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Non-invasive cardiac imaging in patients with systemic amyloidosis: a practical approach with emphasis on clinical contribution of bone-seeking radiotracers

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Abstract

Purpose

Cardiac amyloidosis is a rare and still underdiagnosed disease leading a poor prognosis. We reviewed the literature regarding non-invasive imaging of cardiac amyloidosis (i.e., echocardiography, magnetic resonance, and nuclear medicine imaging) with special attention to the clinical contribution of bone-seeking radiotracers.

Methods

We performed a PubMed and Scopus literature search using keywords related to imaging of cardiac involvement in systemic amyloidosis. In particular, a review of studies published in the English literature between 2002 and 2017 dealing with clinical contribution of in vivo nuclear medicine imaging using bone-seeking radiotracers has been performed; studies that do not clearly report final diagnoses have been excluded.

Results

Interest for cardiac amyloidosis imaging has raised in the last years; in particular, about 20 recent studies evaluating imaging with bone-seeking radiotracers have been considered for the review. Echocardiography represents the first imaging approach, although its sensitivity (in the early stage) and specificity are limited. Magnetic resonance imaging can show highly suggestive signs for cardiac amyloidosis. Imaging with bone-seeking radiotracers has high accuracy in revealing cardiac amyloidosis etiology—both sensitivity and specificity reach 100% in selected groups of patients—and performs better than other imaging modalities in revealing the early cardiac amyloidosis. PET radiotracers’ contribution is still under investigation.

Conclusions

Imaging can aid in differentiating cardiac amyloidosis from other diseases providing prognostic information. Bone-seeking radiotracers can establish the type of amyloidosis, even without performing biopsy, in a large part of patients, and are able to early detect cardiac involvement in subjects with transthyretin gene mutations.

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Authors and Affiliations

  1. Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy

    Fabio Minutoli, Riccardo Laudicella & Sergio Baldari

  2. Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy

    Gianluca Di Bella & Giuseppe Vita

  3. Department of Imaging and Pathology, KU Leuven-University of Leuven, Louvain, Belgium

    Jan Bogaert

Authors
  1. Fabio Minutoli
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  2. Gianluca Di Bella
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  3. Giuseppe Vita
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  4. Riccardo Laudicella
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  5. Jan Bogaert
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  6. Sergio Baldari
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Contributions

Author contributions

FM: literature search and review, manuscript writing and editing, and content planning. GDB: literature search and review, and manuscript writing. GV: literature search and review, and manuscript writing. RL: literature search and review, and manuscript writing. JB: manuscript editing. SB: manuscript editing and content planning.

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Correspondence to Fabio Minutoli.

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All authors declare that this review is in compliance with the ethical standards of the Journal “Clinical and Translational Imaging”. For this type of study, formal consent is not required.

Conflict of interest

Giuseppe Vita is PI of TTR-FAP trials of Alnylam Pharm. and Ionis Pharm., recipient of research grants from Pfizer and Alnylam Pharm., recipient of honoraria from Alnylam Pharm., Avexis Pharm., Pfizer, Italfarmaco. The other authors (Fabio Minutoli, Gianluca Di Bella, Riccardo Laudicella, Jan Bogaert, and Sergio Baldari) declare that they have no conflict of interest.

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Minutoli, F., Di Bella, G., Vita, G. et al. Non-invasive cardiac imaging in patients with systemic amyloidosis: a practical approach with emphasis on clinical contribution of bone-seeking radiotracers. Clin Transl Imaging 5, 545–559 (2017). https://doi.org/10.1007/s40336-017-0255-6

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  • DOI: https://doi.org/10.1007/s40336-017-0255-6

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