Article Figures & Data
Figures
- FIGURE 1.
Detection of organ involvement by 18F-florbetapir uptake. Distribution of SUVmax values is shown for each organ. Each marker corresponds to single subject. Dotted line indicates assigned threshold of 2.5 SUVmax between normal and abnormal. Hum. = humeral.
- FIGURE 2.
Proportion of subjects demonstrating 18F-florbetapir uptake by organ. Visual involvement was defined as uptake greater than bone marrow. Quantitative assessment was deemed positive if SUVmax for volume of interest within organ was ≥ 2.5. Vertebral body uptake was visual reference; therefore, subjective assessment of abnormal bone marrow uptake was not possible.
- FIGURE 3.
Normal 18F-florbetapir biodistribution. PET maximum-intensity projection image shows 18F-florbetapir distribution in healthy volunteer. (Reprinted with permission of (14).)
- FIGURE 4.
Images from 2 subjects with biopsy-proven active systemic AL amyloidosis. (A) Maximum-intensity projection image from 18F-florbetapir PET/CT shows abnormal uptake in tongue and lungs. (B–D) Axial fused PET/CT images confirm diffuse abnormal uptake throughout tongue (B), parotids and thyroid (C), and both lungs (D). CT appearance of lungs was unremarkable other than mild atelectasis. (E–G) Abnormal uptake (*) is also seen in kidneys (E) and spleen (F and G).
- FIGURE 5.
A 55-y-old man with cardiac AL amyloidosis but in AL remission for more than 1 y. (A) Coronal fusion 18F-florbetapir PET/CT image shows abnormal uptake in lungs. (B and C) Axial fusion images show abnormal uptake in submandibular glands (B) and thyroid (C). This patient also had abnormal uptake in parotids and tongue (not pictured).
Tables
Characteristic Data Age (y) 61 ± 7 Active AL, systemic cardiac 22 Active AL, systemic noncardiac 8 Remission AL, cardiac 10 Height (m) 1.70 ± 0.11 Weight (kg) 77.0 ± 14.7 Body mass index (kg/m2) 26.5 ± 4.0 κ (mg/L)* 15.4 (10.3–27.6) λ (mg/L)* 114.4 (35.1–306.7) κ/λ ratio* 0.19 (0.04–0.46) eGFR (mL/min/1.73 m2) 57 ± 16 24-h urine protein (g) 0.9 ± 2.2 Alkaline phosphatase (U/L) 96 ± 55 ↵* For patients with active AL amyloidosis.
eGFR = estimated glomerular filtration rate.
Qualitative data are expressed as numbers; continuous data are expressed as mean ± SD or as median followed by interquartile range in parentheses.
- TABLE 2
Organ Involvement by Clinical Symptoms and by Visual and Quantitative Uptake of 18F-Florbetapir in Various Organs in Systemic AL Amyloidosis
SUVmax in subjects with… Organ involved Clinical diagnosis Visual analysis Quantitative analysis Involved organs Uninvolved organs Parotid 1 (3%) 20 (50%) 19 (48%) 3.9 ± 1.4 1.5 ± 0.5 Tongue 4 (10%) 17 (43%) 21 (53%) 3.9 ± 1.1 1.8 ± 0.3 Thyroid — 9 (23%) 14 (36%) 6.5 ± 6.3 1.5 ± 0.5 Lung 4 (10%) 11 (28%) 14 (35%) 5.7 ± 3.3 1.0 ± 0.6 Gastric wall 1 (3%) 13 (33%) 15 (38%) 5.4 ± 3.1 1.8 ± 0.4 Pancreas — 5 (13%) 16 (40%) 3.1 ± 0.5 1.9 ± 0.5 Kidney 11 (28%) 4 (10%) 5 (13%) 3.4 ± 0.5 1.9 ± 0.3 Spleen — 8 (20%) 8 (20%) 6.7 ± 2.4 1.8 ± 0.4 Gluteal muscle — 1 (3%) 3 (8%) 3.1 ± 0.2 1.3 ± 0.3 Abdominal wall fat 5 (13%) 4 (10%) 3 (8%) 3.1 ± 0.3 1.1 ± 0.4 Humeral head 8 (20%) 8 (2%) 6 (15%) 3.2 ± 0.7 1.4 ± 0.6 Qualitative data are expressed as numbers followed by percentages in parentheses; continuous data are expressed as mean ± SD. Involved organs are defined as having a SUVmax ≥ 2.5. Liver was considered unevaluable because of known hepatobiliary excretion of 18F-florbetapir. Heart was not evaluated because it comprised study inclusion criteria. Some organs do not have consensus criteria for clinical diagnosis.
- TABLE 3
Organ Involvement in Subjects with Systemic AL Amyloidosis: Active AL (n = 30) Versus Hematologic Remission of AL (n = 10)
Visual Quantitative SUVmax Organ Active Remission Active Remission Active Remission Parotid 15 (50%) 5 (50%) 14 (47%) 5 (50%) 2.7 ± 1.6 2.7 ± 1.6 Tongue 13 (43%) 4 (40%) 15 (50%) 6 (60%) 2.9 ± 1.3 2.8 ± 1.5 Thyroid 6 (20%) 3 (30%) 9 (31%) 5 (50%) 3.3 ± 4.9 3.0 ± 2.3 Lung 9 (30%) 2 (20%) 11 (37%) 2 (20%) 2.2 ± 2.8 1.7 ± 2.0 Gastric wall 13 (43%) 0 (0%) 14 (47%) 1 (10%) 3.5 ± 2.9 1.9 ± 0.4 Pancreas 5 (17%) 0 (0%) 13 (43%) 3 (30%) 2.5 ± 0.8 2.1 ± 0.7 Kidney 4 (13%) 0 (0%) 5 (17%) 0 (0%) 2.2 ± 0.7* 1.7 ± 0.3 Spleen 8 (27%) 0 (0%) 7 (23%) 1 (10%) 2.7 ± 2.6 1.5 ± 1.7 Gluteal muscle 1 (3%) 0 (0%) 3 (10%) 0 (0%) 1.5 ± 0.6 1.3 ± 0.2 Abdominal wall fat 4 (13%) 0 (0%) 3 (10%) 0 (0%) 1.2 ± 0.8 1.2 ± 0.4 Humeral head 8 (27%) 0 (0%) 6 (20%) 0 (0%) 1.8 ± 0.9 1.2 ± 0.5 ↵* P = 0.0002.
Qualitative data are expressed as numbers followed by percentages in parentheses; continuous data are expressed as mean ± SD. Involved organs defined as SUVmax ≥ 2.5. Liver was considered unevaluable because of known hepatobiliary excretion of 18F-florbetapir.
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