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Master Thesis

Amylose et accumulation multi-organes du radiotraceur osseux 99mTC-HMDP

Abstract : This work sought to determine whether the non-invasive diagnosis of systemic AL and TTR amyloidosis was possible in 99mTc-HMDP bone scintigraphy, and its clinical implication. Patients referred to Henri Mondor University Hospital between October 2012 and December 2016 for suspicion of amyloidosis were included. They had comprehensive examinations including early 99mTc-HMDP scintigraphy and TEMP / CT images. The endpoint was the accumulation or absence of accumulation of the radiotracer. The patients were divided into MADI subgroups according to the involvement (0: no accumulation, 1: visceral accumulation excluding the myocardium, 2: exclusive myocardial accumulation, 3: myocardial accumulation associated with other sites). 308 patients, including 247 of amyloidosis were included (75 A-TTR, 107 wt-TTR, 65 AL). 61 patients formed a control group. There were 187 myocardial attacks (100% of A-TTR and wt-TTR against 7.7% of AL), and a number of pulmonary and pleural involvement. Other attacks were described in small proportions. MADI 0 allowed to exclude TTR amyloidosis. MADI 1 was directed to AL amyloidosis, and MADI 2 and 3 to TTR amyloidosis. Among the TTRs, the wt-TTR MADI 3 group had the highest mortality (HR 5.68 compared with MADI 2). This difference was not found in the A-TTRs. AL-MADI 2 and 3 had lower survival (HR 2.45 compared to MADI 0-1). The early 99mTc-HMDP scintigraphy allows AL and TTR amyloidosis to be found in systemic accumulations, the distribution of which (MADI classification) provides diagnostic and prognostic guidance.
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Nathan Malka. Amylose et accumulation multi-organes du radiotraceur osseux 99mTC-HMDP. Médecine humaine et pathologie. 2018. ⟨dumas-02486157⟩

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