Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis

Zhaoye Wu,Chunjing Yu

doi:10.1186/s12872-021-02292-z

Abstract

BackgroundNoninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA). The purpose of this study is to directly compare CMR, SPECT, and PET scans in the diagnosis of CA, and to provide evidence for further scientific research and clinical decision-making.MethodsPubMed, Embase, and Cochrane Library were searched. Studies used CMR, SPECT and/or PET for the diagnosis of CA were included. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), their respective 95% confidence intervals (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated. Quality assessment of included studies was conducted.ResultsA total of 31 articles were identified for inclusion in this meta-analysis. The pooled sensitivities of CMR, SPECT and PET were 0.84, 0.98 and 0.78, respectively. Their respective overall specificities were 0.87, 0.92 and 0.95. Subgroup analysis demonstrated that 99mTc-HMDP manifested the highest sensitivity (0.99). 99mTc-PYP had the highest specificity (0.95). The AUC values of 99mTc-DPD, 99mTc-PYP, 99mTc-HMDP were 0.89, 0.99, and 0.99, respectively. PET scan with 11C-PIB demonstrated a pooled sensitivity of 0.91 and specificity of 0.97 with an AUC value of 0.98.ConclusionOur meta-analysis reveals that SEPCT scans present better diagnostic performance for the identification of CA as compared with other two modalities.

Highlights

Noninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA)
Cardiac amyloidosis (CA) is a myocardial disease characterized by abnormal extracellular deposition of amyloid fibrils, which gives rise to a progressive structural and functional damage to the cardiac tissue [1, 2]
Study selection and characteristics A total of 367 articles were identified from the databases searched

Summary

Introduction

Noninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA). The purpose of this study is to directly compare CMR, SPECT, and PET scans in the diagnosis of CA, and to provide evidence for further scientific research and clinical decision-making. The diagnostic approaches of cardiac amyloidosis include clinical symptoms, laboratory tests, non-invasive imaging, and histopathological diagnosis [6]. This disease is commonly asymptomatic over a period of time from the beginning and the symptoms are usually nonspecific, and its diagnosis is often delayed [2]. Endomyocardial biopsy is an invasive modality which can lead to unwanted complications. Echocardiography is widely employed for the diagnosis of CA in patients

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