Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis

J Nucl Cardiol. 2014 Oct;21(5):925-39. doi: 10.1007/s12350-014-9901-9. Epub 2014 May 31.

Abstract

Background: FDG PET/CT with myocardial perfusion imaging is a useful method for evaluating cardiac sarcoidosis (CS), but interpretation is not standardized. We developed a method for quantification of cardiac FDG PET/CT and evaluated its relationship to conventional interpretation, perfusion defects, clinical events, and immunosuppressive treatment.

Methods and results: FDG PET/CT with MPI studies performed for CS (n = 38) were retrospectively compared to negative control studies acquired for oncologic indications (n = 10). Quantitative measures of FDG volume-intensity (Cardiac Metabolic Activity, CMA) was performed using standardized uptake values (SUVs). CMA (477.7 ± 909 vs 0.55 ± 2.1 vs 0.3 ± 0.3 g glucose, P = .02) was significantly greater in visually FDG-positive studies compared to visually negative and oncologic negative studies. Among patients with CS, CMA was greater in studies with an EF < 50% (760.3 ± 1,148 vs 87.4 ± 161 g glucose, P = .03) and preceding an adverse clinical event (1,095 ± 1,253 vs 73 ± 144 g glucose, P = .006). CMA was the only independent predictor of events by multivariate analysis. In patients with repeat examinations (n = 7), CMA decreased with prednisone treatment in 5 of 6 patients.

Conclusions: Quantification of FDG uptake in CS correlates with lower EFs, clinical events, and immunosuppression treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Fluorodeoxyglucose F18* / pharmacokinetics
  • Heart Diseases / diagnosis*
  • Heart Diseases / metabolism
  • Humans
  • Image Enhancement / methods
  • Image Interpretation, Computer-Assisted / methods*
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Myocardial Perfusion Imaging / methods*
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Retrospective Studies
  • Sarcoidosis / diagnosis*
  • Sarcoidosis / metabolism
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18