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Genovesi et al. Vessel Plus 2021;5:50 Vessel Plus
DOI: 10.20517/2574-1209.2021.67

Review Open Access

Nuclear medicine techniques for the diagnosis of

cardiac amyloidosis: the state of the art

Dario Genovesi, Assuero Giorgetti
Department of Nuclear Medicine, Fondazione CNR-Regione Toscana “Gabriele Monasterio”, Pisa 56124, Italy.

Correspondence to: Dr. Dario Genovesi, Department of Nuclear Medicine, Fondazione CNR/Regione Toscana "Gabriele
Monasterio", Via Moruzzi 1, Pisa 56124, Italy. E-mail: dario.genovesi@ftgm.it

How to cite this article: Genovesi D, Giorgetti A. Nuclear medicine techniques for the diagnosis of cardiac amyloidosis: the state
of the art. Vessel Plus 2021;5:50. https://dx.doi.org/10.20517/2574-1209.2021.67

Received: 19 Apr 2021 First Decision: 16 Jun 2021 Revised: 18 Jun 2021 Accepted: 30 Jun 2021 First online: 5 Jul 2021

Academic Editor: Gianfranco Sinagra Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Amyloidosis is a disease characterized by the deposition of amorphous protein material in the extracellular space
which leads to progressive dysfunction of the affected organ. The forms of amyloidosis that most frequently involve
the heart are transthyretin amyloidosis (ATTR) and immunoglobulin light chain amyloidosis (AL). Nuclear
medicine offers numerous imaging techniques for the evaluation of patients with cardiac amyloidosis, and in the
last decade osteophilic tracer scintigraphy has assumed a fundamental role in the diagnostic process of this
disease. New PET radiopharmaceuticals for the detection of amyloid deposits are proving very effective in
diagnosing the presence of AL amyloidosis and could soon allow a differential diagnosis without the need for
invasive and potentially risky techniques such as endomyocardial biopsy.

Keywords: Amyloidosis, SPECT, PET, ATTR, AL

INTRODUCTION
Amyloidosis is an infiltrative and restrictive disease due to interstitial deposition of misfolded proteins
which leads to organ damage and functional impairment. In most patients with cardiac amyloidosis, the
diagnosis is made only in advanced clinical stages when ventricular function is so compromised that most
of the therapeutic strategies are useless; a correct and prompt clinical diagnosis remains the only possibility
to improve the outcome of this pathology, which is not as rare as was believed in the past. Nuclear medicine
allows, in a non-invasive way, obtaining information on ventricular perfusion, function, and innervation;

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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