Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 9/2014

01-09-2014 | Original Article

Imaging cardiac amyloidosis: a pilot study using 18F-florbetapir positron emission tomography

Authors: Sharmila Dorbala, Divya Vangala, James Semer, Christopher Strader, John R. Bruyere Jr, Marcelo F. Di Carli, Stephen C. Moore, Rodney H Falk

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2014

Login to get access

Abstract

Purpose

Cardiac amyloidosis, a restrictive heart disease with high mortality and morbidity, is underdiagnosed due to limited targeted diagnostic imaging. The primary aim of this study was to evaluate the utility of 18F-florbetapir for imaging cardiac amyloidosis.

Methods

We performed a pilot study of cardiac 18F-florbetapir PET in 14 subjects: 5 control subjects without amyloidosis and 9 subjects with documented cardiac amyloidosis. Standardized uptake values (SUV) of 18F-florbetapir in the left ventricular (LV) myocardium, blood pool, liver, and vertebral bone were determined. A 18F-florbetapir retention index (RI) was computed. Mean LV myocardial SUVs, target-to-background ratio (TBR, myocardial/blood pool SUV ratio) and myocardial-to-liver SUV ratio between 0 and 30 min were calculated.

Results

Left and right ventricular myocardial uptake of 18F-florbetapir were noted in all the amyloid subjects and in none of the control subjects. The RI, TBR, LV myocardial SUV and LV myocardial to liver SUV ratio were all significantly higher in the amyloidosis subjects than in the control subjects (RI median 0.043 min−1, IQR 0.034 – 0.051 min−1, vs. 0.023 min−1, IQR 0.015 – 0.025 min−1, P = 0.002; TBR 1.84, 1.64 – 2.50, vs. 1.26, IQR 0.91 – 1.36, P = 0.001; LV myocardial SUV 3.84, IQR 1.87 – 5.65, vs. 1.35, IQR 1.17 – 2.28, P = 0.029; ratio of LV myocardial to liver SUV 0.67, IQR 0.44 – 1.64, vs. 0.18, IQR 0.15 – 0.35, P = 0.004). The myocardial RI, TBR and myocardial to liver SUV ratio also distinguished the control subjects from subjects with transthyretin and those with light chain amyloid.

Conclusion

18F-Florbetapir PET may be a promising technique to image light chain and transthyretin cardiac amyloidosis. Its role in diagnosing amyloid in other organ systems and in assessing response to therapy needs to be further studied.
Literature
1.
2.
Falk RH. Cardiac amyloidosis: a treatable disease, often overlooked. Circulation. 2011;124:1079–85.PubMedCrossRef
3.
4.
Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, et al. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study. Ann Intern Med. 2004;140:85–93.PubMedCrossRef
5.
Kristen AV, Perz JB, Schonland SO, Hegenbart U, Schnabel PA, Kristen JH, et al. Non-invasive predictors of survival in cardiac amyloidosis. Eur J Heart Fail. 2007;9:617–24.PubMedCrossRef
6.
Miroy GJ, Lai Z, Lashuel HA, Peterson SA, Strang C, Kelly JW. Inhibiting transthyretin amyloid fibril formation via protein stabilization. Proc Natl Acad Sci U S A. 1996;93:15051–6.PubMedCentralPubMedCrossRef
7.
Hawkins PN, Lavender JP, Pepys MB. Evaluation of systemic amyloidosis by scintigraphy with 123I-labeled serum amyloid P component. N Engl J Med. 1990;323:508–13.PubMedCrossRef
8.
Yang L, Rieves D, Ganley C. Brain amyloid imaging – FDA approval of florbetapir F18 injection. N Engl J Med. 2012;367:885–7.PubMedCrossRef
9.
Clark CM, Schneider JA, Bedell BJ, Beach TG, Bilker WB, Mintun MA, et al. Use of florbetapir-PET for imaging beta-amyloid pathology. JAMA. 2011;305:275–83.PubMedCrossRef
10.
Lister-James J, Pontecorvo MJ, Clark C, Joshi AD, Mintun MA, Zhang W, et al. Florbetapir F-18: a histopathologically validated beta-amyloid positron emission tomography imaging agent. Semin Nucl Med. 2011;41:300–4.PubMedCrossRef
11.
Choi SR, Golding G, Zhuang Z, Zhang W, Lim N, Hefti F, et al. Preclinical properties of 18 F-AV-45: a PET agent for Abeta plaques in the brain. J Nucl Med. 2009;50:1887–94.PubMedCentralPubMedCrossRef
12.
Antoni G, Lubberink M, Estrada S, Axelsson J, Carlson K, Lindsjo L, et al. In vivo visualization of amyloid deposits in the heart with 11C-PIB and PET. J Nucl Med. 2013;54:213–20.PubMedCrossRef
13.
Bokhari S, Castano A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. (99m)Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging. 2013;6:195–201.PubMedCentralPubMedCrossRef
14.
Perugini E, Guidalotti PL, Salvi F, Cooke RM, Pettinato C, Riva L, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol. 2005;46:1076–84.PubMedCrossRef
15.
Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD, et al. Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging. 2010;3:155–64.PubMedCrossRef
16.
Banypersad SM, Sado DM, Flett AS, Gibbs SD, Pinney JH, Maestrini V, et al. Quantification of myocardial extracellular volume fraction in systemic Al amyloidosis: an equilibrium contrast cardiovascular magnetic resonance study. Circ Cardiovasc Imaging. 2013;6:34–9.PubMedCrossRef
Metadata
Title
Imaging cardiac amyloidosis: a pilot study using 18F-florbetapir positron emission tomography
Authors
Sharmila Dorbala
Divya Vangala
James Semer
Christopher Strader
John R. Bruyere Jr
Marcelo F. Di Carli
Stephen C. Moore
Rodney H Falk
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2787-6

Other articles of this Issue 9/2014

European Journal of Nuclear Medicine and Molecular Imaging 9/2014 Go to the issue

Book Review

Michael Riccabona: Pediatric Imaging Essentials—Radiography, Ultrasound, CT, and MRI in Neonates and Children

Letter to the Editor

FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection: response to Lazzeri et al

Short Communication

Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance

Original Article

Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide

Original Article

Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation

Original Article

Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure