Quantitative [18F]florbetapir PET/CT may identify lung involvement in patients with systemic AL amyloidosis

Yiu Ming Khor, Sarah Cuddy, Hendrik J. Harms, Marie F. Kijewski, Mi Ae Park, Matthew Robertson, Hyewon Hyun, Marcelo F. Di Carli, Giada Bianchi, Heather Landau, Andrew Yee, Vaishali Sanchorawala, Frederick L. Ruberg, Ronglih Liao, John Berk, Rodney H. Falk, Sharmila Dorbala

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: The clinical diagnosis of pulmonary involvement in individuals with systemic AL amyloidosis remains challenging. [18F]florbetapir imaging has previously identified AL amyloid deposits in the heart and extra-cardiac organs. The aim of this study is to determine quantitative [18F]florbetapir pulmonary kinetics to identify pulmonary involvement in individuals with systemic AL amyloidosis. Methods: We prospectively enrolled 58 subjects with biopsy-proven AL amyloidosis and 9 control subjects (5 without amyloidosis and 4 with ATTR cardiac amyloidosis). Pulmonary [18F]florbetapir uptake was evaluated visually and quantified as distribution volume of specific binding (Vs) derived from compartmental analysis and simpler semiquantitative metrics of maximum standardized uptake values (SUVmax), retention index (RI), and target-to-blood ratio (TBR). Results: On visual analysis, pulmonary tracer uptake was absent in most AL subjects (40/58, 69%); 12% (7/58) of AL subjects demonstrated intense bilateral homogeneous tracer uptake. In this group, compared to the control group, Vs (median Vs 30-fold higher, 9.79 vs. 0.26, p < 0.001), TBR (median TBR 12.0 vs. 1.71, p < 0.001), and RI (median RI 0.310 vs. 0.033, p < 0.001) were substantially higher. Notably, the AL group without visually apparent pulmonary [18F]florbetapir uptake also demonstrated a > 3-fold higher Vs compared to the control group (median 0.99 vs. 0.26, p < 0.001). Vs was independently related to left ventricular SUVmax, a marker of cardiac AL deposition, but not to ejection fraction, a marker of cardiac dysfunction. Also, intense [18F]florbetapir lung uptake was not related to [11C]acetate lung uptake, suggesting that intense [18F]florbetapir lung uptake represents AL amyloidosis rather than heart failure. Conclusions: [18F]florbetapir PET/CT offers the potential to noninvasively identify pulmonary AL amyloidosis, and its clinical relevance warrants further study.

Original languageEnglish (US)
Pages (from-to)1998-2009
Number of pages12
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number8
StatePublished - Jul 1 2020
Externally publishedYes


  • AL
  • Lung
  • PET/CT
  • Quantitative
  • Systemic light chain amyloidosis
  • [18F]florbetapir

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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