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Fig. 2 | BMC Family Practice

Fig. 2

From: Avoiding misdiagnosis: expert consensus recommendations for the suspicion and diagnosis of transthyretin amyloidosis for the general practitioner

Fig. 2

Assessments for noninvasive diagnosis of ATTR amyloidosis. (A-D) 99mTc-DPD bone tracer scintigraphy. a No uptake outside of bone (score 0) is typical of patients without ATTR amyloidosis. b Some uptake outside of bone without myocardial uptake (score 1) may be seen in AL amyloidosis or possibly ATTR amyloidosis; if suspicion is high, consider a biopsy. c Moderate (score 2, myocardial uptake = rib uptake) and d high (score 3, myocardial uptake > rib uptake) uptake in the heart along with suspicious symptoms is diagnostic for ATTR amyloidosis (serum and urine immunofixation and FLC levels must be normal to discount AL amyloidosis). e, f 99mTc-PYP bone tracer scintigraphy. e Planar chest and f SPECT chest scans that demonstrate uptake both in blood pool and in the myocardial wall. 99mTc-DPD, technetium-99 m-3,3-diphosphono-1,2 propanodicarboxylic acid; 99mTc-PYP, technetium-99 m pyrophosphate; AL, light-chain amyloidosis; ATTR, transthyretin amyloid; FLC, free light chain; SPECT, single photon emission computed tomography. a-d Reused with permission from Perugini E, et al. [60]. e-f Courtesy of Morie Gertz

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