Key result
CMR shows ~91% sensitivity for cardiac amyloidosis, while bone scintigraphy provides top specificity for ATTR.
Why the study?
Non-invasive imaging modalities have transformed the diagnosis of cardiac amyloidosis, which is often underdiagnosed until advanced stages, but their relative diagnostic accuracy across amyloid subtypes and disease stages remains unclear.
Does cardiovascular magnetic resonance, bone scintigraphy, PET, echocardiography, or CT improve diagnostic accuracy for cardiac amyloidosis compared to histology or validated non-biopsy criteria in patients with suspected cardiac amyloidosis?
Meta-Analysis (n=5,987)
Does cardiovascular magnetic resonance, bone scintigraphy, PET, echocardiography, or CT improve diagnostic accuracy for cardiac amyloidosis compared to histology or validated non-biopsy criteria in patients with suspected cardiac amyloidosis?
This meta-analysis demonstrates that CMR offers the highest sensitivity for detecting cardiac amyloidosis (especially AL and early disease) while bone scintigraphy provides the highest specificity for ATTR, supporting a tiered multimodal imaging diagnostic strategy.
Supports tiered CMR and bone scintigraphy use in suspected amyloidosis; extends comparative data to refine multimodal diagnostic algorithms.
Background Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy that is underdiagnosed until advanced stages. Non-invasive imaging modalities, including echocardiography, cardiovascular magnetic resonance (CMR), bone scintigraphy, positron emission tomography (PET), and computed tomography (CT), have transformed diagnosis, but their relative accuracy remains unclear. Objectives To compare the diagnostic performance of major cardiac imaging modalities for CA, stratified by amyloid subtype and disease stage. Methods Systematic review and meta-analysis per PRISMA-DTA guidelines. PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus were searched through April 30, 2025. Studies evaluating echocardiography, CMR, bone scintigraphy (99mTc-PYP/DPD/HMDP), PET, or CT against histology or validated non-biopsy criteria were included. Bivariate random-effects models estimated pooled sensitivity and specificity; HSROC curves were generated. Results Fifty-one studies (n=5,987) included; 64% ATTR, 28% AL. CMR had the highest sensitivity (0.91 [0.86–0.94]), while scintigraphy had the highest specificity for ATTR (0.97 [0.95–0.99]). PET (0.88/0.85), echocardiography (0.81/0.83), and CT (0.82/0.85) were intermediate. Comparative ranking: CMR > Scintigraphy > PET > Echocardiography > CT. Subgroup analyses: scintigraphy best for ATTR, CMR best for AL, and early disease. Conclusions CMR provides superior sensitivity; scintigraphy is most specific for ATTR. PET and CT are promising adjuncts. A tiered multimodal imaging approach optimizes diagnosis and early detection.
No takes yet. Share an insight, caveat, or question.
Singhal et al. (2026) conducted a meta-analysis in Cardiac amyloidosis (n=5,987). Non-invasive cardiac imaging (CMR, bone scintigraphy, PET, echocardiography, CT) vs. Histology or validated non-biopsy criteria was evaluated on Pooled sensitivity and specificity for diagnosing cardiac amyloidosis (CMR sensitivity 0.91; Scintigraphy specificity for ATTR 0.97, 95% CI 0.86-0.94 (CMR sensitivity); 0.95-0.99 (Scintigraphy specificity)). Cardiovascular magnetic resonance had the highest sensitivity (0.91 [0.86-0.94]) for cardiac amyloidosis, while bone scintigraphy had the highest specificity for ATTR (0.97 [0.95-0.99]).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: