Key result
SPECT outperforms CMR and PET for detecting cardiac amyloidosis with ~98% sensitivity.
Why the study?
Noninvasive imaging modalities (CMR, SPECT, PET) are extensively used to detect cardiac amyloidosis, but a direct comparison of their diagnostic performance was needed to inform clinical decisions.
Does SPECT imaging provide better diagnostic performance than CMR and PET for the detection of cardiac amyloidosis?
Meta-Analysis (n=2,585)
Does SPECT imaging provide better diagnostic performance than CMR and PET for the detection of cardiac amyloidosis?
SPECT scans present better diagnostic performance for the identification of cardiac amyloidosis compared to CMR and PET, with 99m Tc-HMDP showing the highest sensitivity.
Supports SPECT as preferred imaging for cardiac amyloidosis detection; confirms superior pooled accuracy versus CMR and PET.
Background 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. Methods PubMed, 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. Results A 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 99m Tc-HMDP manifested the highest sensitivity (0.99). 99m Tc-PYP had the highest specificity (0.95). The AUC values of 99m Tc-DPD, 99m Tc-PYP, 99m Tc-HMDP were 0.89, 0.99, and 0.99, respectively. PET scan with 11 C-PIB demonstrated a pooled sensitivity of 0.91 and specificity of 0.97 with an AUC value of 0.98. Conclusion Our meta-analysis reveals that SEPCT scans present better diagnostic performance for the identification of CA as compared with other two modalities.
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Wu et al. (2021) conducted a meta-analysis in Cardiac amyloidosis (n=2,585). SPECT imaging vs. CMR and PET imaging was evaluated on Pooled sensitivity for the detection of cardiac amyloidosis (95% CI 0.94-0.99). SPECT scans demonstrated the highest diagnostic performance for identifying cardiac amyloidosis, with a pooled sensitivity of 0.98 and specificity of 0.92, compared to CMR and PET imaging.
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