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Mattana et al. Vessel Plus 2022;6:13 Vessel Plus
DOI: 10.20517/2574-1209.2021.87

Review Open Access

Clinical application of cardiac scintigraphy with

bone tracers: controversies and pitfalls in cardiac
amyloidosis

1
2
1
2
3
Francesco Mattana , Lorenzo Muraglia , Francesca Girardi , Ivan Cerio , Aldostefano Porcari , Franca
2
1
Dore , Rachele Bonfiglioli , Stefano Fanti 1
1
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Metropolitan Nuclear Medicine, Bologna 40138, Italy.
2
Unit of Nuclear Medicine, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI,
University of Trieste, Trieste 34149, Italy.
3
Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria
Giuliano-Isontina (ASUGI), University of Trieste, Trieste 34149, Italy.
Correspondence to: Dr. Francesco Mattana, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Metropolitan Nuclear
Medicine, via Albertoni 15, Bologna 40138, Italy. E-mail: francesco.mattana22@gmail.com
How to cite this article: Mattana F, Muraglia L, Girardi F, Cerio I, Porcari A, Dore F, Bonfiglioli R, Fanti S. Clinical application of
cardiac scintigraphy with bone tracers: controversies and pitfalls in cardiac amyloidosis. Vessel Plus 2022;6:13.
https://dx.doi.org/10.20517/2574-1209.2021.87
Received: 15 Jun 2021 First Decision: 15 Jul 2021 Revised: 28 Jul 2021 Accepted: 17 Aug 2021 Published: 5 Mar 2022
Academic Editors: Gianfranco Sinagra, Ugolino Livi, Alexander D. Verin Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun
Chen

Abstract
Cardiac amyloidosis (CA) is a life-threatening disease caused by extracellular deposition of amyloidogenic proteins
in the heart tissue; it could be associated with a poor prognosis and remains underdiagnosed and underestimated.
During the last years, bone scintigraphy has been widely used to facilitate the diagnosis of CA, avoid
endomyocardial biopsy, and differentiate amyloid light-chain amyloidosis from transthyretin amyloidosis.
Technetium-99m pyrophosphate ( 99m Tc-PYP) is the most used tracer in the United States, but a standardized and
shared acquisition protocol is still lacking; technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid ( 99m Tc-
DPD) is widely used in Europe and can count on a more grounded data than 99m Tc-PYP. Both tracers suffer from
some diagnostic limitations (due to their biochemical characteristics) and pitfalls that can lead to a misdiagnosis of
CA. We aim to briefly describe the main differences between 99m Tc-PYP and 99m Tc-DPD, analyzing the data
available in the literature and highlighting the most frequent causes of misdiagnosis and pitfalls. Both 99m Tc-DPD
and 99m Tc-PYP show good accuracy for the diagnosis of CA with high specificity and sensibility. Nevertheless, to
achieve this accuracy, the correct acquisition protocols must be followed for each tracer, as suggested in the latest
recommendation. Proper diagnosis of CA has a crucial role in patient management; therefore, it is important for

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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