Evaluation of Cardiac Amyloid

Purpose	Detection and quantification of cardiac amyloid deposits as well as subtyping
Tag(s)
Panel	Cardiac
Define-AI ID	19040031
Originator	David Wymer
Lead	David Wymer
Panel Chair	Carlo De Cecco
Panel Reviewers	Cardiac
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES137

Clinical Implementation

Value Proposition

Detecting and differentiating types of cardiac amyloidosis hold serious implications for the prognosis and treatment of the patient. Applying an AI algorithm to assist radiologists in the detection and characterization would likely improve earlier detection and corresponding treatment plans.

Narrative(s)

Patient with onset of developing nonischemic heart failure. Lab tests, ECG, cardiac imaging, and histopathology are ordered. Clinician evaluates monoclonal gammopathy, left ventricular hypertrophy. and other organ involvement. Algorithm analyzes data from the DICOM study and returns the evaluation for Tc-99m cardiac uptake, heart to contralateral ratio, amyloid detection, and type of amyloid if present.

Workflow Description

Cardiac nuclear scan is taken and sent to PACS and the AI engine. The algorithm is triggered automatically with the image data. This cardiac amyloid algorithm returns Tc-99m PYP cardiac uptake, heart to contralateral ratio, amyloid detection, and type of amyloid if present. An alert message is sent to PACS from the engine with the information, identification, and important features that led the model to this evaluation.

Considerations for Dataset Development

Age	Varied
Sex at Bith	Male, Female
Rib Trauma	Absent, Present
Rib/Bone Metastases	Absent, Present
Dextrocardia	Absent, Present
Heart ROI size	varied
LV wall thickness	varied
LV end-diastolic volume	varied
LV ejection fraction	varied
atrial enlargement	absent, present
pericardial effusion	absent, present
pleural effusions	absent, present
Left ventricular hypertrophy	absent, present

Technical Specifications

Inputs

DICOM Study

Procedure	Nuclear cardiac TC-99m PYP
Views	Anterior and SPECT
Data Type	DICOM
Modality	Nuclear Gamma camera
Body Region	Chest
Anatomic Focus	Heart
Pharmaceutical	TC99m- PYP
Scenario	Heart Failure, conduction abnormality

Primary Outputs

Myocardial Tc-99m PYP cardiac uptake

RadElement ID	RDE906
Definition	Classification of myocardial TC-99m PYP cardiac uptake
Data Type	Categorical
Value Set	No uptake and normal bone uptake Uptake less than rib uptake Uptake equal to rib uptake Uptake greater than rib uptake with mild/absent rib uptake Unknown
Units	N/A

Heart to contralateral ratio

RadElement ID	RDE907
Definition	The fraction of heart ROI mean counts to contralateral chest ROI mean counts
Data Type	Numeric
Value Set	N/A
Units	N/A

Amyloid Detection

RadElement ID	RDE908
Definition	Presence of cardiac amyloid
Data Type	Categorical
Value Set	Cardiac amyloid absent Cardiac amyloid present Unknown
Units	N/A

Type of Amyloid

RadElement ID	RDE909
Definition	Classification of cardiac amyloid
Data Type	Categorical
Value Set	AL ATTR Unknown
Units	N/A