心アミロイドーシス 実践ポイント - jsnc.org

1 99 - ASNC 1 ASNC 99m - L AL TTR ATTR TTR 70 60 80 4 1 TTR 1 3 4 TTR Val122 Ile 1 2 MRI CMR ECV T1 99mTc- [99m Tc-3,3-diphosphono-1,2-propanodicarboxyl ic acid DPD 3,3- -1,2- PYP 2,3 ]

2 ATTR ATTR AL DPD PYP 4 99mTc-PYP CMR ATTR 5 ATTR 99m - 99mTc-PYP Copyright 2019 American Society of Nuclear Cardiology 2 ASNC 12 mm 60 ASNC 60 / CMR ATTR ATTR CMR 5 99 Tc-PYP 5 30 1 20mg 4mg ASNC 10 ml mg mg mg - 99mTc-PYP 99mTc-PYP 15 mCi 99mTc-PYP mSv 99 Tc-DPD 99mTc-DPD 99mTc-PYP 2 ASNC 3 99mTc-PYP 1 99mTc-PYP 1 1 SPECT 1 3 SPECT 1.

3 2. 3 3. 99mTc-PYP 4. 99mTc-PYP 5. 99mTc-PYP ATTR 6 SPECT 99mTc-PYP 99mTc-PYP 4 ASNC 1. 99mTc-PYP 99mTc-PYP 10 20 mCi 370-740 MBq 1 SPECT 3 SPECT SPECT 140 keV 15 20 256 256 64 64 SPECT 128 128 64 64 mm * 90 750.

4 000 SPECT 180 360 90 180 / 40 20 *90 SPECT ASNC 5 SPECT 99mTc-PYP SPECT 1 / H/CL ATTR ATTR 4 99mTc-PYP 2 1. 1 ROI 1 ROI / H/CL ROI ROI SPECT 1 H/CL ATTR ATTR 4 2. 3 99mTc-PYP 2 2 3 2 3 SPECT 6 2 ATTR 2 ATTR 2 3 H/CL ATTR 99mTc-PYP AL AL H/CL 6 ASNC 2.

5 99mTc-PYP 99mTc-PYP 0 1 2 3 1. / H/CL 99m Tc-PYP 2. SPECT 99mTc-PYP ATTR H/CL = ASNC 7 ASNC 3. 99mTc - PYP SPECT / SPECT/CT CT 1. 1 ATTR 2 ATTR 3) ATTR a. 0 H/CL 1 b. 2 3 H/CL c.

6 1 H/CL 1 2. a. CMR 99mTc-PYP b. 99mTc-PYP L c. AL ATTR 8 ASNC ASNC SPECT CPT78803 SPECT CPT 78803 SPECT HCPCS II A9538 99mTc 1 25 SPECT CPT 78800 (1) Ruberg FL, Berk JL. Transthyretin (TTR) cardiac amyloidosis. Circulation 2012;126:1286-300. (2) Perugini E, Guidalotti PL, Salvi F, Cooke RM, Pettinato C, Riva L et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2- propanodicarboxylic acid scintigraphy.

7 J Am Coll Cardiol 2005;46:1076-84. (3) Gertz MA, Brown ML, Hauser MF, Kyle RA. Utility of technetium Tc 99m pyrophosphate bone scanning in cardiac amyloidosis. Arch Intern Med 1987;147:1039-44. (4) Bokhari S, Castano A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. (99m)Tc- pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging 2013;6:195-201. (5) Falk RH, Quarta CC, Dorbala S. How to image cardiac amyloidosis. Circ Cardiovasc Imaging 2014;7:552-62. (6) Hutt DF, Quigley AM, Page J, Hall ML, Burniston M, Gopaul D et al. Utility and limitations of 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in systemic amyloidosis. Eur Heart J Cardiovasc Imaging 2014;15:1289-98. Copyright 2019 American Society of Nuclear Cardiology ASNC 9 ASNC Sharmila Dorbala, MD, MPH (Chair) Sabahat Bokhari, MD Edward Miller, MD, PhD Renee Bullock-Palmer, MD Prem Soman, MD, PhD Randall Thompson, MD Rodney Falk, MD Martha Grogan, MD Matthew Maurer, MD Frederick Ruberg, MD Takashi Kudo, MD, PhD Kenichi Nakajima, MD, PhD 2016 2 2019 2 ASNC