Cardiac Amyloid Imaging with ¹⁸F-Florbetaben PET: A Pilot Study

Abstract

Our aim was to determine the feasibility of 18 F-florbetaben PET in diagnosing cardiac amyloidosis. Methods: 18 F-florbetaben PET was performed on 14 patients: 5 amyloid light chain, 5 amyloid transthyretin, and 4 control with hypertensive heart disease. Qualitative and quantitative assessments of 18 F-florbetaben activity were performed using the SUV mean of the left ventricular myocardium and blood pool and calculation of target-to-background SUV ratio. Myocardial 18 F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0 and 5 min and 15 and 20 min after radiotracer injection. Global left ventricular longitudinal and right ventricular free wall longitudinal strain were calculated using 2-dimensional speckle-tracking echocardiography. Results: Targetto-background SUV ratio and percentage myocardial 18 F-forbetaben retention were higher in amyloid patients than in hypertensive controls. A cutoff of 40% was able to differentiate between cardiac amyloid patients and hypertensive controls. Percentage myocardial 18 F-forbetaben retention was an independent determinant of both global left ventricular longitudinal and right ventricular free wall longitudinal strain via an inverse curve relationship. Conclusion: 18 F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial 18 F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.

Nuclear imaging of cardiac amyloidosis

“…20 Similar findings have been reported with 18 F-florbetabir from other laboratories 22 and with another amyloid specific PET tracer, 18 F-florbetaben. 23 The current study by Capelli et al 21 confirms earlier findings of smaller studies and case reports 13,14 as well as the large-scale study by Gillmore et al 17 showing the potential of 99m Tc-HMDP nuclear imaging in patients with suspected TTR-CA, to reliably differentiate those from AL-CA and other causes of LVH. The biggest limitations, as the authors point out, are small sample size and lack of biopsy confirmation in several patients.…”

Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation

“…Little data available have demonstrated a rather limited role for FDG PET in imaging of CA [128, 129]. To date, the most promising alternatives include more amyloid specific tracers like 11 C-labeled Pittsburgh B (PiB) compound [130, 131] as well as 18 F-labeled compounds such as Florbetapir [132, 133] and Florbetaben [134]. All studies reported on promising results in diagnosis of CA.…”

Role of Imaging in Evaluating Infiltrative Heart Disease

“…The myocardial retention index was reported to be higher in AL versus TTR, although the difference did not reach statistical significance ( p = 0.057) in this small pilot study [55]. A recent study using 18 F florbetaben, a tracer similar to 18 F florbetapir, reported a myocardial 18F florbetaben retention of >40%, accurately distinguished CA patients from hypertensive controls [56]. In addition, the authors described a strong relationship between 18 F florbetaben uptake and myocardial dysfunction, as assessed by strain.…”