Shih Yu-Cheng, Tzeng Bing-Hsiean, Tsai Meng-Chieh, Yu Yuan-Bin, Shiau Yu-Chien, Wang Shan-Ying, Wu Yen-Wen
Division of Nuclear Medicine, Department of Radiology.
Division of Cardiology, Cardiovascular Center.
Acta Cardiol Sin. 2024 Sep;40(5):635-643. doi: 10.6515/ACS.202409_40(5).20240617D.
Cardiac amyloidosis (CA) is a type of systemic amyloidosis. Amyloid-targeting positron emission tomography (PET) has shown potential as an imaging method for CA. However, the optimal imaging protocol and role of F-florbetaben (FBB) PET in the diagnosis and subtyping of CA have yet to be determined.
Patients with suspected CA who had positive or equivocal results of technetium-99m pyrophosphate (PYP) scintigraphy were enrolled for dynamic and late FBB PET imaging. In addition to visual assessment, a kinetic modeling-based approach including target-to-background ratio (TBR) and myocardial retention fraction (RF) of serial images reconstructed from a 20-min dynamic acquisition, and a late image at 110 min post-injection were performed. We compared FBB PET measures of four typical patients with light chain amyloidosis (AL), wild-type transthyretin amyloidosis (ATTRwt), variant transthyretin amyloidosis (ATTRv), and heart failure, respectively. We also reviewed the literature on the clinical use of amyloid PET in CA.
Myocardial tracer retention was only found in the AL patient on the late images. TBR and RF were highest in the AL patient followed by the ATTRwt patient, and lowest in the ATTRv and non-CA patients.
FBB PET has potential in the detection and non-invasive subtyping of CA, especially in subjects with equivocal PYP findings or monoclonal gammopathy.
心脏淀粉样变性（CA）是一种全身性淀粉样变性。靶向淀粉样蛋白的正电子发射断层扫描（PET）已显示出作为CA成像方法的潜力。然而，F-氟代贝他苯（FBB）PET在CA诊断和亚型分类中的最佳成像方案及作用尚未确定。
对99m锝焦磷酸盐（PYP）闪烁扫描结果为阳性或不确定的疑似CA患者进行动态和延迟FBB PET成像。除了视觉评估外，还采用基于动力学建模的方法，包括从20分钟动态采集重建的系列图像的靶本底比（TBR）和心肌滞留分数（RF），以及注射后110分钟的延迟图像。我们分别比较了4例典型的轻链淀粉样变性（AL）、野生型转甲状腺素蛋白淀粉样变性（ATTRwt）、变异型转甲状腺素蛋白淀粉样变性（ATTRv）和心力衰竭患者的FBB PET测量值。我们还回顾了关于淀粉样蛋白PET在CA临床应用的文献。
仅在延迟图像上的AL患者中发现心肌示踪剂滞留。TBR和RF在AL患者中最高，其次是ATTRwt患者，在ATTRv和非CA患者中最低。
FBB PET在CA的检测和无创亚型分类方面具有潜力，尤其是在PYP结果不确定或存在单克隆丙种球蛋白病的患者中。
