{"title":"<sup>18</sup>F-Florbetaben PET/CT for the Diagnosis and Subtyping of Cardiac Amyloidosis: A Case Series and Review of the Literature.","authors":"Yu-Cheng Shih, Bing-Hsiean Tzeng, Meng-Chieh Tsai, Yuan-Bin Yu, Yu-Chien Shiau, Shan-Ying Wang, Yen-Wen Wu","doi":"10.6515/ACS.202409_40(5).20240617D","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac amyloidosis (CA) is a type of systemic amyloidosis. Amyloid-targeting positron emission tomography (PET) has shown potential as an imaging method for CA. However, the optimal imaging protocol and role of <sup>18</sup>F-florbetaben (FBB) PET in the diagnosis and subtyping of CA have yet to be determined.</p><p><strong>Methods: </strong>Patients with suspected CA who had positive or equivocal results of technetium-99m pyrophosphate (PYP) scintigraphy were enrolled for dynamic and late FBB PET imaging. In addition to visual assessment, a kinetic modeling-based approach including target-to-background ratio (TBR) and myocardial retention fraction (RF) of serial images reconstructed from a 20-min dynamic acquisition, and a late image at 110 min post-injection were performed. We compared FBB PET measures of four typical patients with light chain amyloidosis (AL), wild-type transthyretin amyloidosis (ATTRwt), variant transthyretin amyloidosis (ATTRv), and heart failure, respectively. We also reviewed the literature on the clinical use of amyloid PET in CA.</p><p><strong>Results: </strong>Myocardial tracer retention was only found in the AL patient on the late images. TBR and RF were highest in the AL patient followed by the ATTRwt patient, and lowest in the ATTRv and non-CA patients.</p><p><strong>Conclusions: </strong>FBB PET has potential in the detection and non-invasive subtyping of CA, especially in subjects with equivocal PYP findings or monoclonal gammopathy.</p>","PeriodicalId":6957,"journal":{"name":"Acta Cardiologica Sinica","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413950/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Cardiologica Sinica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.6515/ACS.202409_40(5).20240617D","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Cardiac amyloidosis (CA) is a type of systemic amyloidosis. Amyloid-targeting positron emission tomography (PET) has shown potential as an imaging method for CA. However, the optimal imaging protocol and role of 18F-florbetaben (FBB) PET in the diagnosis and subtyping of CA have yet to be determined.
Methods: Patients with suspected CA who had positive or equivocal results of technetium-99m pyrophosphate (PYP) scintigraphy were enrolled for dynamic and late FBB PET imaging. In addition to visual assessment, a kinetic modeling-based approach including target-to-background ratio (TBR) and myocardial retention fraction (RF) of serial images reconstructed from a 20-min dynamic acquisition, and a late image at 110 min post-injection were performed. We compared FBB PET measures of four typical patients with light chain amyloidosis (AL), wild-type transthyretin amyloidosis (ATTRwt), variant transthyretin amyloidosis (ATTRv), and heart failure, respectively. We also reviewed the literature on the clinical use of amyloid PET in CA.
Results: Myocardial tracer retention was only found in the AL patient on the late images. TBR and RF were highest in the AL patient followed by the ATTRwt patient, and lowest in the ATTRv and non-CA patients.
Conclusions: FBB PET has potential in the detection and non-invasive subtyping of CA, especially in subjects with equivocal PYP findings or monoclonal gammopathy.
目的：心脏淀粉样变性（CA）是全身性淀粉样变性的一种。淀粉样蛋白靶向正电子发射断层扫描（PET）已显示出作为CA成像方法的潜力。然而，18F-氟贝特宾（FBB）PET在诊断CA和CA亚型中的最佳成像方案和作用仍有待确定：方法：对焦磷酸锝-99m（PYP）闪烁扫描结果为阳性或不明确的疑似 CA 患者进行动态和晚期 FBB PET 成像检查。除了肉眼评估外，我们还采用了一种基于动力学建模的方法，包括从20分钟动态采集中重建的序列图像的靶-背景比（TBR）和心肌保留分数（RF），以及注射后110分钟的晚期图像。我们比较了四位典型轻链淀粉样变性（AL）、野生型转甲状腺素淀粉样变性（ATTRwt）、变异型转甲状腺素淀粉样变性（ATTRv）和心力衰竭患者的 FBB PET 测量结果。我们还回顾了淀粉样蛋白 PET 在 CA 中临床应用的文献：结果：仅在AL患者的晚期图像中发现了心肌示踪剂滞留。TBR和RF在AL患者中最高，其次是ATTRwt患者，而在ATTRv和非CA患者中最低：结论：FBB PET具有检测和无创亚型CA的潜力，尤其适用于PYP结果不明确或有单克隆丙种球蛋白病的受试者。
期刊介绍：
Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.
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