Table 3.
Comparisons of benefits and limitations between transthoracic echocardiography, cardiac magnetic resonance, and bone scintigraphy
| TTE | Bone scintigraphy | CMR | |
|---|---|---|---|
| Costa | $ | $$$$ | $$$$$$$$ |
| Accessibility | Widely available | Centres with gamma camera access. | Tertiary cardiac centres. |
| Cannulation | Not routinely required, required for contrast echocardiography. | Required for radioactive tracers. | Required for gadolinium-based contrast agents. |
| Biological damage | No | Yes | No |
| Duration | 20 min | Scan duration of 30 min performed 2–4 h post tracer injection. | 45–60 min |
| Advantages | Safe in pregnancy | Not operator-dependent Unaffected by body habitus. Discriminate between ATTR and AL amyloidosis.b Detect cardiac involvement in early disease stages. |
Can distinguish ATTR-CA from other heart muscle diseases. Full tissue characterization. Potential use to monitor disease evolution and treatment response. |
| Limitations | Tissue characterization not available Image quality affected by operator and body habitus |
Not safe in pregnancy or breastfeeding. Time-consuming. Exposure to ionizing radiation. |
Time-consuming. Injection of contrast agents not feasible in renal impairment. Suboptimal image quality in arrhythmias and poor breathing). |
AL; light chain; ATTR-CA; transthyretin cardiac amyloidosis; CMR; cardiac magnetic resonance; TTE; transthoracic echocardiography.
Costs estimates are taken from NHS tariffs (2020/21) and may differ in different countries.
In combination with search for monoclonal proteins in serum and urine.