Diagnostic Accuracy of [ 11 C]PIB Positron Emission Tomography for Detection of Cardiac Amyloidosis

Sara Rosengren, Tor Skibsted Clemmensen, Lars Tolbod, Sven-Olof Granstam, Hans Eiskjær, Gerhard Wikström, Ola Vedin, Tanja Kero, Mark Lubberink, Hendrik J Harms, Frank A Flachskampf, Tomasz Baron, Kristina Carlson, Fabian Mikkelsen, Gunnar Antoni, Niels Frost Andersen, Steen Hvitfeldt Poulsen, Jens Sörensen
JACC. Cardiovascular Imaging 2020 May 8

OBJECTIVES: This dual-site study evaluated the diagnostic accuracy of the method.

BACKGROUND: Pittsburgh compound ([11 C]PIB) positron emission tomography (PIB-PET) has shown promise as a specific and noninvasive method for the diagnosis of cardiac amyloidosis (CA).

METHODS: The study had 2 parts. In the initial study, 51 subjects were included, 36 patients with known CA and increased wall thickness (15 immunoglobulin light chain [AL] and 21 transthyretin [ATTR] amyloidosis) and 15 control patients (7 were nonamyloid hypertrophic and 8 healthy volunteers). Subjects underwent PIB-PET and echocardiography. Sensitivity and specificity of PIB-PET were established for 2 simple semiquantitative approaches, standardized uptake value ratio (SUVR) and retention index (RI). The second part of the study included 11 amyloidosis patients (5 AL and 6 hereditary ATTR) without increased wall thickness to which the optimal cutoff values of SUVR (>1.09) and RI (>0.037 min-1 ) were applied prospectively.

RESULTS: The diagnostic accuracy of visual inspection of [11 C]PIB uptake was 100% in discriminating CA patients with increased wall thickness from controls. Semiquantitative [11 C]PIB uptake discriminated CA from controls with a 94% (95% confidence interval [CI]: 80% to 99%) sensitivity for both SUVR and RI and specificity of 93% (95% CI: 66% to 100%) for SUVR and 100% (95% CI: 75% to 100%) for RI. [11 C]PIB uptake was significantly higher in AL-CA than in ATTR-CA patients (p < 0.001) and discriminated AL-CA from controls with 100% (95% CI: 88% to 100%) accuracy for both the semiquantitative measures. In the prospective group without increased wall thickness, RI was elevated compared to controls (p = 0.001) and 5 of 11 subjects were evaluated as [11 C]PIB PET positive.

CONCLUSIONS: In a dual-center setting, [11 C]PIB PET was highly accurate in detecting cardiac involvement in the main amyloid subtypes, with 100% accuracy in AL amyloidosis. A proportion of amyloidosis patients without known cardiac involvement were [11 C]PIB PET positive, indicating that the method may detect early stages of CA.

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