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. 2022 Aug;29(4):1919-1932.
doi: 10.1007/s12350-021-02608-8. Epub 2021 Apr 16.

Cardiac amyloidosis characterization by kinetic model fitting on [18F]florbetaben PET images

M F Santarelli  1   2 , D Genovesi  3 , M Scipioni  4   5 , V Positano  3 , B Favilli  3 , A Giorgetti  3 , G Vergaro  6 , L Landini  3   7 , M Emdin  3   6 , P Marzullo  3
Affiliations

Cardiac amyloidosis characterization by kinetic model fitting on [18F]florbetaben PET images

M F Santarelli et al. J Nucl Cardiol. 2022 Aug.

Abstract

Objective: To evaluate the feasibility of kinetic modeling-based approaches from [18F]-Flobetaben dynamic PET images as a non-invasive diagnostic method for cardiac amyloidosis (CA) and to identify the two AL- and ATTR-subtypes.

Methods and results: Twenty-one patients with diagnoses of CA (11 patients with AL-subtype and 10 patients with ATTR-subtype of CA) and 15 Control patients with no-CA conditions underwent PET/CT imaging after [18F]Florbetaben bolus injection. A two-tissue-compartment (2TC) kinetic model was fitted to time-activity curves (TAC) obtained from left ventricle wall and left atrium cavity ROIs to estimate kinetic micro- and macro-parameters. Combinations of kinetic parameters were evaluated with the purpose of distinguishing Control subjects and CA patients, and to correctly label the last ones as AL- or ATTR-subtype. Resulting sensitivity, specificity, and accuracy for Control subjects were: 0.87, 0.9, 0.89; as far as CA patients, the sensitivity, specificity, and accuracy were respectively 0.9, 1, and 0.97 for AL-CA patients and 0.9, 0.92, 0.97 for ATTR-CA patients.

Conclusion: Pharmacokinetic analysis based on a 2TC model allows cardiac amyloidosis characterization from dynamic [18F]Florbetaben PET images. Estimated model parameters allows to not only distinguish between Control subjects and patients, but also between AL- and ATTR-amyloid patients.

Keywords: PET dynamic imaging; amyloid light chain (AL); amyloid transthyretin (ATTR); cardiac amyloidosis; kinetic parameters.

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