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Imaging features of wild-type transthyretin amyloid cardiomyopathy in gated and non-gated contrast-enhanced CT.

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Title: Imaging features of wild-type transthyretin amyloid cardiomyopathy in gated and non-gated contrast-enhanced CT.
Authors: Yamaguchi, Shinpei1,2 (AUTHOR), Oda, Seitaro1 (AUTHOR) seisei0430@nifty.com, Kidoh, Masafumi1 (AUTHOR), Yoshimura, Fumihiro1 (AUTHOR), Hayashi, Hidetaka1 (AUTHOR), Kuyama, Naoto3 (AUTHOR), Oguni, Tetsuya3 (AUTHOR), Takashio, Seiji3 (AUTHOR), Usuku, Hiroki3 (AUTHOR), Izumiya, Yasuhiro3 (AUTHOR), Nagayama, Yasunori1 (AUTHOR), Nakaura, Takeshi1 (AUTHOR), Aoki, Takatoshi2 (AUTHOR), Tsujita, Kenichi3 (AUTHOR), Hirai, Toshinori1 (AUTHOR)
Source: European Radiology. Nov2025, Vol. 35 Issue 11, p7064-7073. 10p.
Subjects: Cardiac amyloidosis, Cardiac imaging, Diagnosis, Microcirculation disorders, Computed tomography
Abstract: Objective: Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) could be common, but its diagnosis is often overlooked. If the imaging features of ATTR-CM can be identified using conventional computed tomography (CT), which is commonly employed in clinical practice, its diagnostic value would be great. This study aimed to assess the imaging features of the condition in conventional non-gated contrast-enhanced CT. Methods: We retrospectively analyzed 43 consecutive patients diagnosed with wild-type ATTR-CM and performed a semi-quantitative evaluation of myocardial hypo-enhancement in the portal venous phase of conventional contrast-enhanced CT. A myocardial hypo-enhancement score (MHES) was calculated and compared between patients with ATTR-CM and 43 age-, sex-, height-, and weight-matched controls. Correlations between the score and clinical parameters such as the myocardial extracellular volume fraction (ECV) were also assessed. Results: The MHES was significantly higher in the ATTR-CM group than in the control group (p < 0.01). It was also significantly higher in the high-ECV ATTR-CM subgroup (> 55%) than in the low-ECV ATTR-CM (≤ 55%) subgroup and the control group. There was good agreement between myocardial hypo-enhancement and late enhancement (kappa = 0.43), with 90.4% of the hypo-enhanced segments showing late enhancement. The detection sensitivity of late enhancement segments was higher in gated coronary CT angiography than in non-gated portal venous phase CT (69.2% vs 87.1%, p < 0.01). Conclusion: Wild-type ATTR-CM exhibited a tendency for myocardial hypo-enhancement, predominantly in the basal segments on conventional non-gated contrast-enhanced CT, suggesting an association with myocardial microcirculatory dysfunction. Key Points: QuestionCan myocardial hypo-enhancement in non-gated contrast-enhanced CT help diagnose wild-type ATTR-CM, particularly in settings where late iodine enhancement imaging is unavailable? FindingsHypo-enhancement, predominantly in basal segments, was higher in ATTR-CM patients and correlated with ECV and global longitudinal strain, suggesting microcirculatory dysfunction. Clinical relevanceIdentifying myocardial hypo-enhancement in basal segments on conventional non-gated contrast-enhanced CT may provide a valuable diagnostic clue for ATTR-CM, particularly in facilities lacking LIE imaging, allowing for earlier recognition and potential clinical intervention. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Imaging features of wild-type transthyretin amyloid cardiomyopathy in gated and non-gated contrast-enhanced CT.