Imaging an ATTR cardiac amyloidosis patient using fluorine-18 sodium fluoride PET/CT: A case report

Abstract

Cardiac amyloidosis (CA) is a disease caused by a build-up of protein aggregations known as amyloids in cardiac tissue. As the deposits increase, the heart muscles become increasingly stiff, and eventually, the pumping function deteriorates. There are two main types of amyloidosis: light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis. If ATTR-CA is suspected, the diagnosis can usually be confirmed by an endomyocardial biopsy. Alternatively, it can be diagnosed non-invasively by bone scintigraphy using Technetium-99m pyrophosphate (Tc-99mPYP), Tc99m-diphosphono-1,2-propanodicarboxylic acid (Tc99m-DPD), or Tc-99m-hydroxymethylene diphosphonate (Tc-99m-HMDP) in the absence of abnormal light chains on serum free light-chain assays and immunofixation of the serum and urine. However, other bone tracers can assist in the diagnosis of ATTR-CA, including fluorine-18 sodium fluoride (18F-NaF). In this case report, we will show positive 18F-NaF PET/CT images of an ATTR-CA patient.