Molecular Imaging in Focus: Emerging PET/CT Radiotracer 124I-Evuzamatide Offers Promise for Detection of Cardiac Amyloidosis

The emerging positron emission tomography/computed tomography (PET/CT) imaging agent ¹²⁴I- evuzamitide may offer significant utility in the detection of cardiac amyloidosis, according to new phase 3 research presented at the European Society of Cardiology (ESC) Congress and recently published in the Journal of the American Medical Association (JAMA).¹

For the multicenter REVEAL study, researchers reviewed data from PET/CT imaging obtained three to five hours after administration of ¹²⁴I- evuzamitide for 170 patients (median age of 72) suspected of cardiac amyloidosis.

The study authors found that overall sensitivity and specificity for¹²⁴I- evuzamitide were 94 percent and 86 percent respectively. For patients with the transthyretin amyloidosis (ATTR) subtype, the researchers noted a 96 percent sensitivity rate and an 86 percent specificity rate. For patients with the amyloid light-chain (AL) subtype, ¹²⁴I- evuzamitide offered 95 percent sensitivity and 86 percent specificity, according to the study.

Can the PET/CT Agent ¹²⁴I- Evuzamitide Enhance and Simply Detection of Cardiac Amyloidosis?

In a recent interview with Diagnostic Imaging, lead study author Sharmila Dorbala, MD, MPH, also noted the high negative predictive value (94 percent) for ¹²⁴I- evuzamitide may go a long way toward simplifying testing for cardiac amyloidosis.

“ … What this is going to do, I think, is change the field from going into clinical history (and) imaging with echo or MRI free light chain studies and multiple testings to one single test, which could potentially tell the doctor this patient is amyloid yes (or) amyloid no, and that could be a big game changer I think,” noted Dr. Dorbala, the director of nuclear cardiology at the Brigham and Women’s Hospital in Boston.

(Editor’s note: For related content, see “Emerging PET Imaging Agent Gets FDA’s Breakthrough Therapy Designation for Cardiac Amyloidosis,” “Can AI Enhance Ultrasound Detection of Cardiac Amyloidosis? What a Multicenter Study Reveals” and “Novel Kinetic Model Improves PET Tracer Quantification in ATTR Cardiac Amyloidosis.”)

Could ¹²⁴I- Evuzamitide Facilitate Earlier Detection of Cardiac Amyloidosis in High-Risk Patients?

Dr. Dorbala suggested that the capability of ¹²⁴I-evuzamatide to directly show amyloid disease pathology may open up new pathways in the evaluation and monitoring of people at high risk for cardiac amyloidosis.

“In those patients, we could perform active surveillance using a tracer such as this, and this could enable us to detect very early amyloid deposits potentially before onset of symptoms or organ dysfunction. I think the exciting part of having something like this is that you could look at a future where you could design therapies to prevent organ dysfunction from amyloidosis. Prevention is a possibility if you can detect the disease early before there's organ dysfunction so that's why it's exciting on many fronts,” emphasized Dr. Dorbala, a professor of radiology at Harvard Medical School.

Reference

1. Dorbala S, Maurer MS, Cuddy SAM, et al. 124I-evuzamatide positron emission tomography/computed tomography for diagnosing cardiac amyloidosis: the REVEAL nonrandomized clinical trial. JAMA. 2026 Aug 30. doi: 10.1001/jama.2026.17361. Online ahead of print.