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

• Published in: Journal of nuclear cardiology Vol. 29; no. 4; pp. 1919 - 1932
• Main Authors: Santarelli, M.F., Genovesi, D., Scipioni, M., Positano, V., Favilli, B., Giorgetti, A., Vergaro, G., Landini, L., Emdin, M., Marzullo, P.
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01.08.2022; Springer International Publishing; Springer Nature B.V
• Subjects: amyloid light chain (AL); Amyloid Neuropathies, Familial; amyloid transthyretin (ATTR); Amyloidosis; Aniline Compounds; cardiac amyloidosis; Cardiology; Cardiomyopathies; Humans; Imaging; kinetic parameters; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; PET dynamic imaging; Positron Emission Tomography Computed Tomography; Radiology; Stilbenes; EF; amyloid transthyretin (ATTR); TBR; PW; CMR; OSEM; AL; SVM; ROI; ATTR; AUC; kinetic parameters; MBF; SUV; PET dynamic imaging; RI; TAC; cardiac amyloidosis; AIC; CA; amyloid light chain (AL)
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-021-02608-8

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. 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. 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.