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    Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Category: Imaging, QoL and Patient-Reported Outcome and Supportive Care

    Identification of Extracardiac Organ Involvement in Systemic Light Chain Amyloidosis using 18F-Florbetaben Positron Emission Tomography.

    (PA-151) Identification of Extracardiac Organ Involvement in Systemic Light Chain Amyloidosis Using 18f-florbetaben Positron Emission Tomography

    Thursday, September 18, 2025

    Introduction:      18F-florbetaben is an emerging radiotracer with high affinity for the β-pleated amyloid fibrils. Preliminary investigations utilizing 18F-florbetaben positron emission tomography/computed tomography (PET/CT) in patients with systemic amyloidosis have demonstrated its efficacy in detecting cardiac amyloid deposition, with clear differentiation from non-amyloid controls. Given its specificity for amyloid structures, 18F-florbetaben also holds promise for the non-invasive assessment of extracardiac organ involvement in systemic amyloidosis, potentially broadening its clinical utility beyond cardiac imaging.

    Methods:   

    Patients with a confirmed diagnosis of systemic light-chain (AL) amyloidosis, either newly diagnosed or previously treated, were prospectively enrolled in this study. All participants underwent baseline imaging with 18F-florbetaben PET/CT, followed by a repeat scan at 6-months. Imaging acquisition was performed from immediately post-intravenous administration of the radiotracer to 40 minutes.

    Qualitative assessment of 18F-florbetaben uptake and retention was conducted across the myocardium and visceral organs within the thoracic and upper abdominal fields of view. Tracer distribution patterns were evaluated to identify potential amyloid involvement beyond the cardiac structures, with particular attention to extracardiac organ uptake suggestive of systemic disease burden.

    Results:   

    A total of 17 participants underwent baseline 18F-florbetaben PET/CT. Of these, 7 patients completed a follow-up scan at the 6-month timepoint. There were 9 deaths during the study duration, all due to progressive AL amyloidosis; with 4 of these occurring prior to the planned second imaging timepoint. The median overall survival for the cohort was 8.48 years.

    Pulmonary uptake was observed in 4 patients, characterized predominantly by a diffuse distribution pattern. Skeletal uptake was noted in 6 patients, while splenic uptake was identified in 2 cases. Hepatic uptake was prominent in all participants, with no discernible difference in uptake intensity between patients with known hepatic involvement and those without, thus limiting its ability to identify liver involvement in these patients. Noticeable bowel uptake was observed in a single patient. Due to the limited field of view in the cardiac imaging protocol, the kidneys were not adequately visualised and thus renal uptake could not be assessed.

    Conclusions:   

    In addition to the previously demonstrated utility of evaluating cardiac amyloid burden, 18F-florbetaben PET/CT shows promising potential for detecting extracardiac involvement in organs such as the lungs and spleen, which are not routinely able to be assessed by conventional imaging or biopsy due to the lack of specific, non-invasive diagnostic modalities. The identification of amyloid deposition in these sites suggests that 18F-florbetaben PET/CT may serve as a valuable adjunctive tool in the comprehensive assessment of systemic disease burden.