¹⁸F-florbetaben positron emission tomography detects cardiac involvement in systemic AA amyloidosis

Excerpt

A 62-year-old female with known systemic serum amyloid A (AA) amyloidosis presented with signs and symptoms of new-onset heart failure. Echocardiography demonstrated mild left ventricular (LV) dilation, preserved ejection fraction, and grade II diastolic dysfunction without typical signs of cardiac amyloidosis (CA) but a profound focal hypertrophy of the free right ventricular (RV) wall (a, b). Positron emission tomography/computed tomography (PET/CT) with the amyloid-binding tracer ¹⁸F-florbetaben was subsequently performed since endomyocardial biopsy was not deemed justified due to localized hypertrophy of the free RV wall. As shown in c-e, a highly increased RV tracer uptake with only moderately increased LV tracer uptake was found (retention index for RV and LV is 0.0026 and 0.0016, respectively). Tracer uptake co-localized with the echocardiographic finding of RV hypertrophy, suggesting cardiac involvement of AA amyloidosis with predominant right-sided amyloid deposition. …