Table 2.

Radiotracers for Imaging of Cardiac Amyloidosis

Radiotracer	Imaging Modality	Mechanism of Uptake	Amyloid Subtype Uptake	Imaging Capability	Considerations
Bone avid tracers primarily used in the USA
99mTc-PYP44, 54–57	Planar/SPECT	Bone tracer	ATTR-CM	Diagnostic; possibly early detection	Some uptake in patients with AL amyloidosis, less than ATTR amyloidosis
Bone avid tracers primarily used outside the USA
99mTc-DPD39–41 and 99mTc-HMDP38, 58, 59	Planar/SPECT	Bone tracer	ATTR-CM	Diagnostic; possibly early detection and disease monitoring	Some uptake in patients with AL amyloidosis, less than ATTR amyloidosis
Amyloid-binding radiotracers
11C-PIB47, 60, 61	PET	Amyloid deposits	ATTR-CM, AL amyloidosis	Possibly quantitation of amyloid burden, disease monitoring	Short half-life, expensive isotope relative to SPECT tracers
18F-florbetapir48, 62	PET	Amyloid deposits	ATTR-CM, AL amyloidosis	Possibly early detection, quantitation, and disease monitoring	Expensive isotope relative to SPECT tracers
18F-florbetaben49	PET	Amyloid deposits	ATTR-CM, AL amyloidosis	Possibly early detection, quantitation, and disease monitoring	Expensive isotope relative to SPECT tracers
18F-NaF52, 53	PET	Bone tracer	Equivocal ATTR-CM	Possibly early detection, quantitation, and disease monitoring	No uptake in patients with AL amyloidosis, equivocal uptake in patients with ATTR-CM

¹¹C-PIB, Pittsburgh compound B; ¹⁸F-NaF, sodium fluoride; ¹²³I, iodine-123; ^99mTc-DPD, ^99mtechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid; ^99mTc-HMDP, hydroxymethylene diphosphonate; ^99mTc-PYP, technetium pyrophosphate; AL, amyloid light chain; ATTR-CM, transthyretin amyloidosis with predominant cardiomyopathy (either wild-type or hereditary); PET, positron emission tomography; SPECT, single-photon emission computed tomography.

Note: The tracers ^99mTc-MDP and ^99mTc-aprotinin are not recommended.