Diagnostic and Interventional Radiology
Nuclear Medicine and Molecular Imaging - Review

Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis

1.

Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China

2.

Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China

3.

Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, China

Diagn Interv Radiol 2021; 27: 802-810
DOI: 10.5152/dir.2021.20662
Read: 607 Downloads: 73 Published: 04 November 2021

PURPOSE : Bone tracers have been validated for many years in detecting transthyretin  cardiac amyloidosis (TTR-CA). However, several new studies suggest conflicting results. Our study aimed to systematically evaluate the accuracy of bone radiotracers for diagnosis and differentiation of TTR-CA via a systematic review and meta-analysis.

METHODS: We retrieved articles assessing the performance of bone tracer in diagnosing and differentiating TTR-CA from PubMed, the Cochrane Library, ScienceDirect, and DOAJ databases, dating up to 10 July 2020. The meta-analysis was conducted through Stata 16 software, and the risk of bias for the included studies was assessed by the QUADAS-2 tool. Moreover, we made a comprehensive review. 

RESULTS: Fourteen articles were included in the systematic review, and 9 in the meta-analysis. The pooled sensitivity was 0.97 (95% confidence interval [95% CI] 0.85–0.99) with heterogeneity (I2=73.5, 95% CI 55.6–91.2), and the specificity was 0.92 (95% CI 0.82–0.96) with heterogeneity (I2=42.0, 95% CI 0.0–86.9). The pooled positive and negative likelihood ratios were 11.49 (95% CI 5.07–26.0) and 0.03 (95% CI 0.01–0.18), respectively. The diagnostic odds ratio was 341 (95% CI 53–2194), and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.94–0.97). 

CONCLUSION: The findings evidence that the bone radiotracer is a valuable noninvasive approach that provides high accuracy for diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from immunoglobulin amyloid light-chain cardiac amyloidosis. 99mTc-HMDP may be more accurate than 99mTc-PYP, 99mTc-DPD, and 18F-NaF in the TTR-CA detecting process, and 18F-NaF is a promising bone tracer to diagnose and differentiate TTR-CA.

You may cite this article as: Zhao H, Hu H, Cui W. Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis. Diagn Interv Radiol 2021; 27:802–810.

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