Abstract:
Objective To explore the diagnostic value of Al18F-1, 4, 7-triazacyclononane-1, 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 χ2 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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