PT - JOURNAL ARTICLE AU - Jonathan Wall AU - Emily Martin AU - Alan Stuckey AU - Dustin Powell AU - Ronald Lands AU - Stephen Kennel TI - Clinical Utility of PET/CT Imaging with Peptide Imaging Agent <sup>124</sup>I-p5+14 (AT-01) in Patients with Systemic Amyloidosis. DP - 2021 May 01 TA - Journal of Nuclear Medicine PG - 1702--1702 VI - 62 IP - supplement 1 4099 - http://jnm.snmjournals.org/content/62/supplement_1/1702.short 4100 - http://jnm.snmjournals.org/content/62/supplement_1/1702.full SO - J Nucl Med2021 May 01; 62 AB - 1702Objectives: Systemic amyloidosis is a disease with heterogeneous presentation, making rapid and accurate diagnosis challenging. A definitive diagnosis is often made following histological evaluation of a single tissue biopsy. PET/CT imaging, using the amyloid-reactive peptide 124I-p5+14, can detect many forms of amyloid throughout the body (NCT03678259), which may assist in the initial diagnosis. In addition, we hypothesize that this imaging modality can provide further clinical information that may improve patient management and disease understanding. Here we present case studies demonstrating the use of 124I-p5+14 imaging to: 1) Assess the amyloid status of transplanted organs; 2) Demonstrate resolution of amyloid; and 3) Identify amyloid in anatomic sites not recognized by the physician. Methods: Patients &gt;18 years of age with a confirmed diagnosis of amyloidosis (based on biopsy, genotyping, or imaging studies) and not requiring heparin therapy have been recruited. Subjects received ~1.4 mg of 124I-p5+14 (&lt;2 mCi) administered as a single IV bolus. PET/CT images were acquired at 5 h post injection using a Biograph 16 TruePoint with a low dose CT (120 kVp, 50 effective mAs). PET/CT images were reviewed by a radiologist who was blinded to the clinical features of the patient. Results: Of the 42 patients recruited, two patients with AL amyloidosis had transplanted organs (heart, n=1 and kidney, n=1). In the cardiac transplanted patient, radiotracer uptake was evidenced in the heart. In contrast, the transplanted kidney was negative - despite both native kidneys having positive uptake. A separate patient, diagnosed with AL amyloidosis by renal biopsy in 2013 (eGFR ~ 25), was imaged with no evidence of 124I-p5+14 uptake in either kidney, suggesting resolution of the amyloid. In many patients, radiotracer uptake in amyloid was observed in anatomic sites not identified by the clinical record, but consistent with expected sites of amyloidosis, based on literature. Conclusion: PET/CT imaging of patients with amyloidosis, using 124I-p5+14, provides not only a discrimination of the presence of amyloid, but it also provides additional clinically-relevant information that can be used for patient management and improving outcomes. Acknowledgements: Support for this work comes from the Amyloidosis and Cancer Theranostics Program gift fund. We appreciate the support of the Cancer Institute and Department of Nuclear Medicine at the University of Tennessee Medical Center. Attralus Inc. owns intellectual property associated with 124I-p5+14 (AT-01).