Transthyretin cardiac amyloidosis (ATTR-CM) is a recognized cause of heart failure that results from age-related or hereditary transthyretin misfolding and systemic amyloid deposition. It is characterized by clinical heterogeneity and may affect the heart among peripheral and autonomous nervous system, gastrointestinal tract, kidneys and eyes. Technetium-99m bone-avid scintigraphy with standardized planar and SPECT/CT protocols, interpreted using Perugini grading and heart-to-contralateral lung ratios after exclusion of light-chain amyloidosis, enables highly sensitive, non-invasive diagnosis of ATTR-CM and early detection in at-risk individuals. This narrative review synthesizes recent data on molecular imaging, emphasizing the central role of nuclear medicine physicians in applying multimodality diagnostic algorithms, recognizing typical and equivocal scan patterns. It further explores emerging roles for quantitative SPECT/CT and amyloid PET tracers in monitoring response to disease-modifying therapies, including tetramer stabilizers (tafamidis, acoramidis), RNA interference silencers (vutrisiran, patisiran), and investigational fibril-targeting antibodies and gene-editing strategies, underscoring a shift from purely diagnostic imaging toward dynamic treatment monitoring in ATTR-CM.
Primary thyroid follicular lymphoma (FL) is exceedingly rare with frequently low fluorine-18-fluorodeoxyglucose (18F-FDG) avidity, challenging accurate staging. We report the case of a 49-year-old female who underwent left thyroid lobectomy for a thyroid imaging reporting and data system (TI-RADS) 4a nodule, with histopathology confirming low-grade FL. Postoperative 18F-FDG positron emission tomography/computed tomography (PET/CT) showed only mild uptake at the surgical bed and cervical lymph nodes, interpreted as reactive change. A subsequent aluminum fluoride-18-1,4,7-triazacyclononane-1,4,7-triacetic acid-Pentixather (Al18F-NOTA-Pentixather) C-X-C chemokine receptor type 4 (CXCR4)-targeted PET/CT, however, revealed multiple intensely avid cervical and abdominal nodal lesions and spleen involvement. This imaging discrepancy underscores the limitations of 18F-FDG in low-grade lymphomas and suggests that CXCR4-targeted PET/CT may offer a more accurate reflection of disease burden, with potential implications for staging and therapeutic management.
Systematic cardiovascular risk assessment and stratification across the entire cancer care continuum is essential among cancer patients, largely due to potential cardiotoxic effects of oncologic therapeutic regiments. Prior to initiation of cancer therapy, cardiotoxicity risk assessment should include comprehensive evaluation of baseline cardiovascular status and baseline measurement of cardiac biomarkers. Patient-related factors should be integrated with therapy-related risks associated with specific oncologic regiments and/or radiotherapy. During cancer treatment, continuous cardiovascular surveillance is necessary to detect early or subclinical myocardial dysfunction. Monitoring strategies involve periodic clinical evaluation, serial echocardiographic assessment and biomarker measurements. Surveillance protocols should be adapted according to the cardiotoxic potential of the administered regimen; as early detection of cardiotoxicity allows prompt cardioprotective interventions and adjustment of oncologic treatments. Cardiovascular assessment after cancer therapy is crucial due to potential delayed cardiotoxic effects. During the first year, post-treatment, structured follow-up is recommended to identify persistent or emerging cancer therapy-related cardiotoxicities. Long-term surveillance is also particularly important for cancer survivors exposed to cardiotoxic agents, given their increased risk of chronic cardiovascular complications. Digitalization improves cardio-oncology risk assessment through artificial intelligence, electronic health records, and remote monitoring enabling earlier detection and personalized cardiovascular surveillance. A multidisciplinary cardio-oncology approach and structured surveillance across the entire cancer care continuum is crucial to reduce cardiovascular morbidity and improve long-term outcomes.
