Abstract

Purpose

To investigate the utility of the combined use of ¹¹C-Pittsburgh compound B (¹¹C-PiB) positron emission tomography (PET) imaging and ^99mTc-pyrophosphate (^99mTc-PYP) scintigraphy for detection and differentiation of three major types of cardiac amyloidosis, i.e. immunoglobulin light chain (AL), hereditary transthyretin (ATTRv), and wild-type transthyretin (ATTRwt) amyloidosis.

Methods

Whole-body ¹¹C-PiB PET and ^99mTc-PYP scintigraphy were performed in 17 patients with AL amyloidosis, 22 patients with ATTRv, and eight patients with ATTRwt amyloidosis. The correlations between organ involvement and the uptake of ¹¹C-PiB and ^99mTc-PYP were analyzed in each patient.

Results

Cardiac amyloidosis was detectable by ^99mTc-PYP scintigraphy or ¹¹C-PiB PET in all systemic amyloidosis patients with cardiac involvement. ^99mTc-PYP scintigraphy and ¹¹C-PiB PET showed an interesting complementary relation. Strict combination of positive ¹¹C-PiB and negative ^99mTc-PYP uptake (PiB pattern) was observed in all AL amyloidosis patients with cardiac involvement. In contrast, strict combination of positive ^99mTc-PYP and negative ¹¹C-PiB uptake (PYP pattern) was observed in all ATTRwt amyloidosis patients with cardiac involvement. ATTRv amyloidosis patients with cardiac involvement were divided into two groups: PiB pattern or PYP pattern. All of the early-onset V30M (p.V50M) ATTRv patients showed the PiB pattern, whereas all of the late-onset V30M and non-V30M ATTRv patients showed the PYP pattern.

Conclusions

All three major types of cardiac amyloidosis can be detected and differentiated non-invasively by combined use of the two amyloid imaging methods and TTR gene testing.

中文翻译：

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使用 99mTc-焦磷酸盐闪烁显像和 11C-匹兹堡复合 B PET 成像对心脏淀粉样变性进行无创检测和鉴别。

摘要

目的

研究¹¹ C-匹兹堡化合物 B ( ¹¹ C-PiB) 正电子发射断层扫描 (PET) 成像和^99m Tc-焦磷酸盐 ( ^99m Tc-PYP) 显像在检测和区分三种主要心脏类型中的效用淀粉样变性，即免疫球蛋白轻链 (AL)、遗传性转甲状腺素蛋白 (ATTRv) 和野生型转甲状腺素蛋白 (ATTRwt) 淀粉样变性。

方法

对 17 名 AL 淀粉样变性患者、22 名 ATTRv 患者和 8 名 ATTRwt 淀粉样变性患者进行了全身¹¹ C-PiB PET 和^99m Tc-PYP 闪烁扫描。在每位患者中分析器官受累与¹¹ C-PiB 和^99m Tc-PYP摄取之间的相关性。

结果

在所有有心脏受累的系统性淀粉样变性患者中，通过^99m Tc-PYP 闪烁扫描或¹¹ C-PiB PET可检测到心脏淀粉样变性。^99m Tc-PYP 闪烁扫描和¹¹ C-PiB PET 显示出有趣的互补关系。在所有有心脏受累的 AL 淀粉样变患者中观察到¹¹ C-PiB阳性和^99m Tc-PYP 摄取阴性（PiB 模式）的严格组合。相比之下，正^99m Tc-PYP和负^11的严格组合在所有心脏受累的 ATTRwt 淀粉样变性患者中观察到 C-PiB 摄取（PYP 模式）。有心脏受累的ATTRv 淀粉样变性患者分为两组：PiB 型或PYP 型。所有早发性 V30M (p.V50M) ATTRv 患者均显示 PiB 模式，而所有晚发性 V30M 和非 V30M ATTRv 患者均显示 PYP 模式。

结论

通过结合使用两种淀粉样蛋白成像方法和TTR基因检测，可以无创地检测和区分所有三种主要类型的心脏淀粉样变性。