68Ga FAPI PET/MRI in Cardiac Amyloidosis.

Abstract

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).