloidosis. Myocardial visual Perugini score (VISUAL_PS) and systemic ExtCU (pulmonary, appendicular muscular, visceral, and miscellaneous) were recorded.

resultsThe study included 224 patients (DPD: n = 109, comprising 70 ATTRwt, 20 ATTRv, 19 AL; HMDP: n = 115, comprising 90 ATTRwt, 13 ATTRv, 12 AL). In ATTRwt, the DPD cohort presented predominantly with Perugini Grade 2 (76%), whereas the HMDP cohort skewed toward Grade 3 (72%, p < 0.001). DPD was significantly associated with appendicular muscular uptake (ATTRwt: 84% vs. 38%, p < 0.001), creating a competitive "soft-tissue sink effect". Conversely, HMDP demonstrated a unique predilection for pulmonary retention (ATTRwt: 68% vs. 46%, p = 0.008; ATTRv: 61% vs. 10%, p = 0.006). Visceral uptake was rare in ATTR but was a robust negative predictor strongly favoring AL amyloidosis (OR 0.016, p < 0.001).

conclusions[99mTc]Tc-DPD and [99mTc]Tc-HMDP possess distinct biodistribution profiles precluding direct interchangeability. HMDP maximizes myocardial contrast, whereas DPD provides a superior representation of the systemic musculoskeletal amyloid burden. Nuclear medicine physicians must adopt tracer-specific interpretive approaches to optimize non-invasive phenotyping.

trial registrationnot applicable.

Indexed as

Bone ScintigraphyCardiac AmyloidosisExtracardiac UptakePerugini ScoreRadiotracers Distribution

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.