Pearls & Pitfalls: Nuclear Scintigraphy & Other Advanced Imaging Tools

This webinar follows the diagnostic pathway for cardiac amyloidosis beyond the initial echocardiogram, using patient cases to illustrate how the workup diverges once amyloidosis is suspected. In order to detect cardiac amyloidosis at an early stage, imagers need to not only recognize flags of suspicion but to also take appropriate diagnostic pathways for a given patient’s findings. This session will help attendees apply cardiac amyloid radionuclide scintigraphy appropriately, know when cardiac MRI adds diagnostic value, and recognize the light-chain findings that should prompt biopsy.

Using real-world cases, we will:

• Follow next steps from echocardiographic findings suspicious for cardiac amyloidosis through to confirmatory cardiac amyloid radionuclide imaging (CARI), with emphasis on grading criteria, interpretation pitfalls, and situations where a “positive” CARI scan is not sufficient to close the diagnostic loop.
• Examine imaging options when diagnostic picture is discordant or incomplete on echo and CARI alone, and explore the added value of cardiac MRI in clarifying diagnosis and characterizing disease burden, including late gadolinium enhancement and native T1/ECV mapping.
• Walk through approach when have abnormal serum free light chains, illustrating why AL amyloidosis must be excluded before relying on PYP, and how this finding redirects the workup toward hematology referral and endomyocardial biopsy.

Faculty:

• Sarah Cuddy, MD (Chair)
• Jeremy Slivnick, MD, FASE
• Vasvi Singh, MD, FSCCT, FASNC

CME Information: 1 AMA PRA Category 1 Credit^TM