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

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Journal of Nuclear Cardiology Aims and scope

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.

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Abbreviations

AL:

Immunoglobulin light-chain derived amyloidosis

ATTR:

Transthyretin derived amyloidosis

AIC:

Akaike information criterion

AUC:

Area under curves

CA:

Cardiac amyloidosis

CMR:

Cardiac magnetic resonance

EF:

Ejection fraction

MBF:

Myocardial blood flow

OSEM:

Ordered-subset expectation maximization

PW:

Posterior wall

RI:

Retention index

ROI:

Region of interest

SUV:

Standardized uptake value

SVM:

Support vector machine

TAC:

Time/activity curve

TBR:

Target to background ratio

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Acknowledgments

Authors would like to thank Dr. Simona Muccioli for the precious support given in the clinical data analysis.

Disclosure

No potential conflict of interest relevant to this article was reported

Author information

Authors and Affiliations

  1. CNR Institute of Clinical Physiology, CNR Research Area – Via Moruzzi, 1, 56124, Pisa, Italy

    M. F. Santarelli MF, PhD & M. Scipioni

  2. Fondazione Toscana “G. Monasterio”, Pisa, Italy

    M. F. Santarelli MF, PhD, D. Genovesi MD, V. Positano MSc, B. Favilli MSc, A. Giorgetti MD, L. Landini, M. Emdin MD, PhD & P. Marzullo MD

  3. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    M. Scipioni

  4. Scuola Universitaria Superiore ‘S. Anna”, Pisa, Italy

    G. Vergaro MD & M. Emdin MD, PhD

  5. Dipartimento di Ingegneria dell’Informazione: DII, Pisa University, Pisa, Italy

    L. Landini

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Santarelli, M.F., Genovesi, D., Scipioni, M. et al. Cardiac amyloidosis characterization by kinetic model fitting on [18F]florbetaben PET images. J. Nucl. Cardiol. 29, 1919–1932 (2022). https://doi.org/10.1007/s12350-021-02608-8

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