Ces radiol. 2024, 78(2):120-124 | DOI: 10.55095/CesRadiol2024/016

Rare detection of AL amyloidosis by 99mTc-DPD cardiac scintigraphy in a 73-year-old patient with exertional dyspnea and heart failureOriginal article

Jiří Doležal1, Petr Liška1, Miloš Baše2, Jakub Radocha3, Marie Buncová4, Miloš Kubánek5
1 Oddělení nukleární medicíny LF UK a FN, Hradec Králové
2 Kadiologická ambulance, Rychnov nad Kněžnou
3 IV. interní klinika LF UK a FN, Hradec Králové
4 Pracoviště nukleární medicíny, Institut klinické a experimentální medicíny, Praha
5 Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

Aim: To present an interesting case of detection of ALmyocardial amyloidosis by cardiac scintigraphy with 99mTc-DPD in a73-year-old patient investigated for exertional dyspnea and heart failure.

Method: Cardiac ultrasound revealed left ventricularhypertrophy with decreased left ventricular systolic function. The patientsubsequently underwent coronary angiography with normal coronary findings.Myocardial amyloidosis was suspected and myocardial scintigraphy with 99mTc-butedronate was indicated. The administered activity of 99mmTc-DPD was 700 MBq intravenously. Planar scintigraphy and chestSPECT were performed 3 hours after intravenous administration of theradiopharmaceutical.

Results: Diffusely increased uptake of 99mTc-DPDin the myocardium of the left and right ventricles was observed. The intensityof tracer uptake corresponded to Perugini scale grade 3. The examination wassuggestive of cardiac amyloidosis. To differentiate transthyretin and ALamyloidosis, we performed immunoelectrophoresis of serum and urinary proteinstogether with assessment of free immunoglobulin light chains. The analysisrevealed marked elevation of free lambda chains and detected paraprotein IgGlambda 6,5 g/L, which confirmed an increased level of free immunoglobulinlight chains. An endomyocardial biopsy confirmed the lambda light chaintype ofmyocardial amyloidosis. A biological therapy, with daratumumab in acombination with bortezomib, cyclophosphamide and dexamethasone, was initiated.

Conclusion: Myocardial scintigraphy with 99mTc-DPDis a highly sensitive method for the diagnosis of transthyretin amyloidcardiomyopathy. However, it can be positive in AL amyloidosis andmonoclonal gammopathy must be evaluated in all subjects with cardiacamyloidosis by means of immunoelectrophoresis of serum and urine together withassessment of free immunoglobulin light chains. An abnormal result of theseassays requires a bioptic verification of amyloid.

Keywords: amyloidosis, heart, 99mTc-DPD, scintigraphy

Published: June 1, 2024  Show citation

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Doležal J, Liška P, Baše M, Radocha J, Buncová M, Kubánek M. Rare detection of AL amyloidosis by 99mTc-DPD cardiac scintigraphy in a 73-year-old patient with exertional dyspnea and heart failure. Ces radiol. 2024;78(2):120-124. doi: 10.55095/CesRadiol2024/016.
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