OtherClinical Investigations

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

Wataru Okumura, Tsutomu Iwasaki, Takuji Toyama, Tatsuya Iso, Masashi Arai, Noboru Oriuchi, Keigo Endo, Tomoyuki Yokoyama, Tadashi Suzuki and Masahiko Kurabayashi
Journal of Nuclear Medicine December 2004, 45 (12) 1989-1998;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Short-axis and vertical long-axis slices of myocardial PET and SPECT images were divided into 13 segments.

  • FIGURE 2.
    FIGURE 2.

    Comparison of nuclear measurements between histologically diagnosed cardiac sarcoidosis (HCS) and clinically diagnosed cardiac sarcoidosis (CCS). Frequency of abnormal segments on 99mTc-MIBI SPECT and TDS in HCS (white bar) was significantly higher than that in CCS (black bar) (B and D). In contrast, frequency of abnormal segments on fasting 18F-FDG PET and T-SUV in HCS were lower than those in CCS, although significant difference could be observed only for T-SUV (A and C). NS = not significant.

  • FIGURE 3.
    FIGURE 3.

    Relationship between nuclear measurements (T-SUV and TDS) and clinical data (LVEF and serum ACE level) in patients with cardiac sarcoidosis (group A). Statistically significant correlations were observed between TDS and LVEF (A) and between T-SUV and serum ACE level (B).

  • FIGURE 4.
    FIGURE 4.

    Correlation between SUV and DS in segments with abnormal 18F-FDG uptake (A), those with abnormal 99mTc-MIBI perfusion (B), and those with abnormal 18F-FDG uptake or 99mTc-MIBI defect (C). Significant negative correlations were observed in all types of abnormal segment.

  • FIGURE 5.
    FIGURE 5.

    Localization of 3 types of abnormal segment.

  • FIGURE 6.
    FIGURE 6.

    Fasting 18F-FDG PET images (top) and 99mTc-MIBI SPECT images (bottom) in patient 9. 18F-FDG PET revealed markedly increased uptake of 18F-FDG in segments 1–8, whereas 99mTc-MIBI SPECT revealed no abnormal findings.

  • FIGURE 7.
    FIGURE 7.

    Fasting 18F-FDG PET images (top) and 99mTc-MIBI SPECT images (bottom) in patient 1. 18F-FDG PET revealed slightly increased uptake of 18F-FDG in segments 1, 2, 4, and 12. 99mTc-MIBI SPECT clearly revealed moderate reduction of 99mTc-MIBI uptake in segments 5, 6, and 12 and severe reduction of 99mTc-MIBI uptake in segment 3.

Tables

  • TABLE 1

    Characteristics of 22 Patients

    Patient no.Age (y)SexECG findingsLVEF (%)Histologic diagnosis of extracardiac sarcoidosisBlood glucose (mg/dL)Serum ACE (IU/L 37°C)
    Group A
        169MComplete AVB41Myocardium1037.4
        269FSecond AVB45Myocardium858.8
        365FST-T change, VT33Myocardium8212.3
        473FST-T change, second AVB47Intraabdominal LN9114.4
        552FCRBBB, ST-T change, VT71TBLB7612.5
        646FCRBBB + LAH, second AVB40TBLB7430.1
        755FCRBBB + LAH, first AVB, VT42Scalene node10411.1
        878FST-T change, second AVB67Scalene node9213.4
        973FSecond AVB, PSVT57Skin9422.4
        1062FCRBBB + LAH, VT47Skin7230.0
        1162FSecond AVB68Skin8118.3
    Group B
        1262FNormal71TBLB953.5
        1354FCRBBB80TBLB8519.7
        1444MNormal78TBLB7730.2
        1537FNormal60TBLB8439.3
        1656FNormal76TBLB10212.5
        1774FCRBBB82Scalene node7920.7
        1867MNormal67Scalene node10112.1
        1966FNormal67Skin9227.8
        2071FNormal68Skin7411.2
        2164FNormal75Skin8226.0
        2268FST-T change73Skin10418.0

    • ECG = electrocardiography; LVEF = left ventricular ejection fraction; ACE = angiotensin-converting enzyme; AVB = atrioventricular block; VT = ventricular tachycardia; LN = lymph node; CRBBB = complete right bundle branch block; TBLB = transbronchial lung biopsy; LAH = left anterior hemiblock; PSVT = paroxymal supraventricular tachycardia.

