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

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Journal of Nuclear Cardiology Aims and scope

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.

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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

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Disclosures

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

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Authors and Affiliations

  1. Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada

    Patrick Martineau MD, PhD

  2. Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Patrick Martineau MD, PhD & Matthieu Pelletier-Galarneau MD, MSc

  3. Department of Medical Imaging, Institut de Cardiologie de Montréal, 5000 Belanger, Montreal, QC, H1T1C8, Canada

    Vincent Finnerty MSc, Sébastien Authier B Eng, Francois Harel MD, PhD & Matthieu Pelletier-Galarneau MD, MSc

  4. Department of Medicine, Institut de Cardiologie de Montréal, Montréal, Canada

    Geneviève Giraldeau MD

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Correspondence to Matthieu Pelletier-Galarneau MD, MSc.

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Martineau, P., Finnerty, V., Giraldeau, G. et al. Examining the sensitivity of 18F-NaF PET for the imaging of cardiac amyloidosis. J. Nucl. Cardiol. 28, 209–218 (2021). https://doi.org/10.1007/s12350-019-01675-2

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