Abstract 233: A Network Meta-analysis Comparing The Performance Of Magnetic Resonance Imaging, Positron Emission Tomography And Bone Scintigraphy Techniques In Detecting Cardiac Amyloidosis

Aims: Diagnosing cardiac amyloidosis with non-invasive imaging studies can be challenging. We aims to systematically review the published literature and compare the performance of magnetic resonance (CMR), positron emission tomography (PET) and bone scintigraphy (BS) for diagnosis of cardiac amyloidosis. Methods: Medical electronic databases were searched for studies evaluating the diagnostic performance of CMR, PET or BS in diagnosing cardiac amyloidosis where histopathological examination of endomyocardial biopsy tissue or extra-cardiac organs were used as reference standards. We evaluated; CMR: extracellular volume (ECV), late gadolinium enhancement (LGE), T1 mapping; PET: F18-Amyloid, F18-Sodium Fluoride (NaF), and C11-PIB; BS: Technetium-99m (Tc) hydroxymethylene diphosphonate (Tc-HMDP), Tc-3,3-diphosphono-1,2-propanodicarboxylicacid (Tc-DPD), Tc- pyrophosphate (Tc-PYP). Methodological quality was assessed using a Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). To summarize sensitivity, specificity, and superiority, we used an arm-based hierarchical model which expresses the logit transformed sensitivity and specificity as the sum of fixed effects for test, correlated study-effects to model the inherent correlation between sensitivity and specificity and a random error associated with various tests evaluated in each study. Results: Of the 2871 studies identified, 39 studies met the inclusion criteria. Sensitivity and specificity and Superiority of the various imaging modalities in diagnosing cardiac amyloidosis were calculated (Figure). Study quality assessed by QUADAS-2 was generally good with negligible evidence of bias. Conclusion: Various non-invasive imaging modalities have been studied for diagnosing cardiac amyloidosis with varying sensitivity and specificity. Comparative studies may be warranted to improve non-invasive diagnostic algorithms of suspected cardiac amyloidosis.