Diagnostic and Interventional Radiology
Nuclear Medicine and Molecular Imaging - Review

Performance of bone tracer for the diagnosing and distinguishing of transthyretin cardiac amyloidosis: a systematic review and meta-analysis


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


Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China


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

Diagn Interv Radiol 2020; 1: -
Read: 41 Published: 04 December 2020

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

METHODS: We retrieved PubMed, the Cochrane Library, ScienceDirect, and DOAJ database, date up to 10 July 2020, for researches assessing the performance of bone tracer in diagnosing and differentiating TTR-CA. 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 for the systematic review, and 9 for 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 PLR and NLR were 11.49 (95% CI 5.07-26.0) and 0.03 (95% CI 0.01-0.18), respectively. The DOR was 341 (95% CI 53-2194), and the AUC was 0.96 (95% CI 0.94-0.97).

CONCLUSION: The findings evidence that the bone radiotracer provides high accuracy of diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from AL-CA, which is a valuable noninvasive approach. 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 distinguish TTR-CA.

EISSN 1305-3612