  • TABLE 2

    Guidelines for Diagnosis of Cardiac Sarcoidosis from Japanese Ministry of Health and Welfare

    Criterion for diagnosis of cardiac sarcoidosis
    1: Histologic diagnosis group
        Cardiac sarcoidosis is diagnosed when histologic analysis of operative or endomyocardial biopsy specimens demonstrates epithelioid granuloma without caseating granuloma.
    2: Clinical diagnosis group
        In patients with histologic diagnosis of extracardiac sarcoidosis, cardiac sarcoidosis is diagnosed when item “a” and one or more of items “b-e” are present.
            a. Complete right bundle branch block, left-axis deviation, atrioventricular block, ventricular tachycardia, premature ventricular contraction (more than second grade of Lown’s classification), or abnormal Q or ST-T change on electrocardiogram or ambulatory electrocardiogram
            b. Abnormal wall motion, regional wall thinning or thickening, or dilatation of left ventricle on echocardiogram
            c. Perfusion defect in 201T1 myocardial scintigraphy or abnormal accumulation in 67Ga-citrate or 99mTc-pyrophosphate myocardial scintigraphy
            d. Abnormal intracardiac pressure, low cardiac output, or abnormal wall motion or depressed ejection fraction of left ventricle
            e. Interstitial fibrosis or cellular infiltration over moderate grade in endomyocardial biopsy even if findings are nonspecific
  • TABLE 3

    SUV of 18F-FDG for Each of 13 Myocardial Segments in Healthy Volunteers

    ParameterMyocardial segment
    12345678910111213
    Mean1.941.921.891.851.871.871.981.951.941.931.931.921.86
    SD0.200.210.190.230.190.250.200.240.180.200.220.260.16
    Mean + 2 SD2.342.332.282.302.262.372.392.422.292.342.372.442.18
  • TABLE 4

