Perugini grading scale

Last revised by Sally Louise Ayesa on 3 Jul 2022

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. 


  • 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 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 negative4

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