Skip to main content
SpringerLink
Log in

Reproducibility and Repeatability of Assessment of Myocardial Light Chain Amyloidosis Burden Using 18F-Florbetapir PET/CT

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

18F-florbetapir PET is emerging as an excellent quantitative tool to quantify cardiac light chain (AL) amyloidosis burden. The primary aim of this study was to determine interobserver reproducibility and intraobserver repeatability, defined per the recommendations of the Quantitative Imaging Biomarker Alliance technical performance group, of PET 18F-florbetapir retention index (RI) in patients with cardiac AL amyloidosis.

Methods

The study cohort comprised 37 subjects with systemic AL amyloidosis enrolled in the prospective study: Molecular Imaging of Primary Amyloid Cardiomyopathy (clinical trials.gov NCT: 02641145). Using 10 mCi of 18F-florbetapir, a 60-minute dynamic cardiac scan was acquired. Global and segmental left ventricular estimates of retention index (RI) of 18F-florbetapir were calculated (Carimas 2.9 software, Turku, Finland). RI was analyzed twice, at least 24 hours apart, by two independent observers. Intraobserver repeatability and interobserver reproducibility were evaluated using Bland–Altman plots and scatter plots with fitted linear regression curves.

Results

All reproducibility (interobserver, r = 0.98) and repeatability (intraobserver, R=0.99 for each observer) measures of 18F-florbetapir RI are excellent. On the Bland–Altman plots, the agreement limits for global 18F-florbetapir RI were high and ranged for reproducibility (interobserver) from − 9.3 to + 9.4% (Fig. 1), and for repeatability (observer 1 from − 10.8 to + 10.7% and from − 9.2 to + 11.4%, for observer 2).

Conclusions

The present study showed excellent interobserver reproducibility and intraobserver repeatability of 18F-florbetapir PET retention index in patients with cardiac AL amyloidosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

Abbreviations

AL:

Light chain

AL-CMP:

Light chain amyloidosis with cardiomyopathy

PET:

Positron imaging tomography

RI:

Retention index

LV:

Left ventricle

NT-ProBNP:

N-terminal pro b-type natriuretic peptide

CTnT:

Cardiac troponin T

eGFR:

Estimated glomerular filtration rate

MICA:

Molecular Imaging of Primary Amyloid Cardiomyopathy

References

  1. Falk RH, Alexander KM, Liao R, Dorbala S. AL (light-chain) cardiac amyloidosis: A review of diagnosis and therapy. J Am Coll Cardiol. 2016;68:1323–41.

    Article  Google Scholar 

  2. Ruberg FL, Berk JL. Transthyretin (TTR) cardiac amyloidosis. Circulation. 2012;126:1286–300.

    Article  Google Scholar 

  3. Richards DB, Cookson LM, Berges AC, Barton SV, Lane T, Ritter JM, et al. Therapeutic clearance of amyloid by antibodies to serum amyloid P component. N Engl J Med. 2015;373:1106–14.

    Article  CAS  Google Scholar 

  4. Gertz MA, Landau H, Comenzo RL, Seldin D, Weiss B, Zonder J, et al. First-in-human phase I/II study of NEOD001 in patients with light chain amyloidosis and persistent organ dysfunction. J Clin Oncol. 2016;34:1097–103.

    Article  CAS  Google Scholar 

  5. Dorbala S, Kijewski MF, Park MA. Quantitative molecular imaging of cardiac amyloidosis: The journey has begun. J Nucl Cardiol. 2016;23:751–3.

    Article  Google Scholar 

  6. Park MA, Padera RF, Belanger A, Dubey S, Hwang DH, Veeranna V, et al. 18F-florbetapir binds specifically to myocardial light chain and transthyretin amyloid deposits: Autoradiography study. Circ Cardiovasc Imaging. 2015;8:e002954.

    Article  Google Scholar 

  7. Dorbala S. Imaging cardiac amyloidosis: An opportunity for nuclear cardiology. J Nucl Cardiol. 2014;21:1043–4.

    Article  Google Scholar 

  8. Raunig DL, Mcshane LM, Pennello G, Gatsonis C, Carson PL, Voyvodic JT, et al. Quantitative imaging biomarkers: A review of statistical methods for technical performance assessment. Stat Methods Med Res. 2014;24:27–67.

    Article  Google Scholar 

  9. Dorbala S, Vangala D, Semer J, Strader C, Bruyere JR Jr, Di Carli MF, et al. Imaging cardiac amyloidosis: A pilot study using (18)F-florbetapir positron emission tomography. Eur J Nucl Med Mol Imaging. 2014;41:1652–62.

    Article  CAS  Google Scholar 

  10. Nesterov SV, Turta O, Han C, Maki M, Lisinen I, Tuunanen H, et al. C-11 acetate has excellent reproducibility for quantification of myocardial oxidative metabolism. Eur Heart J Cardiovasc Imaging. 2015;16:500–6.

    Article  Google Scholar 

  11. Kero T, Lindsjo L, Sorensen J, Lubberink M. Accurate analysis and visualization of cardiac (11)C-PIB uptake in amyloidosis with semiautomatic software. J Nucl Cardiol. 2016;23:741–50.

    Article  Google Scholar 

Download references

Disclosure

RHF has received consulting fees from Ionis Pharmaceuticals and Alnylam Pharmaceuticals and research funding from GlaxoSmithKline. SD serves as a consultant for Proclara, Pfizer, AAA, and GEHC and has received research funds from Pfizer. The other authors do not have any conflicts to disclose.

Author information

Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Ariana Nodoushani BS, Mohammed Samir El-Sady BS, Mi-Ae Park PhD, Marcelo F. Di Carli MD, Marie Foley Kijewski DSc & Sharmila Dorbala MD, MPH

  2. Ponce Health Sciences University, Ponce, USA

    Gloria L. Castilloveitia MD

  3. Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Heart & Vascular Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Rodney H. Falk MD & Sharmila Dorbala MD, MPH

Authors
  1. Ariana Nodoushani BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed Samir El-Sady BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mi-Ae Park PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gloria L. Castilloveitia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rodney H. Falk MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcelo F. Di Carli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marie Foley Kijewski DSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sharmila Dorbala MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ariana Nodoushani BS.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast.

Funding

SD and RF are supported by NIH RO1 Grant (RO1 HL 130563); SD is supported by American Heart Association Grant (AHA 16 CSA 2888 0004).

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nodoushani, A., El-Sady, M.S., Park, MA. et al. Reproducibility and Repeatability of Assessment of Myocardial Light Chain Amyloidosis Burden Using 18F-Florbetapir PET/CT. J. Nucl. Cardiol. 28, 2004–2010 (2021). https://doi.org/10.1007/s12350-019-01961-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-019-01961-z

Keywords

Search

Navigation