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Examining the sensitivity of 18F-NaF PET for the imaging of cardiac amyloidosis

  • Patrick Martineau
  • Vincent Finnerty
  • Geneviève Giraldeau
  • Sébastien Authier
  • Francois Harel
  • Matthieu Pelletier-GalarneauEmail author
Original Article

Abstract

Background

Conventional nuclear imaging with bone-seeking radiopharmaceuticals has been shown to be a sensitive test for the detection of transthyretin cardiac amyloidosis (ATTR); however, to date, few data exist on the utility of 18F-sodium fluoride (NaF) positron emission tomography (PET) in subjects with cardiac amyloidosis (CA).

Methods

Myocardial perfusion imaging and cardiac 18F-NaF PET/CT of 7 subjects with ATTR, four with light-chain CA (AL), and four controls were retrospectively reviewed. Qualitative interpretation and quantitative analyses with average left ventricular standardized uptake values (SUVmean) and target-to-background ratios (TBRmean) were performed.

Results

Average TBRmean was significantly increased in subjects with ATTR (0.98 ± 0.09) compared to AL (0.85 ± 0.08, P = .026) and CTL (0.82 ± 0.07, P = .020), while SUVmean was not (P = .14). Receiver-operator characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.91, with a sensitivity/specificity of 75%/100% for TBRmean using a cutoff value of 0.89 for the diagnosis of ATTR. Qualitative interpretation resulted in a sensitivity/specificity of 57%/100% for ATTR.

Conclusions

While 18F-NaF PET/CT demonstrates good diagnostic accuracy for ATTR, particularly when using quantitative analysis, the low TBRmean values observed in ATTR indicate poor myocardial signal. 18F-NaF PET/CT is not yet ready for clinical use in CA until further comparison studies are performed with 99mTc-DPD/PYP.

Keywords

Cardiac amyloidosis transthyretin ATTR bone scintigraphy sodium fluoride positron emission tomography 

Abbreviations

AL

Light-chain amyloidosis

ATTR

Transthyretin cardiac amyloidosis

CA

Cardiac amyloidosis

cMRI

Contrast enhanced magnetic resonance imaging

DPD

Diphosphonopropanodicarboxylic acid

EMB

Endomyocardial biopsy

LVH

Left ventricular hypertrophy

MDP

Methylene diphosphonate

NaF

Sodium fluoride

PYP

Pyrophosphate

SUV

Standard uptake value

TBR

Target-to-background ratio

Notes

Disclosures

Patrick Martineau, Vincent Finnerty, Geneviève Giraldeau, Sébastien Authier, Francois Harel, and Matthieu Pelletier-Galarneau have nothing to disclose.

Supplementary material

12350_2019_1675_MOESM1_ESM.pptx (8.7 mb)
Supplementary material 1 (PPTX 8864 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Patrick Martineau
    • 1
    • 2
  • Vincent Finnerty
    • 3
  • Geneviève Giraldeau
    • 4
  • Sébastien Authier
    • 3
  • Francois Harel
    • 3
  • Matthieu Pelletier-Galarneau
    • 2
    • 3
    Email author
  1. 1.Department of RadiologyHealth Sciences Centre, University of ManitobaWinnipegCanada
  2. 2.Gordon Center for Medical Imaging, Massachusetts General HospitalHarvard UniversityBostonUSA
  3. 3.Department of Medical ImagingInstitut de Cardiologie de MontréalMontrealCanada
  4. 4.Department of MedicineInstitut de Cardiologie de MontréalMontréalCanada

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