JACC. Advances · 2026
18F-Florbetaben PET Detection of Cardiac and Multi-Organ Involvement for Identifying AL and ATTR Cardiac Amyloidosis.
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Sprauel Telma, Itti Emmanuel, Imbert Laetitia, Zaragori Timothée, Doyen Matthieu, Roch Véronique, Verger Antoine, Huttin Olivier, Jacquet Caroline, Donal Erwan, Lejeune Florence, Veran Nicolas, Piccoli Juliette, Lairez Olivier, Hitzel Anne, Cariou Eve, Chambert Benjamin, Soullier Camille, Zaroui Amira, Hossu Gabriela, Damy Thibaud, Marie Pierre-Yves
Аннотация
BACKGROUND: 18F-florbetaben positron emission tomography (PET) is reported to detect i) cardiac amyloidosis (CA), particularly AL (light chain) forms, and ii) sites of extracardiac AL-amyloid infiltrates.
OBJECTIVES: The purpose of this study was to identify CA and differentiate AL-CA from ATTR-CA (transthyretin) by evaluating cardiac and multi-organ involvement with whole-body 18F-florbetaben PET.
METHODS: Multicentric study of 61 patients with left ventricular hypertrophy due to AL-CA (n = 25), ATTR-CA (n = 25), and aortic stenosis (n = 11, controls). A 20-minute whole-body PET was preceded by a 10-minute dynamic cardiac PET recording started during 18F-florbetaben injection.
RESULTS: Tracer uptake was significantly increased in whole-body PET of CA patients compared to controls, with AL-CA patients, in particular, exhibiting increased uptake in myocardium, lung, and spleen, and decreased uptake in blood, salivary glands, skeletal muscle, and liver. Among cardiac parameters, the myocardial/blood standardized uptake value (SUV)max ratio from whole-body PET best differentiated AL-CA from ATTR-CA, with 90% (55/61) of patients identified correctly (kappa value: 0.819) using SUVmax ratio thresholds of 2-to-4 for ATTR-CA and >4 for AL-CA. When combining cardiac with extracardiac PET variables, the selected multivariate predictors were myocardial uptake volume and the lung and salivary gland SUVmean. Thresholds of myocardial uptake volume >10 mL for CA and lung/salivary gland SUVmean >0.285 for AL-CA correctly identified 93% (57/61) of patients (kappa value: 0.871). PET variables improved the overall prediction provided by the bone scan Perugini score (P < 0.001).
CONCLUSIONS: Whole-body 18F-florbetaben PET identifies CA and differentiates AL-CA from ATTR-CA. These distinctions are strengthened by combining assessments of cardiac and multi-organ involvement.
OBJECTIVES: The purpose of this study was to identify CA and differentiate AL-CA from ATTR-CA (transthyretin) by evaluating cardiac and multi-organ involvement with whole-body 18F-florbetaben PET.
METHODS: Multicentric study of 61 patients with left ventricular hypertrophy due to AL-CA (n = 25), ATTR-CA (n = 25), and aortic stenosis (n = 11, controls). A 20-minute whole-body PET was preceded by a 10-minute dynamic cardiac PET recording started during 18F-florbetaben injection.
RESULTS: Tracer uptake was significantly increased in whole-body PET of CA patients compared to controls, with AL-CA patients, in particular, exhibiting increased uptake in myocardium, lung, and spleen, and decreased uptake in blood, salivary glands, skeletal muscle, and liver. Among cardiac parameters, the myocardial/blood standardized uptake value (SUV)max ratio from whole-body PET best differentiated AL-CA from ATTR-CA, with 90% (55/61) of patients identified correctly (kappa value: 0.819) using SUVmax ratio thresholds of 2-to-4 for ATTR-CA and >4 for AL-CA. When combining cardiac with extracardiac PET variables, the selected multivariate predictors were myocardial uptake volume and the lung and salivary gland SUVmean. Thresholds of myocardial uptake volume >10 mL for CA and lung/salivary gland SUVmean >0.285 for AL-CA correctly identified 93% (57/61) of patients (kappa value: 0.871). PET variables improved the overall prediction provided by the bone scan Perugini score (P < 0.001).
CONCLUSIONS: Whole-body 18F-florbetaben PET identifies CA and differentiates AL-CA from ATTR-CA. These distinctions are strengthened by combining assessments of cardiac and multi-organ involvement.