Multimodal Radiomics Model (18F-FAPI PET/CT + CMR) for AL Cardiac Amyloidosis Prognosis (AL-CA)

A Prospective Study on the Prognostic Assessment of Light Chain Type Cardiac Amyloidosis (AL-CA) Based on Multimodal Fusion Radiomics Model of 18F-FAPI PET/CT and 3D CMR

1. Goal of the Study:

   The goal of this prospective observational study is to develop and validate a novel, non-invasive method for predicting the prognosis of patients with light-chain cardiac amyloidosis (AL-CA). This method integrates advanced multi-modal imaging techniques and artificial intelligence (radiomics) to provide early and accurate assessment of treatment response and survival outcomes.

2. Main Question:

   Can a multi-modal radiomics model, based on the fusion of [¹⁸F]FAPI PET/CT (assessing fibroblast activation) and 3D Cardiac MRI (CMR) (assessing structural damage) imaging data, accurately predict 12-month all-cause mortality and dynamically track disease progression in patients with AL-CA receiving standard care?

3. Participants:

   Population: Patients diagnosed with AL-CA (confirmed by endomyocardial biopsy or extracardiac biopsy plus specific cardiac criteria: NT-proBNP >332 pg/mL, mean left ventricular wall thickness >12 mm, excluding hypertension/other causes).

   Setting: Single-center study at Beijing Anzhen Hospital, Capital Medical University.

   Number: 49 patients (calculated sample size accounting for dropouts).

   Key Criteria:

   Inclusion: Confirmed AL-CA diagnosis, receiving standard AL-CA treatment (chemotherapy e.g., Daratumumab-based regimen + supportive cardiac care).

   Exclusion: Active infection, advanced malignancy (life expectancy <12 months), severe cognitive impairment/immobility affecting imaging compliance/follow-up.

4. Study Design & Procedures:

   Design: Single-center prospective cohort study.

   Intervention: Participants receive standard-of-care treatment for AL-CA as per guidelines (chemotherapy regimen based on Daratumumab, Bortezomib, Cyclophosphamide, Dexamethasone; tailored cardiac support including diuretics, rate control, anticoagulation if needed).

   Procedures:

   Baseline: Upon enrollment, participants undergo comprehensive assessment: [¹⁸F]FAPI PET/CT scan, 3D CMR scan, blood tests (NT-proBNP, troponin, free light chains, etc.), clinical staging (Mayo 2012), functional assessment (NYHA class), quality of life questionnaire (KCCQ).

   Imaging: Specialized software (Siemens True D) performs cross-platform fusion of PET/CT and 3D CMR images. Radiomics features are extracted from the fused images using dedicated software (Siemens FeAture Explorer).

   Follow-up:

   Clinical: Every 3 months (symptoms, medication adherence, adverse events, lab tests including NT-proBNP).

   Imaging: Repeat [¹⁸F]FAPI PET/CT and 3D CMR scans at 6 months post-baseline. Radiomics features are extracted again.

   Endpoints: Primary endpoint is 12-month all-cause mortality. Secondary endpoints include re-hospitalization rates and changes in NYHA class. Follow-up continues until the 12-month endpoint for all participants.

   Data Analysis: Machine learning (LASSO-Cox regression) is used to select key radiomics features from baseline and 6-month scans and integrate them with quantitative imaging parameters (FAPI uptake volume, SUVmax, LGE burden, ECV) and clinical data to build prognostic models predicting 12-month survival.

5. Comparison:

Researchers will compare the predictive performance of the developed multi-modal radiomics model against:

• Traditional clinical biomarkers: NT-proBNP levels and Mayo Clinic staging.
• Standard quantitative imaging parameters alone: Such as myocardial FAPI uptake volume, SUVmax, or CMR-derived extracellular volume (ECV) measured at baseline and 6 months.

The goal is to demonstrate superior accuracy in predicting 12-month all-cause mortality using the integrated radiomics approach.

Study Overview

• Status: Enrolling by invitation
• Conditions: Cardiac Amyloidosis; AL Amyloidosis (AL)

• Study Type: Observational
• Enrollment (Estimated): 49

Contacts and Locations

Study Locations

• China
  • 北京市
    • Beijing, 北京市, China, 100029
      • Beijing Anzhen Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Study Design

1. Study Type: Single-center prospective cohort study (evaluating the prognostic value of radiomics parameters under standardized treatment).
2. Study Population: Patients with suspected or confirmed cardiac light-chain amyloidosis (AL-CA) via endocardial or extracardiac biopsy who are admitted to the Department of Hematology, Beijing Anzhen Hospital, from Feburary 2025 to August 2028.

Description

Inclusion Criteria:

• Pathologically confirmed AL cardiac amyloidosis (AL-CA) by endocardial biopsy;
• Pathologically confirmed AL-CA by extracardiac (bone marrow, adipose tissue, tongue muscle, etc.) biopsy, with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) > 332 pg/mL, left ventricular mean wall thickness > 12 mm, and exclusion of hypertension and other secondary causes of left ventricular hypertrophy;
• Receiving standard AL-CA treatment regimens (including chemotherapy and supportive therapy).

Exclusion Criteria:

• Complicated with active infection or advanced malignant tumor (expected survival time < 12 months);
• Presence of severe cognitive impairment, limited mobility, or other conditions that affect compliance with imaging examinations or the completeness of follow-up.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Rationale: AL-CA: Clearly identifies the disease population (Light-chain Cardiac Amyloidosis). Mul

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
12-month survival	12 months

Collaborators and Investigators

• Sponsor: Beijing Anzhen Hospital
• Investigators: Principal Investigator: wei dong, MD,PHD, Beijing Anzhen Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 13, 2025
• Primary Completion (Estimated): February 1, 2028
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: July 29, 2025
• First Submitted That Met QC Criteria: July 29, 2025
• First Posted (Actual): August 5, 2025

Study Record Updates

• Last Update Posted (Actual): August 5, 2025
• Last Update Submitted That Met QC Criteria: July 29, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Metabolic Diseases; Immune System Diseases; Neoplasms by Histologic Type; Lymphoproliferative Disorders; Immunoproliferative Disorders; Neoplasms, Plasma Cell; Paraproteinemias; Proteostasis Deficiencies; Immunoglobulin Light-chain Amyloidosis; Amyloidosis
• Other Study ID Numbers: BeijingAnzhen dongwei; High Level research funding (Other Grant/Funding Number: Beijing Anzhen Hospital)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No