DOI: 10.1007/s00259-018-4013-4Pages: 1945-1955

Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis

1. Oncology Institute of Southern Switzerland, Clinic of Nuclear Medicine and PET/CT Center

2. Ente Ospedaliero Cantonale, Health Technology Assessment Unit

3. Ente Ospedaliero Cantonale, Clinical Trial Unit

4. Lausanne University Hospital, Department of Nuclear Medicine and Molecular Imaging

5. University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging

6. Spedali Civili of Brescia and University of Brescia, Department of Nuclear Medicine

7. University of Groningen, University Medical Center Groningen, Department of Rheumatology & Clinical Immunology

8. University of Pisa, Department of Nuclear Medicine

9. University of Twente, Department of Biomedical Photonic Imaging

Correspondence to:
Giorgio Treglia
Tel: +41 918118919




Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR.


A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) “amyloid” OR “amyloidosis” AND (b) “TTR” OR “ATTR” OR “transthyretin” AND (c) “scintigraphy” OR “scan” OR “SPECT” OR “SPET” OR “bone” OR “skeletal” OR “skeleton” OR “PYP” OR “DPD” OR “HMDP” OR “MDP” OR “HDP”. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated.


The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89–95%), specificity 95.4% (95% CI 77–99%), LR+ 7.02 (95% CI 3.42–14.4), LR− 0.09 (95% CI 0.06–0.14), and DOR 81.6 (95% CI 44–153). Mild heterogeneity was found among the selected studies.


Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.

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  • Accepted: Apr 6, 2018
  • Online: Apr 23, 2018

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