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Yamaguchi%2C+Shinpei%22&quot;&gt;Yamaguchi, Shinpei&lt;/searchLink&gt;&lt;relatesTo&gt;1,2&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Oda%2C+Seitaro%22&quot;&gt;Oda, Seitaro&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;i&gt; seisei0430@nifty.com&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kidoh%2C+Masafumi%22&quot;&gt;Kidoh, Masafumi&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Yoshimura%2C+Fumihiro%22&quot;&gt;Yoshimura, Fumihiro&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hayashi%2C+Hidetaka%22&quot;&gt;Hayashi, Hidetaka&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kuyama%2C+Naoto%22&quot;&gt;Kuyama, Naoto&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Oguni%2C+Tetsuya%22&quot;&gt;Oguni, Tetsuya&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Takashio%2C+Seiji%22&quot;&gt;Takashio, Seiji&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Usuku%2C+Hiroki%22&quot;&gt;Usuku, Hiroki&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Izumiya%2C+Yasuhiro%22&quot;&gt;Izumiya, Yasuhiro&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Nagayama%2C+Yasunori%22&quot;&gt;Nagayama, Yasunori&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Nakaura%2C+Takeshi%22&quot;&gt;Nakaura, Takeshi&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Aoki%2C+Takatoshi%22&quot;&gt;Aoki, Takatoshi&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tsujita%2C+Kenichi%22&quot;&gt;Tsujita, Kenichi&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hirai%2C+Toshinori%22&quot;&gt;Hirai, Toshinori&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. Nov2025, Vol. 35 Issue 11, p7064-7073. 10p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cardiac+amyloidosis%22&quot;&gt;Cardiac amyloidosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cardiac+imaging%22&quot;&gt;Cardiac imaging&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Diagnosis%22&quot;&gt;Diagnosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Microcirculation+disorders%22&quot;&gt;Microcirculation disorders&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Computed+tomography%22&quot;&gt;Computed tomography&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) could be common, but its diagnosis is often overlooked. If the imaging features of ATTR-CM can be identified using conventional computed tomography (CT), which is commonly employed in clinical practice, its diagnostic value would be great. This study aimed to assess the imaging features of the condition in conventional non-gated contrast-enhanced CT. Methods: We retrospectively analyzed 43 consecutive patients diagnosed with wild-type ATTR-CM and performed a semi-quantitative evaluation of myocardial hypo-enhancement in the portal venous phase of conventional contrast-enhanced CT. A myocardial hypo-enhancement score (MHES) was calculated and compared between patients with ATTR-CM and 43 age-, sex-, height-, and weight-matched controls. Correlations between the score and clinical parameters such as the myocardial extracellular volume fraction (ECV) were also assessed. Results: The MHES was significantly higher in the ATTR-CM group than in the control group (p &lt; 0.01). It was also significantly higher in the high-ECV ATTR-CM subgroup (&gt; 55%) than in the low-ECV ATTR-CM (≤ 55%) subgroup and the control group. There was good agreement between myocardial hypo-enhancement and late enhancement (kappa = 0.43), with 90.4% of the hypo-enhanced segments showing late enhancement. The detection sensitivity of late enhancement segments was higher in gated coronary CT angiography than in non-gated portal venous phase CT (69.2% vs 87.1%, p &lt; 0.01). Conclusion: Wild-type ATTR-CM exhibited a tendency for myocardial hypo-enhancement, predominantly in the basal segments on conventional non-gated contrast-enhanced CT, suggesting an association with myocardial microcirculatory dysfunction. Key Points: QuestionCan myocardial hypo-enhancement in non-gated contrast-enhanced CT help diagnose wild-type ATTR-CM, particularly in settings where late iodine enhancement imaging is unavailable? FindingsHypo-enhancement, predominantly in basal segments, was higher in ATTR-CM patients and correlated with ECV and global longitudinal strain, suggesting microcirculatory dysfunction. Clinical relevanceIdentifying myocardial hypo-enhancement in basal segments on conventional non-gated contrast-enhanced CT may provide a valuable diagnostic clue for ATTR-CM, particularly in facilities lacking LIE imaging, allowing for earlier recognition and potential clinical intervention. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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