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18F-sodium fluoride PET/MRI myocardial imaging in patients with suspected cardiac amyloidosis

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We evaluated the diagnostic performance of 18F-NaF PET/MRI in patients with suspected cardiac amyloidosis (CA).

Methods

Twenty-seven consecutive patients underwent myocardial PET 1 hour after injection of 4 MBq/kg 18F-NaF with simultaneous MRI including cine-MRI, T1 and T2 mapping, first-pass and late gadolinium enhancement (LGE). 18F-NaF uptake was measured visually and semi-quantitatively by calculating myocardium-to-blood pool (M/B) ratios. CA was confirmed histologically.

Results

Transthyretin (TTR)-CA was diagnosed in 16 patients, light-chain (AL)-CA in 7, and no-CA in 4. Visual interpretation of 18F-NaF images revealed a relative increase in myocardial uptake in only 3 patients, all with TTR CA, and a relative decrease in 13, including 7 AL CA, 3 no-CA, and 3 TTR CA. M/B ratios were significantly higher in TTR CA (1.00 ± 0.12) than in AL CA (0.81 ± 0.06, P = 0.001) or in no-CA (0.73 ± 0.16, P = 0.006). The optimal M/B cut-off to distinguish TTR CA from AL CA was ≥ 0.90 (Fischer, P = 0.0005). By comparison, classification of patients using 99mTc-HMDP heart-to-mediastinum ratios with the previously published cut-off ≥ 1.21 reached higher significance (P < 0.0001). Among MRI parameters, myocardial T1, LGE score, and extracellular volume were higher in CA than in no-CA patients, 1409 ± 76 vs 1278 ± 35 ms (P = 0.004), 10.35 ± 5.30 vs 3.50 ± 3.42 (P = 0.03), and 46 ± 10 vs 33 ± 8 % (P = 0.01), respectively.

Conclusion

18F-NaF PET/MRI shows good diagnostic performance when semi-quantification is used. However, contrast is low and visual interpretation may be challenging in routine. PET/MRI could constitute a one-stop-shop evaluation of amyloid load and cardiac function in patients needing rapid work-up.

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Abbreviations

18F-NaF:

18F-sodium fluoride

PET/MRI:

Positron emission tomography/magnetic resonance imaging

TTR:

Transthyretin

AL:

Light-chain

CA:

Cardiac amyloidosis

99mTc-HMDP:

99mTc-hydroxymethylene diphosphonate

SUV:

Standardized uptake value

LGE:

Late gadolinium enhancement

NTproBNP:

N-terminal pro-brain natriuretic peptide

ROC:

Receiver operating characteristics

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Disclosures

All authors have approved the manuscript, and agree with its submission to the Journal of Nuclear Cardiology. There is no financial or other relation that could lead to a conflict of interest.

Ethical approval

The procedure followed was in accordance with the ethical standards guidelines of the responsible committee on human experimentation.

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Authors and Affiliations

  1. SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France

    Mukedaisi Abulizi MD, Islem Sifaoui MD, Mijiti Wuliya-Gariepy MD, Jean-Marc Israël MD, Berivan Emsen MD, Vania Tacher MD, Alain Luciani MD, PhD, Jean-François Deux MD, PhD & Emmanuel Itti MD, PhD

  2. Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France

    Mukedaisi Abulizi MD, Islem Sifaoui MD, Mounira Kharoubi MD, Diane Bodez MD, Vania Tacher MD, Thibaud Damy MD, PhD, Jean-François Deux MD, PhD & Emmanuel Itti MD, PhD

  3. Department of Cardiology, CHU Henri Mondor, AP-HP/U-PEC, 94010, Créteil, France

    Mijiti Wuliya-Gariepy MD, Mounira Kharoubi MD, Diane Bodez MD & Thibaud Damy MD, PhD

  4. Siemens Healthineers, Erlangen, Germany

    Aurélien Monnet MSc & David Didierlaurent PhD

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  1. Mukedaisi Abulizi MD
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  2. Islem Sifaoui MD
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  6. Berivan Emsen MD
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  12. Thibaud Damy MD, PhD
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  13. Jean-François Deux MD, PhD
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  14. Emmanuel Itti MD, PhD
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Corresponding author

Correspondence to Emmanuel Itti MD, PhD.

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Abulizi, M., Sifaoui, I., Wuliya-Gariepy, M. et al. 18F-sodium fluoride PET/MRI myocardial imaging in patients with suspected cardiac amyloidosis. J. Nucl. Cardiol. 28, 1586–1595 (2021). https://doi.org/10.1007/s12350-019-01885-8

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