Dieser Artikel soll einen Überblick zur kardialen Amyloidose schaffen und gibt ein
Update zum aktuellen Stand der nuklearmedizinischen Diagnostik bei kardialer Amyloidose.
Im Fokus stehen hierbei vor allem die Skelettszintigrafie als etabliertes diagnostisches
Verfahren sowie die Positronenemissionstomografie (PET) mit neueren Amyloid-spezifischen
PET-Tracern.
Abstract
Cardiac amyloidosis (CA) is an underestimated and underdiagnosed cause of heart failure
and is associated with high mortality. The main subtypes responsible for cardiac involvement
are AL amyloidosis and ATTR amyloidosis. Since reliable diagnosis is still challenging
and endomyocardial biopsies are often necessary, nuclear imaging methods could play
a crucial role here. For years, skeletal scintigraphy with phosphate tracers has been
an established method for the detection of ATTR amyloidoses with a sensitivity and
specificity of > 99 % and 86 %, respectively. Newer amyloid-specific PET tracers such
as the F-18-labelled substances flutemetamol, florbetaben and florbetapir also have
great potential. A first meta-analysis of the few studies with these tracers showed
a pooled sensitivity and specificity of 95 % and 98 %, respectively. Thus, promising
results in the diagnosis of cardiac AL- and ATTR-amyloidosis are available, but studies
with higher numbers of testees are still missing. It is to be expected that cardiac
amyloidosis will increasingly become part of everyday nuclear medicine in the future
and therefore a sound knowledge of the diagnostic possibilities is of great importance.
This review article gives an overview of the implementation and ideal use of the different
imaging procedures by means of different clinical scenarios based on case studies
and shows the existing evidence to date.
Schlüsselwörter
Kardiale Amyloidose - Skelettszintigrafie - kardiale Bildgebung - Amyloid-Tracer -
SPECT - PET
Keywords
cardiac amyloidosis - bone scan - cardiac imaging - amyloid tracer - SPECT - PET
