title: National patterns in imaging utilization for diagnosis of cardiac amyloidosis: A focus on Tc99m-pyrophosphate scintigraphy.
abstract: Tc99m-pyrophosphate (Tc99m-PYP) scintigraphy has emerged as a diagnostic modality for transthyretin (TTR) cardiac amyloidosis (CA). We sought to examine the variability in test utilization across multiple centers in the US.
  
  
  
  An electronic, web-based survey addressing specifics on Tc-99m PYP imaging was emailed to ASNC members, totaling 2785 recipients. Only one response per institution was allowed.
  
  
  
  Responses were collected from 101 centers between July 2 and July 27, 2015. Among the respondents, 24% performed Tc-99m PYP specifically for CA diagnosis. The most commonly used dose was 20 mCi (37%) and most centers (35%) imaged 1 hour after injection. Scans were most often interpreted by cardiologists (60%). Quantification of uptake was performed in 57% of institutions with almost half (43%) utilizing the heart-to-contralateral lung (H/CL) ratio.
  
  
  
  This national survey shows relatively low penetrance and high variability in Tc99m-PYP scintigraphy for CA diagnosis highlighting the need for standardization.
authors.affiliation: Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Serge C
authors.initials: SC
authors.lastname: Harb
authors.affiliation: Department of Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Haq
authors.affiliation: American Society of Nuclear Cardiology, Bethesda, MD, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Flood
authors.affiliation: American Society of Nuclear Cardiology, Bethesda, MD, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Guerrieri
authors.affiliation: American Society of Nuclear Cardiology, Bethesda, MD, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Passerell
authors.affiliation: Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA. jaberw@ccf.org.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Miller
mesh_terms: D028227:Amyloid Neuropathies, Familial / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D019275:Radiopharmaceuticals; D016698:Technetium Tc 99m Pyrophosphate; D014481:United States / Q000453:epidemiology; D014600:Utilization Review
chemical_list: D019275:Radiopharmaceuticals; D016698:Technetium Tc 99m Pyrophosphate
keywords: National survey; Tc99m-pyrophosphate; cardiac amyloidosis