18Fluorine sodium fluoride positron emission tomography, a potential biomarker of transthyretin cardiac amyloidosis.
Non-invasive imaging to diagnose and quantify amyloid load, progression, and response to treatment are central for the care of patients with cardiac amyloidosis.18Fluorine-labeled sodium fluoride (18F-NaF) is a widely available radioisotope and PET imaging allows for absolute quantification of tracer uptake.



Patients with biopsy-proven transthyretin (ATTR-CA) and light-chain cardiac amyloidosis (AL) (3 ATTRwt, 2 ATTRV122I, 2 AL) and controls (n = 5), underwent18F-NaF PET imaging. Scans were assessed visually for radiotracer uptake and analyzed using standard uptake values in the entire myocardium (SUVm) and in a 17-segment cardiac model. Wilcoxon rank-sum tests were used for statistical analyses.



Qualitative18F-NaF uptake was absent in controls and AL patients. There was qualitative18F-NaF uptake in ATTR-CA patients, with slightly increased uptake in wild-type patients. SUVm for controls and AL patients overlapped at 0.8(0.4-0.9) and 0.95(0.9-1.0), respectively (P = 0.434). At 1.5(1.4-1.7), SUVm for ATTR-CA patients was ≈1.5*SUVm of controls (P = 0.012) and AL patients (P = 0.078). While there was diffuse18F-NaF myocardial in ATTR-CA patients, the degree of uptake varied according to cardiac segment.



18F-NaF PET effectively imaged and differentiated ATTR-CA patients. Semi-automatic software enabled quantification of radiotracer uptake and regional distribution.18F-NaF PET may be useful for disease monitoring and localizing amyloid deposition in ATTR-CA patients.
Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA. rm3090@cumc.columbia.edu.
Rachelle
R
Morgenstern
Department of Radiology, Columbia University College of Physicians and Surgeons, Box 28, New York, NY, 10032, USA.
Randy
R
Yeh
Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA.
Adam
A
Castano
Center for Advanced Center for Heart Failure, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH12-1391, New York, NY, 10032, USA.
Mathew S
MS
Maurer
Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA.
Sabahat
S
Bokhari
D000368:Aged; D000369:Aged, 80 and over; D028227:Amyloid Neuropathies, Familial / Q000000981:diagnostic imaging*; D015415:Biomarkers; D009202:Cardiomyopathies / Q000000981:diagnostic imaging; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012969:Sodium Fluoride
D015415:Biomarkers; D005462:Fluorine Radioisotopes; D012969:Sodium Fluoride; C000615276:Fluorine-18