Bridging Diagnostic Gaps in AL Cardiac Amyloidosis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: AL cardiac amyloidosis (n=1). Intervention: 68 Ga-FAPI-46 PET/CT.

Q: What does this research mean for the field?

68 Ga-FAPI-46 PET/CT enables accurate diagnosis of AL cardiac amyloidosis after inconclusive conventional testing. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Srinivas Ananth Kumar; Harish Goyal; A Shaheer Ahmed; Prashanth Srinivasan; Dhanapathi Halanaik

doi:10.1097/rlu.0000000000006325

January 21, 2026Clinical Nuclear Medicine

Bridging Diagnostic Gaps in AL Cardiac Amyloidosis

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Key result

68 Ga-FAPI-46 PET/CT guides repeat biopsy to confirm AL cardiac amyloidosis after equivocal standard workup.

n=1

Why the study?

AL cardiac amyloidosis is challenging to diagnose due to limitations of biopsy and conventional imaging.

Does 68 Ga-FAPI-46 PET/CT improve diagnostic accuracy in patients with suspected AL cardiac amyloidosis and an equivocal conventional workup?

Key Points

This report aims to showcase the diagnostic challenges and highlight the effectiveness of FAPI PET/CT in confirming AL cardiac amyloidosis.
Presented a case of a 56-year-old man with symptoms of dyspnea and palpitations.
Utilized echocardiography and cardiac MRI for initial assessment.
Performed multiple biopsies including bone marrow and endomyocardial, which yielded inconclusive results.
Applied 68 Ga-FAPI-46 PET/CT imaging to assess myocardial uptake.
Echocardiography revealed hypertrophic cardiomyopathy with reduced ejection fraction.
Initial imaging and biopsy results were inconclusive, complicating diagnosis.
FAPI PET/CT showed intense myocardial uptake leading to a repeat bone marrow biopsy that confirmed AL amyloidosis.

Study Design

Type

Case Report (n=1)

Structured PICO

Does 68 Ga-FAPI-46 PET/CT improve diagnostic accuracy in patients with suspected AL cardiac amyloidosis and an equivocal conventional workup?

P

Population

1 56-year-old man with progressive dyspnea, palpitations, and macroglossia, with echocardiography revealing hypertrophic cardiomyopathy with reduced ejection fraction and inconclusive initial diagnostic workup for AL cardiac amyloidosis.

I

Intervention

68 Ga-FAPI-46 PET/CT

C

Comparator

Conventional diagnostic workup (Cardiac MRI, bone marrow biopsy, endomyocardial biopsy, and 99m Tc-pyrophosphate scintigraphy)

O

Outcome

Diagnostic confirmation of AL amyloidosissurrogate

68 Ga-FAPI-46 PET/CT may serve as a valuable diagnostic tool to clarify the diagnosis of AL cardiac amyloidosis when conventional imaging and biopsies yield equivocal results.

Implication

May aid select equivocal AL amyloidosis cases; hypothesis-generating and should not change practice.

Abstract

AL cardiac amyloidosis (CA) is challenging to diagnose due to limitations of biopsy and conventional imaging. Endomyocardial biopsy (EMB) can yield false negatives, and 99m Tc-pyrophosphate scintigraphy is less reliable for AL amyloidosis. We report a 56-year-old man with progressive dyspnea, palpitations, and macroglossia, in whom echocardiography revealed hypertrophic cardiomyopathy with reduced ejection fraction. Cardiac MRI, bone marrow biopsy (BMB), and EMB were inconclusive, while PYP scintigraphy was equivocal. 68 Ga-FAPI-46 PET/CT demonstrated intense myocardial uptake, prompting a repeat BMB confirming AL amyloidosis. This case underscores the emerging role of FAPI PET/CT in clarifying diagnosis after an equivocal workup, enabling targeted therapy.

Discussion

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Cite This Study

Kumar et al. (2026) conducted a case report in AL cardiac amyloidosis (n=1). 68 Ga-FAPI-46 PET/CT was evaluated. 68 Ga-FAPI-46 PET/CT demonstrated intense myocardial uptake in a 56-year-old man with an equivocal standard workup, successfully guiding a repeat biopsy to confirm AL cardiac amyloidosis.

synapsesocial.com/papers/6984348bf1d9ada3c1fb2c09 https://doi.org/10.1097/rlu.0000000000006325

Topics

Cardiomyopathy

Cardiac amyloidosis

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Bridging Diagnostic Gaps in AL Cardiac Amyloidosis

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Topics

Bridging Diagnostic Gaps in AL Cardiac Amyloidosis

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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