Little D, Feger J, Ayesa S, et al. Perugini grading scale. Reference article, Radiopaedia.org (Accessed on 24 Mar 2025) https://doi.org/10.53347/rID-78076
The Perugini grading scale is a semi-quantitative method of scoring cardiac uptake following injection of 99mTc-DPD, 99mTc-Pyrophosphate or 99mTc-HMDP scintigraphy in the investigation of cardiac amyloidosis (particularly ATTR amyloidosis). The grading scale visually compares tracer uptake in the myocardium and ribs.
Classification
grade 0: no cardiac uptake and normal rib uptake
grade 1: cardiac uptake which is less than rib uptake
grade 2: cardiac uptake with intensity similar to rib uptake
grade 3: cardiac uptake greater than rib uptake with mild or absent rib uptake
Visual scores of 2 or greater on planar +/- SPECT/CT imaging are classified as ATTR-positive studies. Scores of less than 2 are interpreted as ATTR negative 4.
1. Perugini E, Guidalotti P, Salvi F et al. Noninvasive Etiologic Diagnosis of Cardiac Amyloidosis Using 99mTc-3,3-Diphosphono-1,2-Propanodicarboxylic Acid Scintigraphy. J Am Coll Cardiol. 2005;46(6):1076-84. doi:10.1016/j.jacc.2005.05.073 - Pubmed
2. Hutt D, Fontana M, Burniston M et al. Prognostic Utility of the Perugini Grading of 99mTc-DPD Scintigraphy in Transthyretin (ATTR) Amyloidosis and Its Relationship with Skeletal Muscle and Soft Tissue Amyloid. European Heart Journal - Cardiovascular Imaging. 2017;18(12):1344-50. doi:10.1093/ehjci/jew325 - Pubmed
3. Cappelli F, Gallini C, Di Mario C et al. Accuracy of 99mTc-Hydroxymethylene Diphosphonate Scintigraphy for Diagnosis of Transthyretin Cardiac Amyloidosis. J Nucl Cardiol. 2019;26(2):497-504. doi:10.1007/s12350-017-0922-z - Pubmed
4. Dorbala S, Bokhari S, Miller E, et al (2019) ASNC practice point: 99mTechnetium-pyrophosphate imaging for transthyretin cardiac amyloidosis. Am Soc Nucl Cardiol. Guideline
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