68Ga FAPI PET/MRI in Cardiac Amyloidosis

HomeRadiologyVol. 303, No. 1 PreviousNext Reviews and CommentaryFree AccessImages In Radiology68Ga FAPI PET/MRI in Cardiac AmyloidosisWei Guo, Haojun Chen Wei Guo, Haojun Chen Author AffiliationsFrom the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, 55 Zhenhai Road, Xiamen 361003, China.Address correspondence to H.C. (e-mail: [email protected]).Wei GuoHaojun Chen Published Online:Dec 21 2021https://doi.org/10.1148/radiol.211951MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 66-year-old woman presented with progressive dyspnea for 3 months. Cardiac MRI showed diffuse thickening of the left ventricle with global left ventricularle subendocardial delayed contrast material enhancement that was suggestive of cardiac amyloidosis (Figure, A). Serum free light-chain analysis showed an altered κ and λ ratio of 0.0036 (normal range, 0.26–1.65), with an increased proportion of λ light chains (2355 mg/L; normal range, 6–26 mg/L). Bone marrow biopsy results showed multiple myeloma. A research gallium 68 (68Ga)–conjugated fibroblast-activation protein inhibitor (FAPI) PET/CT examination was performed for staging of the multiple myeloma (ClinicalTrials.gov identifier: NCT04416165), which showed diffuse and inhomogeneous 68Ga FAPI uptake in the thickened left ventricle myocardium and tongue (Figure, B). Tongue biopsy results showed positive Congo red staining consistent with amyloid involvement. Thus, a diagnosis of cardiac and lingual amyloidosis secondary to multiple myeloma was made.Images in 66-year-old woman who presented with progressive dyspnea for 3 months. (A) Cardiac MRI scan in four-chamber view shows diffuse thickening of left ventricle with global subendocardial left ventricular late gadolinium enhancement (arrows), which is suggestive of cardiac amyloidosis. (B) Gallium 68 (68Ga)–conjugated fibroblast-activation protein inhibitor (FAPI) PET/CT scan, which is fused with previous cardiac MRI scans, shows intense 68Ga FAPI uptake (arrows) localized within thickened left ventricle myocardium.Download as PowerPointOpen in Image Viewer Multiple myeloma is the most common primary bone malignancy. The median age at diagnosis is 60–70 years. The incidence is higher in men than in women (7.1 per 100 000 vs 4.6 per 100 000, respectively). Light-chain amyloidosis occurs in 5%–10% of patients with multiple myeloma, and cardiac involvement is associated with worsened outcomes (1). Cardiac amyloidosis deposition leads to cardiomyocyte necrosis and interstitial fibrosis (2). 68Ga FAPI PET/MRI may be useful for imaging cardiac amyloidosis, as it shows both areas of fibrosis and inflammation.Disclosures of Conflicts of Interest: W.G. No relevant relationships. H.C. No relevant relationships.Supported by the National Natural Science Foundation of China (grant nos. 81801735 and 82071961).References1. Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC. Multiple myeloma. Lancet 2009;374(9686):324–339. Crossref, Medline, Google Scholar2. Shah KB, Inoue Y, Mehra MR. Amyloidosis and the heart: a comprehensive review. Arch Intern Med 2006;166(17):1805–1813. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 2 2021Revision requested: Sept 2 2021Revision received: Sept 10 2021Accepted: Sept 15 2021Published online: Dec 21 2021Published in print: Apr 2022 FiguresReferencesRelatedDetailsCited ByNon-oncologic incidental uptake on FAPI PET/CT imagingMasatoshiHotta, Angela CRieger, Mahbod GJafarvand, NandakumarMenon, AndreaFarolfi, Matthias RBenz, JeremieCalais2023 | The British Journal of Radiology, Vol. 96, No. 1142Fibroblast Activation Protein Inhibitor (FAPI)-Based Theranostics—Where We Are at and Where We Are Heading: A Systematic ReviewMarko Magdi AbdouSidrak, Maria SilviaDe Feo, FerdinandoCorica, JoanaGorica, MiriamConte, LucaFilippi, OrazioSchillaci, GiuseppeDe Vincentis, VivianaFrantellizzi2023 | International Journal of Molecular Sciences, Vol. 24, No. 4Myocardial fibroblast activation imaging in light chain cardiac amyloidosisXiao-YingXi, LiWang, AijunLiu, Min-FuYang2022 | Journal of Nuclear CardiologyFeasibility of 68Ga-Labeled Fibroblast Activation Protein Inhibitor PET/CT in Light-Chain Cardiac AmyloidosisXuezhuWang, YuboGuo, YajuanGao, ChaoRen, ZhenghaiHuang, BoweiLiu, XiaoLi, LongChang, KainiShen, HaiyanDing, HuiZhang, ZhuangTian, MarcusHacker, ShuyangZhang, YiningWang, JianLi, XiangLi, LiHuo2022 | JACC: Cardiovascular Imaging, Vol. 15, No. 11Nuclear Molecular Imaging of Disease Burden and Response to Treatment for Cardiac AmyloidosisMinZhao, RaffaellaCalabretta, JosefYu, PatrickBinder, ShuoHu, MarcusHacker, XiangLi2022 | Biology, Vol. 11, No. 10Recommended Articles Radiologic-Pathologic Correlation of Primary and Secondary Cardiomyopathies: MR Imaging and Histopathologic Findings in Hearts from Autopsy and TransplantationRadioGraphics2017Volume: 37Issue: 3pp. 719-736Radionuclide Imaging of Cardiac Amyloidosis and Sarcoidosis: Roles and Characteristics of Various TracersRadioGraphics2020Volume: 40Issue: 7pp. 2029-2041Trends in Diagnostic Imaging of Cardiac Amyloidosis: Emerging Knowledge and ConceptsRadioGraphics2020Volume: 40Issue: 4pp. 961-981Amyloidosis: Multisystem Spectrum of Disease with Pathologic CorrelationRadioGraphics2021Volume: 41Issue: 5pp. 1454-1474Diagnostic Value of Extracellular Volume Quantification and Myocardial Perfusion Analysis at CT in Cardiac AmyloidosisRadiology2021Volume: 300Issue: 2pp. 326-335See More RSNA Education Exhibits Cardiac Amyloid - Correlation of Cardiac Magnetic Resonance and PathologyDigital Posters2022Multimodality Imaging Findings in Cardiac AmyloidosisDigital Posters2020Imaging Spectrum of Amyloidosis: What A Radiologist Should Know ?Digital Posters2022 RSNA Case Collection Cardiac sarcoidosisRSNA Case Collection2020Chronic myocardial infarctionRSNA Case Collection2020Cardiac AmyloidosisRSNA Case Collection2020 Vol. 303, No. 1 Metrics Altmetric Score PDF download