Diagnostic value of quantitative assessment of cardiac 18 F-fluoro-2-deoxyglucose uptake in suspected cardiac sarcoidosis

Ann Nucl Med. 2018 Jun;32(5):319-327. doi: 10.1007/s12149-018-1250-3. Epub 2018 Mar 20.

Abstract

Objective: The identification of cardiac sarcoidosis is challenging as there is no gold standard consensually admitted for its diagnosis. The aim of this study was to evaluate the diagnostic value of the assessment of cardiac dynamic 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET/CT) and net influx constant (Ki) in patients suspected of cardiac sarcoidosis.

Methods: Data obtained from 30 biopsy-proven sarcoidosis patients suspected of cardiac sarcoidosis who underwent a 50-min list-mode cardiac dynamic 18F-FDG PET/CT after a 24 h high-fat and low-carbohydrate diet were analyzed. A normalized coefficient of variation of quantitative glucose influx constant, calculated as the ratio: standard deviation of the segmental Ki (min-1)/global Ki (min-1) was determined using a validated software (Carimas® 2.4, Turku PET Centre). Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare criteria. Receiving operating curve analysis was performed to determine sensitivity and specificity of cardiac dynamic 18F-FDG PET/CT analysis to diagnose cardiac sarcoidosis.

Results: Six out of 30 patients (20%) were diagnosed as having cardiac sarcoidosis. Myocardial glucose metabolism was significantly heterogeneous in patients with cardiac sarcoidosis who showed significantly higher normalized coefficient of variation values compared to patients without cardiac sarcoidosis (0.513 ± 0.175 vs. 0.205 ± 0.081; p = 0.0007). Using ROC curve analysis, we found a cut-off value of 0.38 for the diagnosis of cardiac sarcoidosis with a sensitivity of 100% and a specificity of 91%.

Conclusions: Our results suggest that quantitative analysis of cardiac dynamic 18F-FDG PET/CT could be a useful tool for the diagnosis of cardiac sarcoidosis.

Keywords: Cardiac sarcoidosis; Dynamic acquisition; FDG; Positron emission tomography; Quantitative analysis.

MeSH terms

  • Adult
  • Aged
  • Diet, Carbohydrate-Restricted
  • Diet, High-Fat
  • Echocardiography
  • Female
  • Fluorodeoxyglucose F18*
  • Glucose / metabolism
  • Heart / diagnostic imaging*
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / metabolism
  • Heart Diseases / pathology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Perfusion Imaging
  • Myocardium / metabolism
  • Myocardium / pathology
  • Positron Emission Tomography Computed Tomography*
  • ROC Curve
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Sarcoidosis / diagnostic imaging*
  • Sarcoidosis / metabolism
  • Sarcoidosis / pathology
  • Software

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Glucose