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The degree of uptake is visually graded using planar images utilising the Perugini score. Today, non-invasive diagnosis of ATTR-CM is broadly established in practice; however, in patients with mild tracer uptake (Perugini grade 1), no definite diagnosis can be made without endomyocardial biopsy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Within the scope of a prospective cardiac amyloidosis registry at the Medical University of Vienna, all patients who underwent bone scintigraphy graded as Perugini grade 1 with additional SPECT\/CT imaging performed between September 2014 and May 2025 were retrospectively analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      41 patients (70.8 years, IQR: 64.9\u201378.8, 41.5% female) were included. The majority (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200932, 78.0%) of scans were ordered for a suspicion of ATTR-CM. On SPECT\/CT images, true LV tracer uptake was confirmed in 4 (9.8%) patients, and 1 (2.4%) patient presented with focal myocardial uptake. In all other patients, tracer uptake was not within the myocardial tissue but rather blood-pool uptake. In follow-up [\n                      <jats:sup>99m<\/jats:sup>\n                      Tc]-DPD scintigraphy, myocardial tracer uptake eventually progressed to Perugini grade 2 in 3 patients who previously demonstrated mild LV myocardial tracer uptake. In contrast, those with diffuse LV uptake did not show any signs of progression in follow-up SPECT\/CT imaging.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      SPECT\/CT is mandatory in patients with mild mediastinal tracer uptake interpreted as Perugini grade 1. Among patients with Perugini grade 1 and confirmed [\n                      <jats:sup>99m<\/jats:sup>\n                      Tc]-DPD LV uptake on SPECT\/CT images, progression to Perugini grade 2 was observed in all individuals who underwent nuclear medicine imaging follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07653-w","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T02:49:10Z","timestamp":1762915750000},"page":"2662-2673","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Additive diagnostic value of thoracic SPECT\/CT imaging in perugini grade 1 patients who underwent bone scintigraphy"],"prefix":"10.1007","volume":"53","author":[{"given":"Michael","family":"Poledniczek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Rettl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Kronberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena Marie","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Ermolaev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Duca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Nitsche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Binder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Camuz Ligios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahshid","family":"Eslami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Binder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens P.","family":"Spielvogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roza","family":"Badr Eslam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich","family":"Beitzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kastner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Bergler-Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas A.","family":"Kammerlander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hengstenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8018-3884","authenticated-orcid":false,"given":"Raffaella","family":"Calabretta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"7653_CR1","doi-asserted-by":"publisher","unstructured":"Wechalekar AD, Gillmore JD, Hawkins PN. 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The remaining authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approvals were granted by the Ethics Committee of Medical University of Vienna (Approval No. 1019\/2023 and Approval No. 2352\/2024).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was waived by the institutional review board.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All individuals agreed to the publication of this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}