{
  "abstract": "Background: Bone scintigraphy using [99mTc]Tc-DPD or [99mTc]Tc-HMDP is a non-invasive cornerstone for diagnosing transthyretin cardiac amyloidosis (ATTR-CA). However, their interchangeability and the clinical relevance of systemic extracardiac uptake (ExtCU) remain poorly defined.\n\nAim: To systematically compare the diagnostic performance and whole-body biodistribution profiles of [99mTc]Tc-DPD and [99mTc]Tc-HMDP in patients with suspected cardiac amyloidosis (CA).\n\nMethods: We retrospectively evaluated a multicenter cohort of patients investigated for suspected CA who underwent late planar whole-body scintigraphy and targeted SPECT/CT with either radiotracer as part of their diagnostic workup. Inclusion required a final, confirmed diagnosis of ATTRwt, ATTRv, or AL amyloidosis. Myocardial visual Perugini score (VISUAL_PS) and systemic ExtCU (pulmonary, appendicular muscular, visceral, and miscellaneous) were recorded.\n\nResults: The study included 224 patients (DPD: n = 109, comprising 70 ATTRwt, 20 ATTRv, 19 AL; HMDP: n = 115, comprising 90 ATTRwt, 13 ATTRv, 12 AL). In ATTRwt, the DPD cohort presented predominantly with Perugini Grade 2 (76%), whereas the HMDP cohort skewed toward Grade 3 (72%, p < 0.001). DPD was significantly associated with appendicular muscular uptake (ATTRwt: 84% vs. 38%, p < 0.001), creating a competitive “soft-tissue sink effect”. Conversely, HMDP demonstrated a unique predilection for pulmonary retention (ATTRwt: 68% vs. 46%, p = 0.008; ATTRv: 61% vs. 10%, p = 0.006). Visceral uptake was rare in ATTR but was a robust negative predictor strongly favoring AL amyloidosis (OR 0.016, p < 0.001).\n\nConclusions: [99mTc]Tc-DPD and [99mTc]Tc-HMDP possess distinct biodistribution profiles precluding direct interchangeability. HMDP maximizes myocardial contrast, whereas DPD provides a superior representation of the systemic musculoskeletal amyloid burden. Nuclear medicine physicians must adopt tracer-specific interpretive approaches to optimize non-invasive phenotyping.\n\nTrial registration: not applicable.",
  "abstract_shown": true,
  "affiliations": [
    "Nuclear medicine, Alma Mater Studiorum University of Bologna, Bologna, 40138 Italy",
    "Department of Nuclear Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy",
    "Nuclear Medicine Unit, Hospital Care Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy",
    "Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy",
    "Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy",
    "Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy",
    "Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Andrea Di Giorgio",
      "orcid": "0009-0006-3973-4409"
    },
    {
      "affs": [
        1
      ],
      "name": "Giacomo Battisti"
    },
    {
      "affs": [
        1
      ],
      "name": "Norma Bonazzi"
    },
    {
      "affs": [
        2
      ],
      "name": "Sonia Elisa Prisco"
    },
    {
      "affs": [
        3
      ],
      "name": "Maria Starace"
    },
    {
      "affs": [
        4
      ],
      "name": "Simone Longhi"
    },
    {
      "affs": [
        0,
        5
      ],
      "name": "Stefano Fanti"
    },
    {
      "affs": [
        3
      ],
      "name": "Valentina Berti"
    },
    {
      "affs": [
        6
      ],
      "name": "Francesco Cappelli"
    },
    {
      "affs": [
        5
      ],
      "name": "Rachele Bonfiglioli"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fxkc5qn0w2skr.bib",
  "cited_by": 0,
  "doi": "10.1007/s00259-026-08153-1",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13727854/",
  "id": "fxkc5qn0w2skr",
  "issns": [
    "1619-7070",
    "1619-7089"
  ],
  "landing_url": "https://doi.org/10.1007/s00259-026-08153-1",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "1312|Amyloidosis: Diagnosis, Treatment, Outcomes"
    ]
  ],
  "openalex": "W7223350937",
  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s00259-026-08153-1.pdf",
  "pmcid": "PMC13727854",
  "pmid": "42909580",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fxkc5qn0w2skr.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:23:39Z",
      "native_id": "PMC13727854",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s00259-026-08153-1"
    }
  ],
  "subjects": [
    {
      "field": "biochemistry",
      "origin": "openalex:1312|Amyloidosis: Diagnosis, Treatment, Outcomes",
      "subfield": "molecular-biology"
    }
  ],
  "title": "The role of extracardiac radiotracer biodistribution in the evaluation of cardiac amyloidosis: a retrospective multicenter study on [99mTc]Tc-DPD and [99mTc]Tc-HMDP",
  "title_text": "The role of extracardiac radiotracer biodistribution in the evaluation of cardiac amyloidosis: a retrospective multicenter study on [99mTc]Tc-DPD and [99mTc]Tc-HMDP",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:58Z",
  "url": "https://research.draconitic.com/paper/fxkc5qn0w2skr",
  "venue": "European Journal of Nuclear Medicine and Molecular Imaging",
  "versions": []
}