18 F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac amyloidosis (n=14). Intervention: 18F-sodium fluoride PET/MR vs. AL amyloidosis patients and healthy controls. Primary outcome: Myocardial target-to-background ratio (TBRmax) of 18F-sodium fluoride.

Q: What does this research mean for the field?

18F-sodium fluoride PET/MR shows significantly higher myocardial tracer uptake in patients with ATTR cardiac amyloidosis compared to patients with AL amyloidosis and control subjects, allowing differentiation between the two forms. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Maria Giovanna Trivieri; Marc Richard Dweck; Ronan Abgral; Philip M. Robson; Nicolas A. Karakatsanis; Anuradha Lala; Johanna Contreras; Gagan Sahni; Radha S. Gopalan; Peter D. Gorevic; Valentı́n Fuster; Jagat Narula; Zahi Adel Fayad

doi:10.1016/j.jacc.2016.09.953

December 1, 2016Journal of the American College of CardiologyOpen Access

18 F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis

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Key result

18F-NaF PET/MR shows ~48% higher myocardial uptake in ATTR cardiac amyloidosis versus AL amyloidosis.

n=14

Why the study?

Differentiation between AL and ATTR cardiac amyloidosis is important due to different prognoses and treatment strategies, but current imaging cannot distinguish them in a single scan.

Does 18 F-sodium fluoride hybrid PET/MR imaging differentiate ATTR from AL cardiac amyloidosis?

Key Points

To evaluate whether simultaneous hybrid 18 F-sodium fluoride PET/MR imaging can identify cardiac amyloidosis and differentiate between ATTR and AL subtypes in a single scan.
Conducted simultaneous dynamic 18 F-sodium fluoride PET (386 ± 69 MBq) and CMR (cine imaging, late gadolinium enhancement, and T1 mapping) using a hybrid PET/MR system with a 90-minute bed time.
All amyloid patients displayed diffuse myocardial late gadolinium enhancement, but native T1 mapping could not distinguish between AL and ATTR subtypes (1405 ± 26 ms vs. 1464 ± 160 ms, p = 0.57).
Myocardial 18 F-sodium fluoride uptake in ATTR patients (TBRmax = 1.14 ± 0.24) was 68% higher than in controls (TBRmax = 0.68 ± 0.04) and 48% higher than in AL amyloid patients (TBRmax = 0.77 ± 0.06).
A TBRmax threshold of >0.84 differentiated all ATTR cases, and PET uptake correlated with amyloid burden on native T1 mapping in ATTR patients (r 2 = 0.93; p = 0.04).

Study Design

Type

Cross-Sectional (n=14)

Structured PICO

Does 18 F-sodium fluoride hybrid PET/MR imaging differentiate ATTR from AL cardiac amyloidosis?

P

Population

14 subjects (mean age 61, 29% female), including 4 with ATTR cardiac amyloidosis, 3 with AL amyloidosis, and 7 healthy controls, evaluated with a single hybrid PET/MR scan.

E

Exposure

Simultaneous 18 F-sodium fluoride positron emission tomography and cardiovascular magnetic resonance (hybrid PET/MR) imaging.

C

Comparator

Comparison between patients with ATTR amyloid, AL amyloid, and control subjects.

O

Outcome

Myocardial 18 F-sodium fluoride uptake quantified using standard uptake values and target-to-background ratio (TBR) after correction for blood-pool activity.surrogate

Main Result

Absolute Event Rate: 1.14% vs 0.77%

Limitations

Small cohort size
Small cohort size, limiting representativeness

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Implication

Hybrid 18 F-sodium fluoride PET/MR imaging can successfully differentiate ATTR from AL cardiac amyloidosis, showing significantly increased uptake only in patients with ATTR.

Abstract

Cardiac amyloidosis exists in 2 predominant forms: acquired monoclonal immunoglobulin light-chain (AL) and transthyretin-related (familial and wild-type/senile) amyloid (ATTR). Differentiation is important because they have different prognoses and are amenable to different treatment strategies.

Discussion

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Cite This Study

Trivieri et al. (2016) conducted a cross-sectional in Cardiac amyloidosis (n=14). 18F-sodium fluoride PET/MR vs. AL amyloidosis patients and healthy controls was evaluated on Myocardial target-to-background ratio (TBRmax) of 18F-sodium fluoride. 18F-sodium fluoride PET/MR demonstrated higher myocardial uptake in patients with ATTR cardiac amyloidosis (TBRmax 1.14) compared to those with AL amyloidosis (0.77) and controls (0.68).

synapsesocial.com/papers/6acf69773316c606f341f98f https://doi.org/10.1016/j.jacc.2016.09.953

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18 F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

18 F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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