11C-Pittsburgh B PET 显像在心脏淀粉样变性中的应用。
11C-Pittsburgh B PET imaging in cardiac amyloidosis.
机构信息
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.
Department of Nuclear Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea.
出版信息
JACC Cardiovasc Imaging. 2015 Jan;8(1):50-59. doi: 10.1016/j.jcmg.2014.09.018. Epub 2014 Nov 4.
OBJECTIVES
This study sought to investigate the efficacy of (11)C-Pittsburgh B (PiB) positron emission tomography (PET)/computed tomography (CT) in the diagnosis of cardiac amyloidosis.
BACKGROUND
The PiB compound has been promising for detection of amyloid deposits in the brain.
METHODS
A total of 22 consecutive patients were enrolled in this prospective pilot study of monoclonal gammopathy patients with suspected cardiac amyloidosis. The study consisted of a series of (11)C-PiB PET/CT, echocardiography, cardiac magnetic resonance, and endomyocardial biopsy within a 1-month period. In addition, 10 normal subjects were recruited to determine the most optimal cut-off value for a positive (11)C-PiB PET/CT scan.
RESULTS
Among the 22 patients, 15 patients were diagnosed as cardiac amyloidosis by endomyocardial biopsy and 5 patients had undergone chemotherapy previously before the (11)C-PiB PET/CT. There were no differences in echocardiographic parameters between patients with versus without cardiac amyloidosis, except for a marginal difference in the left ventricular end-diastolic dimension (median 41.0 mm [range 33.0 to 49.0 mm] vs. 50.0 mm [range 38.0 to 55.0 mm], p = 0.066). (11)C-PiB PET/CT was positive in 13 of 15 biopsy-proven cardiac amyloidosis patients, whereas none of the patients without cardiac amyloidosis demonstrated positive (11)C-PiB PET/CT scan results. The maximal myocardium-to-blood cavity ratio was significantly different between patients with versus without cardiac amyloidosis (median 3.9 [range 1.7 to 19.9] vs. 1.0 [range 0.8 to 1.2], p < 0.001). In association with the significant difference of (11)C-PiB uptake in the myocardium between the chemotherapy naïve versus the previous chemotherapy group (median 10.4 [range 1.7 to 19.9] vs. 2.3 [range 1.7 to 3.8], p = 0.014), all except 1 patient among the 5 previously treated patients had responded to chemotherapy by serum free light chain assay results at the time of (11)C-PiB PET/CT scan.
CONCLUSIONS
(11)C-PiB PET/CT may be valuable for the diagnosis of cardiac amyloidosis noninvasively. Whether (11)C-PiB PET/CT may be a good surrogate marker of active light chain deposition in the myocardium warrants further investigation in a larger number of patients.
目的
本研究旨在探讨（11）C-Pittsburgh B（PiB）正电子发射断层扫描（PET）/计算机断层扫描（CT）在诊断心脏淀粉样变性中的作用。
背景
PiB 化合物在检测大脑中的淀粉样沉积物方面很有前景。
方法
这项单克隆丙种球蛋白病患者疑似心脏淀粉样变性的前瞻性试点研究共纳入 22 例连续患者。该研究包括在 1 个月内进行一系列（11）C-PiB PET/CT、超声心动图、心脏磁共振和心内膜心肌活检。此外，还招募了 10 名正常受试者，以确定（11）C-PiB PET/CT 扫描阳性的最佳截断值。
结果
在 22 例患者中，15 例经心内膜心肌活检诊断为心脏淀粉样变性，5 例患者在（11）C-PiB PET/CT 检查前已接受化疗。有心脏淀粉样变性和无心脏淀粉样变性患者的超声心动图参数无差异，仅左心室舒张末期内径存在边缘差异（中位数 41.0mm[范围 33.0 至 49.0mm] vs. 50.0mm[范围 38.0 至 55.0mm]，p=0.066）。15 例经活检证实的心脏淀粉样变性患者中，13 例（11）C-PiB PET/CT 阳性，而无心脏淀粉样变性患者均无（11）C-PiB PET/CT 扫描阳性结果。有心脏淀粉样变性和无心脏淀粉样变性患者的心肌与血腔的最大摄取比值差异有统计学意义（中位数 3.9[范围 1.7 至 19.9] vs. 1.0[范围 0.8 至 1.2]，p<0.001）。与先前化疗组相比，化疗初治组（11）C-PiB 在心肌中的摄取有显著差异（中位数 10.4[范围 1.7 至 19.9] vs. 2.3[范围 1.7 至 3.8]，p=0.014），在进行（11）C-PiB PET/CT 检查时，所有 5 例先前接受过治疗的患者中，除 1 例外，其血清游离轻链检测结果均提示对化疗有反应。
结论
（11）C-PiB PET/CT 可能对心脏淀粉样变性的无创诊断有价值。（11）C-PiB PET/CT 是否可以作为心肌中活性轻链沉积的良好替代标志物，还需要在更多患者中进一步研究。
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