Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds
Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds
Purpose
18F-Florbetapir has been reported to show cardiac uptake in patients with systemic light-chain amyloidosis (AL). This study systematically assessed uptake of 18F-florbetapir in patients with proven systemic amyloidosis at sites outside the heart.
Methods
Seventeen patients with proven cardiac amyloidosis underwent 18F-florbetapir PET/CT imaging, 15 with AL and 2 with transthyretin amyloidosis (ATTR). Three patients had repeat scans. All patients had protocolized assessment at the UK National Amyloidosis Centre including imaging with 123I-serum amyloid P component (SAP). 18F-Florbetapir images were assessed for areas of increased tracer accumulation and time–uptake curves in terms of standardized uptake values (SUVmean) were produced.
Results
All 17 patients showed 18F-florbetapir uptake at one or more extracardiac sites. Uptake was seen in the spleen in 6 patients (35%; 6 of 9, 67%, with splenic involvement on 123I-SAP scintigraphy), in the fat in 11 (65%), in the tongue in 8 (47%), in the parotids in 8 (47%), in the masticatory muscles in 7 (41%), in the lungs in 3 (18%), and in the kidney in 2 (12%) on the late half-body images. The 18F-florbetapir spleen retention index (SRI) was calculated. SRI >0.045 had 100% sensitivity/sensitivity (in relation to 123I-SAP splenic uptake, the current standard) in detecting splenic amyloid on dynamic imaging and a sensitivity of 66.7% and a specificity of 100% on the late half-body images. Intense lung uptake was seen in three patients, one of whom had lung interstitial infiltration suggestive of amyloid deposition on previous high-resolution CT. Repeat imaging showed a stable appearance in all three patients suggesting no early impact of treatment response.
Conclusion
18F-Florbetapir PET/CT is a promising tool for the detection of extracardiac sites of amyloid deposition. The combination of uptake in the heart and uptake in the spleen on 18F-florbetapir PET/CT, a hallmark of AL, suggests that this tracer holds promise as a screening tool for AL.
1129–1138
Wagner, T.
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Page, J
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Skillen, A
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Ross, James, Clark
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Manwani, R.
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McCool, D
ab0429ad-8f53-4612-b0c9-6098d1d8c3c4
Hawkins, P.N.
65de4839-1ea1-47d2-a477-cc96eab8c88f
Wechalekar, Ashutosh D.
bc29b606-bdbf-4f40-bf53-a472c776e743
16 March 2018
Wagner, T.
9be6a779-f4f5-4353-a8bf-81af48744c73
Page, J
903317a7-d4e4-455c-8ff7-81a9c659859c
Skillen, A
0cd78343-9322-41de-b118-b58f4bdb66b2
Ross, James, Clark
01f0b1a4-7f20-4283-b0b4-6b9c8534170e
Manwani, R.
04e4576f-e8ea-4cd1-834f-6b5c19e4455c
McCool, D
ab0429ad-8f53-4612-b0c9-6098d1d8c3c4
Hawkins, P.N.
65de4839-1ea1-47d2-a477-cc96eab8c88f
Wechalekar, Ashutosh D.
bc29b606-bdbf-4f40-bf53-a472c776e743
Wagner, T., Page, J, Skillen, A, Ross, James, Clark, Manwani, R., McCool, D, Hawkins, P.N. and Wechalekar, Ashutosh D.
(2018)
Extracardiac 18F-florbetapir imaging in patients with systemic amyloidosis: more than hearts and minds.
European Journal of Nuclear Medicine and Molecular Imaging, 45, .
(doi:10.1007/s00259-018-3995-2).
Abstract
Purpose
18F-Florbetapir has been reported to show cardiac uptake in patients with systemic light-chain amyloidosis (AL). This study systematically assessed uptake of 18F-florbetapir in patients with proven systemic amyloidosis at sites outside the heart.
Methods
Seventeen patients with proven cardiac amyloidosis underwent 18F-florbetapir PET/CT imaging, 15 with AL and 2 with transthyretin amyloidosis (ATTR). Three patients had repeat scans. All patients had protocolized assessment at the UK National Amyloidosis Centre including imaging with 123I-serum amyloid P component (SAP). 18F-Florbetapir images were assessed for areas of increased tracer accumulation and time–uptake curves in terms of standardized uptake values (SUVmean) were produced.
Results
All 17 patients showed 18F-florbetapir uptake at one or more extracardiac sites. Uptake was seen in the spleen in 6 patients (35%; 6 of 9, 67%, with splenic involvement on 123I-SAP scintigraphy), in the fat in 11 (65%), in the tongue in 8 (47%), in the parotids in 8 (47%), in the masticatory muscles in 7 (41%), in the lungs in 3 (18%), and in the kidney in 2 (12%) on the late half-body images. The 18F-florbetapir spleen retention index (SRI) was calculated. SRI >0.045 had 100% sensitivity/sensitivity (in relation to 123I-SAP splenic uptake, the current standard) in detecting splenic amyloid on dynamic imaging and a sensitivity of 66.7% and a specificity of 100% on the late half-body images. Intense lung uptake was seen in three patients, one of whom had lung interstitial infiltration suggestive of amyloid deposition on previous high-resolution CT. Repeat imaging showed a stable appearance in all three patients suggesting no early impact of treatment response.
Conclusion
18F-Florbetapir PET/CT is a promising tool for the detection of extracardiac sites of amyloid deposition. The combination of uptake in the heart and uptake in the spleen on 18F-florbetapir PET/CT, a hallmark of AL, suggests that this tracer holds promise as a screening tool for AL.
Text
Wagner2018_Article_Extracardiac18F-florbetapirIma
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Published date: 16 March 2018
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Local EPrints ID: 453651
URI: http://eprints.soton.ac.uk/id/eprint/453651
ISSN: 1619-7070
PURE UUID: f76d7fc2-b894-42a4-bfc5-eca368f3d842
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Date deposited: 20 Jan 2022 17:43
Last modified: 17 Mar 2024 04:03
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Contributors
Author:
T. Wagner
Author:
J Page
Author:
A Skillen
Author:
R. Manwani
Author:
D McCool
Author:
P.N. Hawkins
Author:
Ashutosh D. Wechalekar
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