Vol.:(0123456789) 1 3 Clinical and Translational Imaging https://doi.org/10.1007/s40336-021-00459-4 MINI-REVIEW 18F‑Florbetaben: a potential nuclear protagonist in the diagnosis of cardiac amyloidosis Dario Genovesi 1  · Assuero Giorgetti 1 Received: 7 June 2021 / Accepted: 4 August 2021 © Italian Association of Nuclear Medicine and Molecular Imaging 2021 Abstract Purpose The purpose of this mini-review is to summarize the evidence published so far regarding the use of 18F-Florbetaben for the evaluation of myocardial amyloid deposits, underlining the methodological diferences of the various studies and the respective results. Methods Through a search on PubMed/MEDLINE, articles concerning the use of the radiopharmaceutical 18F-Florbetaben for the evaluation of patients with cardiac amyloidosis were selected. Case reports, review articles, editorials, letters or com- ments to previous publications were not considered eligible for evaluation. Results Out of a total of 14 publications, six articles were eligible for review. The analysis of the results highlighted the ability of 18F-Florbetaben to identify patients with cardiac amyloidosis; in particular, by applying well-defned acquisition times, it is possible not only to distinguish patients with amyloidosis from patients with non-infltrative ventricular hyper- trophy, but also to diferentiate both qualitatively and quantitatively, the transthyretin forms from those from light chains of immunoglobulins. Conclusions The correct use of PET with 18F-forbetaben can allow to obtain an earlier diagnosis of immunoglobulin light chain amyloidosis allowing to anticipate the initiation of specifc therapies and, possibly, increasing patient survival. Keywords Cardiac amyloidosis · 18F-Florbetaben · Light chains amyloidosis (AL) · Transthyretin amyloidosis (ATTR) Introduction Amyloidosis is an infltrative disease due to the deposition in the extracellular space of the tissues of an amorphous protein substance derived from misfolded proteins; the pro- gressive deposition of this substance leads to organ damage and functional impairment [1]. Cardiac Amyloidosis (CA) is responsible of 5–15% of cases of heart failure with preserved ejection fraction and increased wall thickness [2]; often the diagnosis of CA is late and is made only in advanced clini- cal stages when the ventricular function is markedly com- promised; a correct and timely clinical diagnosis remains the only possibility to improve the outcome of this dis- ease which does not seem to be as rare as it was believed in the past. The amyloid proteins that mostly involve the heart are the form derived from transthyretin deposition (ATTR) and the form derived from immunoglobulin light chain deposition (AL) [3–5]. Nuclear medicine has made a great contribution to the diagnosis of this disease; in fact, for the diagnosis of ATTR it is now possible to perform a scintigraphic study with osteophilic tracers marked with metastable technetium 99 such as 99mTc-PYP, 99mTc-DPD, 99mTc-HMDP; this diagnostic approach, in the absence of a monoclonal disease, allows an etiological diagnosis without the need for histological confrmation. When a monoclonal disease is present, the etiological diagnosis of CA cannot be reached without further instrumental investigations and it needs biopsy confrmation regardless of the outcome of the scintigraphy [6, 7]; unfortunately a monoclonal gammopathy of undetermined signifcance (MGUS) is present in > 5% of patients over 70-years old, and this complicates the etiologi- cal diagnosis of CA [8]. Since each type of CA has now a specifc disease modifying treatment, the ability to discrimi- nate between the two is of major clinical importance [9, 10] In recent years, the development of PET radiopharmaceu- ticals for the detection of amyloid deposits in neurodegen- erative disorders and their application in nuclear cardiology * Dario Genovesi dario.genovesi@ftgm.it 1 Nuclear Medicine Unit, Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Via Moruzzi 1, 56124 Pisa, Italy