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Usefulness of Fasting ¹⁸F-FDG PET in Identification of Cardiac Sarcoidosis

¹ Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan
² Department of Diagnostic Radiology and Nuclear Medicine, Gunma University School of Medicine, Maebashi, Japan
³ Department of Laboratory Sciences, Gunma University School of Health Science, Maebashi, Japan
⁴ Fujioka General Hospital, Fujioka, Japan

Cardiac PET using ¹⁸F-FDG under fasting conditions (fasting ¹⁸F-FDG PET) is a promising technique for identification of cardiac sarcoidosis and assessment of disease activity. The aim of this study was to investigate the usefulness of fasting ¹⁸F-FDG PET in detecting inflammatory lesions of cardiac sarcoidosis from a pathophysiologic standpoint. Methods: Twenty-two patients with systemic sarcoidosis were classified into 2 groups of 11 each according to the presence or absence of sarcoid heart disease. Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare guidelines for diagnosing cardiac sarcoidosis with the exception of scintigraphic criteria. Nuclear cardiac imaging with fasting ¹⁸F-FDG PET, ^99mTc-methoxyisobutylisonitrile (^99mTc-MIBI) SPECT, and ⁶⁷Ga scintigraphy were performed in all patients. PET and SPECT images were divided into 13 myocardial segments and the standardized uptake value (SUV) of ¹⁸F-FDG was calculated and defect scores (DS) for ^99mTc-MIBI uptake were assessed for each segment. The total SUV (T-SUV) and total DS (TDS) were calculated as the sum of measurements for all 13 segments, and the diagnostic accuracy of fasting ¹⁸F-FDG PET was compared with that of the other nuclear imaging modalities. In addition, pathophysiologic relationships between inflammatory activity and myocardial damage were examined by segmental comparative study using the SUV and DS. Results: In patients with cardiac sarcoidosis, fasting ¹⁸F-FDG PET revealed a higher frequency of abnormal myocardial segments than ^99mTc-MIBI SPECT (mean number of abnormal segments per patient: 6.6 ± 3.0 vs. 3.0 ± 3.2 [mean ± SD], P < 0.05). The sensitivity of fasting ¹⁸F-FDG PET in detecting cardiac sarcoidosis was 100%, significantly higher than that of ^99mTc-MIBI SPECT (63.6%) or ⁶⁷Ga scintigraphy (36.3%). The accuracy of fasting ¹⁸F-FDG PET was significantly higher than ⁶⁷Ga scintigraphy. The T-SUV demonstrated a good linear correlation with serum angiotensin-converting enzyme levels (r = 0.83, P < 0.01), and the TDS showed a significant negative correlation with the left ventricular ejection fraction (r = –0.82, P < 0.01). In abnormal myocardial segments on the nuclear scan, the SUV showed a significant negative correlation with the DS (r = –0.63, P < 0.0001). Conclusion: This study suggests that fasting ¹⁸F-FDG PET can detect the early stage of cardiac sarcoidosis, in which fewer perfusion abnormalities and high inflammatory activity are noted, before advanced myocardial impairment.

Key Words: PET • ¹⁸F-FDG • fasting • cardiac sarcoidosis

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