Logo image
Back
Quantification of Right Ventricular Amyloid Burden with Dynamic 18F-Florbetaben PET/CT and its Correlation with 99mTc-Pyrophosphate Scintigraphy, Echocardiography and Cardiac Magnetic Resonance in Patients with Non-Invasive Diagnosis of Transthyretin Cardiac Amyloidosis: A Pilot Study
Abstract   Open access   Peer reviewed

Quantification of Right Ventricular Amyloid Burden with Dynamic 18F-Florbetaben PET/CT and its Correlation with 99mTc-Pyrophosphate Scintigraphy, Echocardiography and Cardiac Magnetic Resonance in Patients with Non-Invasive Diagnosis of Transthyretin Cardiac Amyloidosis: A Pilot Study

Adriana Pereira Glavam, Marcelo Imbroinise Bittencourt, Paulo Henrique Rosado de Castro, Francisco de Assis Romeiro Figueiroa Benício Coelho, Adriana Soares Xavier de Brito, Isabella Palazzo, Christiane Sacramento Magalhaes, Alex dos Santos Félix, Ana Paula dos Reis Velloso Siciliano, Gabriel Cordeiro Camargo, …
Journal of nuclear cardiology, Vol.62(Supplement), 102889
09/2026
DOI: 10.1016/j.nuclcard.2026.102889
url
https://doi.org/10.1016/j.nuclcard.2026.102889View
Published (Version of record) Open Access

Abstract

Introduction: Right ventricular (RV) uptake on bone seeking tracer scintigraphy has emerged as a prognostic marker in transthyretin cardiac amyloidosis (ATTR-CA). However, how to estimate right ventricular (RV) amyloid burden using 18F-Florbetaben PET/CT in ATTR-CA remains understudied. This pilot study aimed to quantify RV amyloid burden on 18F-Florbetaben PET/CT and assess its correlation with 99mTc-phyrophosphate scintigraphy, echocardiographic, cardiac magnetic resonance (CMR) imaging parameters, and biomarkers. Methods: Non-invasive diagnosis was established by visual myocardial uptake grade 2 or 3 on SPECT/CT in the absence of monoclonal gammopathy. Extensive RV uptake on SPECT/CT was defined as tracer uptake encompassing the apical, mid-ventricular and basal segments while partial uptake was defined as involvement of basal or mid-ventricular segments. ATTR-CA patients and 9 healthy volunteers further underwent a dynamic cardiac 18F-Florbetaben PET/CT scan performed for up to 40 minutes. Whole-heart static images were retrospectively reconstructed from the dynamic list-mode acquisition between 6 -11 min (Static 1), 15 -20 min (Static 2) and 25-30 min (Static 3). PMOD software was used to calculate left ventricle (LV) and right ventricle (RV) SUV averaged, SUV SD and blood pool in each of these intervals. VOIs were manually drawn contouring LV and RV walls, and blood pool activity (10 mm radius sphere in the left atrium). A cardiac time-activity curve (TAC) for LV, RV and blood pool was also acquired. Patients provided informed consent, and the study was approved by the institutional ethics committee. Results: Fifteen patients were enrolled (mean age 77.9 ± 5.4, 86.7% male, 55.3 % African descent). Hereditary ATTR was most prevalent (Val122Ile 60.0%). A visual score of 3 for left ventricular uptake was observed in all SPECT/CT, with a predominantly homogeneous uptake pattern (86.7%). RV uptake was identified in 80.0% of scans. Extensive and partial RV uptake was present in 66.7% and 13.4%, respectively. RV uptake was detected in all PET/CT scans. Importantly, amyloid burden in those with partial or no RV uptake on scintigraphy was similar to those with extensive RV uptake on PET/CT. RV amyloid burden on PET/CT strongly correlated with NT-pro-BNP, LV and RV strain, RV and LV EF, TAPSE and ECV (each p< 0.05). PET/CT values of the nine controls were statistically significantly lower than ATTR-CA patients validating the methodology used to define RV amyloid burden. Conclusion: 18F-Florbetaben PET/CT may be more sensitive in identifying RV involvement then scintigraphy. Moreover, RV amyloid burden strongly correlated to NT-pro-BNP, echocardiography and CMR prognostic parameters suggesting that RV amyloid burden on PET/CT could be a novel marker of poor prognosis in ATTR-CA. Larger studies with longitudinal outcome data are needed to establish the independent prognostic value.

Details

Metrics

1 Record Views
Logo image