Nuclear medicine: pyrophosphate scan: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Nuclear medicine: pyrophosphate scan

Sample item

A 75-year-old man has heart failure with preserved ejection fraction, thick ventricular walls on echocardiography and a negative serum free light chain test. A technetium-99m pyrophosphate scan shows grade 3 myocardial uptake. What is the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Transthyretin cardiac amyloidosis

Bone-avid tracers such as pyrophosphate bind to transthyretin amyloid in the myocardium. With absent monoclonal protein, a grade 2 or 3 uptake permits a non-biopsy diagnosis of ATTR cardiac amyloidosis.

Option by option

  • A. Transthyretin cardiac amyloidosis (correct)

    Correct. Intense myocardial uptake of a bone tracer with no light chains indicates ATTR.

  • B. Acute myocardial infarction

    Acute infarction can take up pyrophosphate focally but not as a diffuse thick-walled picture in this setting.

  • C. Pericarditis

    Pericarditis does not produce this pattern.

  • D. Hypertrophic cardiomyopathy

    Hypertrophic cardiomyopathy does not typically show grade 3 uptake.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Transthyretin cardiac amyloidosis. Bone-avid tracers such as pyrophosphate bind to transthyretin amyloid in the myocardium.

Why is "Acute myocardial infarction" not the answer?

Acute infarction can take up pyrophosphate focally but not as a diffuse thick-walled picture in this setting.

Why is "Pericarditis" not the answer?

Pericarditis does not produce this pattern.

Why is "Hypertrophic cardiomyopathy" not the answer?

Hypertrophic cardiomyopathy does not typically show grade 3 uptake.

What concept does this question test?

It tests Nuclear medicine: pyrophosphate scan in Radiology. With absent monoclonal protein, a grade 2 or 3 uptake permits a non-biopsy diagnosis of ATTR cardiac amyloidosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nuclear medicine: pyrophosphate scan?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.