摘要目的:探讨Al 18F-1, 4, 7-三氮杂环壬烷-1，4，7-三乙酸（NOTA）-成纤维细胞激活蛋白抑制剂（FAPI）PET/CT显像对轻链型心脏淀粉样变（AL-CA）的诊断价值。 方法:前瞻性研究2021年9至12月于首都医科大学附属北京朝阳医院确诊为AL-CA的8例[5例合并多发性骨髓瘤（MM）]患者的临床资料，其中男性7例、女性1例，年龄（62.9±5.6）岁。分别招募与AL-CA患者性别和年龄匹配的5名健康志愿者和5例MM患者作为对照。研究共分为4组：AL-CA+MM组（AL-CA伴MM）5例、AL-only组（AL-CA不伴MM）3例、MM对照组（MM不伴AL-CA）5例、健康对照组5名。所有受试者均接受Al 18F-NOTA-FAPI PET/CT显像。分析4组受试者的实验室检查指标[B型利钠肽（BNP）水平]、心脏超声数据和Al 18F-NOTA-FAPI PET/CT显像结果。多组间计量资料的比较采用LSD检验或Kruskal Wallis检验。2组间计量资料的比较采用两独立样本 t检验（方差齐），计数资料的比较采用 χ2检验。 结果:与MM对照组相比，AL-only组BNP水平升高，差异有统计学意义[（259.0±40.0）pg/ml对（19.2±15.7）pg/ml， t=9.928， P<0.05]；AL-CA+MM组左心室室间隔厚度和左心室后壁厚度增加，差异均有统计学意义[（13.9±1.1）mm对（10.8±0.3）mm， t=6.197， P<0.05；（13.7±0.9）mm对（10.3±0.6）mm， t=6.774， P<0.05]。Al 18F-NOTA-FAPI PET/CT显像结果显示：AL-CA+MM组3例（3/5，60.0%）患者和AL-only组3例（3/3，100.0%）患者左心室心肌Al 18F-NOTA-FAPI摄取均为阳性；MM对照组4例（4/5，80.0%）患者和健康对照组5名（5/5，100.0%）受试者左心室心肌Al 18F-NOTA-FAPI摄取均为阴性。AL-only组左心室心肌最大标准化摄取值（SUV max）和靶本底比值（T/B）均高于健康对照组[SUV max：（4.1±1.1）对（2.1±0.2）， t=3.234， P=0.081；T/B：（4.7±0.6）对（2.2±0.4）， t=6.748， P=0.001]。AL-CA+MM组左心室心肌SUV max和T/B均高于MM对照组[SUV max：（4.2±1.8）对（2.5±1.4）， t=1.699， P=0.128；T/B：（4.2±2.1）对（3.0±1.2）， t=1.120， P=0.295]。AL-CA+MM组左心室心肌SUV max和T/B均高于健康对照组[SUV max：（4.2±1.8）对（2.1±0.2）， t=2.642， P=0.056；T/B：（4.2±2.1）对（2.2±0.4）， t=2.047， P=0.104]。 结论:Al 18F-NOTA-FAPI PET/CT显像具有无创、有效检测AL-CA患者心脏成纤维细胞活化的能力，其对AL-CA患者具有一定的诊断价值。

abstractsObjective:To explore the diagnostic value of Al 18F-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-fibroblast activation protein inhibitor (FAPI) PET/CT imaging in light chain cardiac amyloidosis (AL-CA). Methods:The clinical data of 8 patients (7 males and 1 female, aged (62.9±5.6) years) diagnosed with AL-CA in Beijing Chao-Yang Hospital, Capital Medical University from September to December 2021 were prospectively studied. Five healthy volunteers and 5 patients with multiple myeloma (MM), who matched the gender and age with AL-CA patients, were recruited as controls. All subjects were divided into 4 groups: 5 cases in the AL-CA+MM group (AL-CA with MM), 3 cases in the AL-only group (AL-CA without MM), 5 cases in the MM control group (MM without AL-CA), and 5 cases in the healthy control group. All subjects underwent Al 18F-NOTA-FAPI PET/CT imaging. Laboratory index type B natriuretic peptide (BNP) level, echocardiography data, and Al 18F-NOTA-FAPI PET/CT imaging results were analyzed. Measurement data were compared among the 4 groups by using LSD or Kruskal-Wallis test and between 2 groups by independent samples t-test (homogeneity of variance). Enumeration data were compared by χ2 test. Results:BNP level in the AL-only group was higher than that in the MM control group, and the difference was statistically significant ((259.0±40.0) pg/ml vs. (19.2±15.7) pg/ml, t=9.928, P<0.05). The left ventricular interventricular septum thickness and the left ventricular posterior wall thickness increased in the AL-CA+MM group, and the differences were statistically significant ((13.9±1.1) mm vs. (10.8±0.3) mm, t=6.197, P<0.05; (13.7±0.9) mm vs. (10.3±0.6) mm, t=6.774, P<0.05). Al 18F-NOTA-FAPI PET/CT imaging results showed that the Al 18F-NOTA-FAPI uptake of the left ventricular myocardium was positive in 3 cases (3/5, 60.0%) of the AL-CA+MM group and 3 cases (3/3, 100.0%) of the AL-only group. The left ventricular myocardium Al 18F-NOTA-FAPI uptake was negative in 4 patients (4/5, 80.0%) of the MM control group and 5 subjects (5/5, 100.0%) of the healthy control group. The left ventricular myocardium maximum standardized uptake value (SUV max) and target to background ratio (T/B) in the AL-only group were higher than those in the healthy control group (SUV max: (4.1±1.1) vs. (2.1±0.2), t=3.234, P=0.081; T/B: (4.7±0.6) vs. (2.2±0.4), t=6.748, P=0.001). The SUV max and T/B of the left ventricular myocardium in the AL-CA+MM group were higher than those in the MM control group (SUV max: (4.2±1.8) vs. (2.5±1.4), t=1.699, P=0.128; T/B: (4.2±2.1) vs. (3.0±1.2), t=1.120, P=0.295). The SUV max and T/B of left ventricular myocardium in the AL-CA+MM group were higher than those in the healthy control group (SUV max: (4.2±1.8) vs. (2.1±0.2), t=2.642, P=0.056; T/B: (4.2±2.1) vs. (2.2±0.4), t=2.047, P=0.104). Conclusion:Al 18F-NOTA-FAPI PET/CT imaging can detect cardiac fibroblast activation non-invasively and effectively and has a certain diagnostic value in patients with AL-CA.