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However, planar imaging alone, particularly in patients with Perugini score 1, often lacks diagnostic specificity. This study evaluates the incremental diagnostic value of quantitative SPECT\/CT at 90\u00a0min post-injection (p.i.) when added to standard planar imaging at 60 and 180\u00a0min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective single-center study, 170 patients with suspected cardiac amyloidosis underwent 99mTc-PYP scintigraphy, including planar imaging and SPECT\/CT. Quantitative myocardial uptake was assessed using myocardium-to-vertebra and myocardium-to-rib ratios across predefined left ventricular segments. Imaging findings were correlated with electrocardiographic, echocardiographic, cardiac magnetic resonance (CMR), biomarker, and histopathological data where available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quantitative SPECT\/CT correlated strongly with Perugini scores and improved diagnostic certainty, particularly in patients with equivocal planar findings. The addition of SPECT\/CT led to diagnostic reclassification in more than one-third of patients, with the greatest impact observed in the intermediate Perugini group. Myocardial uptake ratios were significantly associated with NT-proBNP, troponin T, echocardiographic markers of diastolic dysfunction, and CMR parameters including native T1 and extracellular volume. Blood pool activity showed an inverse relationship with myocardial uptake and was associated with both upgrade and downgrade, indicating its role as a confounding factor. Correlation analysis demonstrated only weak associations with renal function and no meaningful correlations with biomarkers or structural parameters. Histopathology (7%) was concordant with imaging findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quantitative SPECT\/CT at 90\u00a0min p.i. provides significant incremental diagnostic value, particularly in equivocal cases. Its ability to improve diagnostic classification and distinguish true myocardial uptake from blood pool activity supports its integration into routine diagnostic algorithms for ATTR-CM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-07969-1","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:21:53Z","timestamp":1780471313000},"page":"6034-6049","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative 99mTc-PYP SPECT\/CT at 90\u00a0minutes improves diagnostic stratification in transthyretin cardiac amyloidosis"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3539-8771","authenticated-orcid":false,"given":"Tina","family":"Nazerani-Zemann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Stanzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Weitzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kuenzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena Maria","family":"Stangl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bucerius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"7969_CR1","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1007\/s10741-020-10062-w","volume":"26","author":"V Bistola","year":"2021","unstructured":"Bistola V, Parissis J, Foukarakis E, Valsamaki PN, Anastasakis A, Koutsis G, et al. 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Written informed consent was obtained from all participants prior to inclusion.","order":1,"name":"Ethics","label":"Compliance with ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee (Ethikkommission der Medizinischen Universit\u00e4t Graz, approval number: 34\u2013138 ex 21\/22) and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participants provided written informed consent for the use of their anonymized data for research and publication purposes.","order":3,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"T.N.-Z., S.S., F.W., T.K., and V.S. declare no conflicts of interest related to this work.","order":4,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}