French survey finds gaps in how physicians report cardiac amyloidosis scans

A large national survey of French nuclear medicine physicians has found that while most specialists follow recommended imaging protocols when diagnosing transthyretin cardiac amyloidosis, reporting practices vary widely, with important gaps in how scan results are communicated to guide further patient care.

The DIAM-ATTR survey, published in EJNMMI Research, was distributed as a cross-sectional online questionnaire to all nuclear medicine physicians in France between March and May 2024. It asked about scintigraphy acquisition protocols, radiotracer use, image interpretation and reporting habits for patients with suspected transthyretin amyloid cardiomyopathy, a condition that is increasingly diagnosed using cardiac bone scintigraphy.

Of the 774 nuclear medicine physicians invited to participate, 100 completed the survey, a response rate of 12.9 percent. The researchers report that most respondents adhered to the recommended acquisition protocols, including late planar imaging, which 99 percent reported using, and routine Perugini grading, applied by 98 percent of respondents.

Single photon emission computed tomography, or SPECT, imaging was also consistently performed. According to the survey results, 89 percent of respondents reported performing SPECT for patients with Perugini Grade 1 uptake, and 85 percent did so for Grades 2 to 3.

Reporting practices, however, showed substantial variation. Only 49 percent of respondents mentioned the need to screen for monoclonal gammopathy when the Perugini grade was 1, and only 17 percent systematically advised re-evaluation by a cardiologist.

The survey respondents themselves identified standardization of imaging protocols and reporting content as key areas for improvement. The authors conclude that in France, nuclear medicine physicians largely follow guidelines for transthyretin cardiac amyloidosis scintigraphy, especially regarding the use of SPECT and Perugini grading, but that gaps remain in reporting, notably for excluding monoclonal gammopathy and guiding Grade 1 cases.

Nuclear medicine physicians play a central role in the diagnosis of cardiac amyloidosis, and the survey was designed to assess current practices and reporting patterns for this diagnosis across France. The authors note that improved education, collaboration and standardized reporting are needed to further optimize diagnosis and outcomes.

The study is an open-access original research article published on 26 October 2026, and the published version is an early-release, peer-reviewed accepted manuscript that remains subject to further editorial edits before the final version of record. As a survey of self-reported practice among 100 responding physicians in a single country, its findings describe reported habits rather than directly measured patient outcomes, and the relatively low response rate means the results may not fully represent all French nuclear medicine physicians.

Subject of Research: Current practices and access to cardiac bone scintigraphy for diagnosing transthyretin cardiac amyloidosis in France

Article Title: Current practices and access to cardiac bone scintigraphy for diagnosing transthyretin cardiac amyloidosis: results of a large national survey

Article References: Hyafil, F., Oghina, S., Legallois, D., Sabouret, P., Trésorier, R., Amara, W., Piriou, N., Canali, G., Noirot-Cosson, C., Bartoli, M., Sauvage, C., Bouquillon, B., Charron, P., & Damy, T. (2026). Current practices and access to cardiac bone scintigraphy for diagnosing transthyretin cardiac amyloidosis: results of a large national survey. EJNMMI Research. https://doi.org/10.1186/s13550-026-01532-7

Image Credits: AI Generated

DOI: 10.1186/s13550-026-01532-7

Keywords: transthyretin cardiac amyloidosis, cardiac bone scintigraphy, nuclear medicine, Perugini grading, SPECT, monoclonal gammopathy, DIAM-ATTR survey, France, reporting practices, ATTR-CM diagnosis, Current, practices