Diagnostic value of positron emission tomography using amyloid-binding radiotracers for cardiac amyloidosis: a systematic review and meta-analysis.

Authors

Amely Walser, Konstantinos Bitos, Andreas A Giannopoulos, Aju P Pazhenkottil, Valerie Treyer, Martin W Huellner, Ronny R Buechel, Philipp A Kaufmann, Dominik C Benz

Published in

European heart journal. Imaging methods and practice. Volume 4. Issue 3. Pages qyag141. Epub Aug 18, 2026.

Abstract

Amyloid-binding positron emission tomography (PET) tracers have emerged as a promising non-invasive tool for the diagnosis of cardiac amyloidosis (CA). This study aimed to assess the diagnostic accuracy of amyloid PET for detecting CA through a meta-analysis of diagnostic test accuracy.
PubMed, Cochrane Library, Embase, and Web of Science were searched through 16 March 2026 for studies reporting the diagnostic performance of amyloid PET for CA. The primary analysis was a bivariate random-effects (Reitsma) model yielding summary sensitivity, specificity, the summary receiver operating characteristics curve with corresponding area under the curve (AUC), and positive and negative likelihood ratios. Subgroup analyses were performed by radiotracer and by amyloid subtype. Risk of bias was assessed using QUADAS-2 and publication bias by Deeks' funnel-plot asymmetry test. Twenty studies comprising 577 patients (407 with CA, 170 controls) met inclusion criteria, covering five radiotracers (¹¹C-PiB, ¹⁸F-florbetaben, ¹⁸F-florbetapir, ¹⁸F-flutemetamol, and ¹²⁴I-evuzamitide). In the primary bivariate model (k = 17), amyloid PET demonstrated a summary sensitivity of 0.91 (95% CI 0.83-0.96), specificity of 0.90 (95% CI 0.79-0.96), and AUC of 0.96, with low between-study heterogeneity (sensitivity I ² = 13.4%; specificity I ² = 0%). Sensitivity was high and consistent across ¹¹C-PiB, ¹⁸F-florbetaben, ¹⁸F-florbetapir, and ¹²⁴I-evuzamitide (0.96-1.00), with the exception of ¹⁸F-flutemetamol, which showed lower and heterogeneous sensitivity (0.70).
Amyloid PET demonstrates high sensitivity and specificity for CA detection, even though the evidence base remains limited in terms of the number and scope of available studies. Prospective multicentre studies in consecutive patients with suspected CA are required to establish its clinical role and standardize acquisition protocols.

PMID:
42689168
Bibliographic data and abstract were imported from PubMed on 03 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.