Diagnostic value of Al18F-NOTA-FAPI PET/CT imaging in light chain cardiac amyloidosis
Objective To explore the diagnostic value of Al18F-1,4,7-triazacyclononane-l,4,7-triacetic acid(NOTA)-fibroblast activation protein inhibitor(FAPI)PET/CT imaging in light chain cardiac amyloidosis(AL-CA).Methods The clinical data of 8 patients(7 males and 1 female,aged(62.9±5.6)years)diagnosed with AL-CA in Beijing Chao-Yang Hospital,Capital Medical University from September to December 2021 were prospectively studied.Five healthy volunteers and 5 patients with multiple myeloma(MM),who matched the gender and age with AL-CA patients,were recruited as controls.All subjects were divided into 4 groups:5 cases in the AL-CA+MM group(AL-CA with MM),3 cases in the AL-only group(AL-CA without MM),5 cases in the MM control group(MM without AL-CA),and 5 cases in the healthy control group.All subjects underwent Al18F-NOTA-FAPI PET/CT imaging.Laboratory index type B natriuretic peptide(BNP)level,echocardiography data,and Al18F-NOTA-FAPI PET/CT imaging results were analyzed.Measurement data were compared among the 4 groups by using LSD or Kruskal-Wallis test and between 2 groups by independent samples t-test(homogeneity of variance).Enumeration data were compared by x2 test.Results BNP level in the AL-only group was higher than that in the MM control group,and the difference was statistically significant((259.0±40.0)pg/ml vs.(19.2±15.7)pg/ml,t=9.928,P＜0.05).The left ventricular interventricular septum thickness and the left ventricular posterior wall thickness increased in the AL-CA+MM group,and the differences were statistically significant((13.9±1.1)mm vs.(10.8±0.3)mm,t=6.197,P＜0.05;(13.7±0.9)mm vs.(10.3±0.6)mm,t=6.774,P＜0.05).Al18F-NOTA-FAPI PET/CT imaging results showed that the Al18F-NOTA-FAPI uptake of the left ventricular myocardium was positive in 3 cases(3/5,60.0％)of the AL-CA+MM group and 3 cases(3/3,100.0％)of the AL-only group.The left ventricular myocardium Al18F-NOTA-FAPI uptake was negative in 4 patients(4/5,80.0％)of the MM control group and 5 subjects(5/5,100.0％)of the healthy control group.The left ventricular myocardium maximum standardized uptake value(SUVmax)and target to background ratio(T/B)in the AL-only group were higher than those in the healthy control group(SUVmax:(4.1±1.1)vs.(2.1±0.2),t=3.234,P=0.081;T/B:(4.7±0.6)vs.(2.2±0.4),t=6.748,P=0.001).The SUVmax and T/B of the left ventricular myocardium in the AL-CA+MM group were higher than those in the MM control group(SUVmax:(4.2±1.8)vs.(2.5±1.4),t=1.699,P=0.128;T/B:(4.2±2.1)vs.(3.0±1.2),t=1.120,P=0.295).The SUVmax and T/B of left ventricular myocardium in the AL-CA+MM group were higher than those in the healthy control group(SUVmax:(4.2±1.8)vs.(2.1±0.2),t=2.642,P=0.056;T/B:(4.2±2.1)vs.(2.2±0.4),t=2.047,P=0.104).Conclusion Al18F-NOTA-FAPI PET/CT imaging can detect cardiac fibroblast activation non-invasively and effectively and has a certain diagnostic value in patients with AL-CA.
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