    Results of Myocardial Nuclear Imaging

    Patient no.67Ga*18F-FDG PET and 99mTc-MIBI SPECT segmental analysis†No. of abnormal segmentsT-SUV of 18F-FDGTDS of 99mTc-MIBI
    Seg. 1Seg. 2Seg. 3Seg. 4Seg. 5Seg. 6Seg. 7Seg. 8Seg. 9Seg. 10Seg. 11Seg. 12Seg. 1318F-FDG99mTc-MIBI
    Group A
        1+3.51(0)3.54(0)2.13(3)3.18(0)1.84(2)1.62(2)2.08(0)2.14(0)1.74(0)2.03(0)1.77(0)2.51(2)2.01(0)4430.19
        2+3.82(0)4.12(0)3.08(2)4.03(2)2.08(0)1.87(0)2.12(0)1.83(0)1.94(0)1.68(0)1.64(2)1.60(2)1.78(0)4431.68
        3−2.84(2)3.81(0)2.51(3)2.82(2)1.89(3)1.61(2)2.64(2)3.54(0)1.68(2)1.83(0)1.95(3)1.95(2)1.87(3)61030.924
        4−14.13(0)6.20(1)8.70(0)2.24(0)2.13(0)2.02(0)14.70(0)9.41(0)6.60(0)4.48(0)2.06(0)2.13(0)5.98(0)8180.81
        5−5.23(0)4.82(0)4.47(0)2.21(0)1.98(0)1.71(0)4.98(0)4.16(0)3.88(0)1.90(0)1.82(0)1.80(0)2.13(0)6041.10
        6+6.88(0)7.31(0)2.23(2)2.20(2)4.72(2)2.08(3)10.94(0)11.12(0)7.79(0)9.32(0)9.20(0)7.60(1)6.11(2)10687.512
        7+4.31(0)4.97(0)2.04(0)1.93(0)1.73(0)1.78(0)3.25(2)3.82(2)1.95(0)1.91(0)1.83(2)1.75(0)1.80(2)4433.18
        8−2.21(0)2.14(0)1.95(0)1.98(0)1.84(0)1.78(0)5.44(0)4.88(0)5.13(0)2.10(0)2.01(0)1.83(0)1.90(0)3035.20
        9−5.74(0)5.12(0)4.18(0)4.24(0)3.64(0)3.56(0)5.01(0)4.76(0)1.74(0)1.95(0)2.28(0)1.83(0)1.78(0)8045.80
        10−13.81(0)9.94(0)6.71(2)8.34(0)6.15(2)8.56(0)12.02(0)9.78(0)9.91(0)9.53(0)7.78(1)8.30(1)6.90(0)134117.76
        11−9.54(0)2.30(0)6.51(0)4.91(0)6.02(0)3.71(0)2.21(0)4.41(0)1.97(0)2.01(0)2.12(0)4.25(0)1.89(0)7051.90
    Sum 7333
    Group B
        12−2.10(0)1.98(0)1.88(0)1.71(0)1.76(0)1.81(0)2.14(0)2.01(0)1.98(0)1.89(0)1.74(0)1.80(0)1.89(0)0024.70
        13−1.56(0)1.61(0)1.41(0)1.53(0)1.43(0)1.45(0)1.69(0)1.79(0)1.88(0)1.61(0)1.79(0)1.78(0)2.01(0)0021.50
        14−1.78(0)1.83(0)1.88(0)1.71(0)1.63(0)1.72(0)1.97(0)1.94(0)1.93(0)2.01(0)2.11(0)2.01(0)1.79(0)0024.30
        15−1.91(0)1.82(0)1.79(0)1.85(0)1.90(0)1.85(0)2.15(0)2.08(0)2.17(0)1.83(0)1.65(0)1.72(0)1.89(0)0024.60
        16−2.18(0)2.08(0)1.92(0)1.95(0)2.08(0)1.89(0)1.82(0)1.79(0)1.70(0)1.71(0)1.94(0)1.91(0)1.99(0)0025.00
        17−1.98(0)2.17(0)1.91(0)2.05(0)1.86(0)1.99(0)1.99(0)2.09(0)1.80(0)1.82(0)1.75(0)1.72(0)1.73(0)0024.90
        18−2.04(0)1.89(0)2.15(0)2.08(0)1.87(0)1.71(0)1.65(0)1.70(0)1.88(0)1.99(0)2.11(0)1.86(0)1.98(0)0024.90
        19−1.97(0)2.13(0)2.07(0)1.78(0)2.05(0)1.90(0)2.27(0)2.29(0)2.10(0)2.15(0)2.19(0)2.29(0)1.62(0)0026.80
        20−1.72(0)1.60(0)1.85(0)1.77(0)1.88(0)2.07(0)1.91(0)1.88(0)1.67(0)1.97(0)1.99(0)1.96(0)1.97(0)0024.20
        21−2.03(0)1.99(0)2.21(0)2.08(0)2.06(0)1.99(0)1.79(0)2.11(0)2.18(0)2.20(0)2.00(0)1.99(0)1.81(0)0026.40
        22−3.11(0)2.81(0)3.13(0)2.77(0)1.91(0)2.12(0)3.30(0)3.13(0)3.10(0)3.07(0)1.81(0)1.95(0)2.10(0)8034.30
    Sum 80

    • ↵* + represents myocardial uptake of 67Ga; − represents no myocardial uptake of 67Ga.

    • ↵† Data for each segment (Seg.) are presented as SUV; score in parentheses represents DS. Boldface values represent abnormal data.

  • TABLE 5

    Diagnostic Performance of Fasting 18F-FDG PET, 99mTc-MIBI SPECT, and 67Ga Scintigraphy

    ParameterPercentage (no. of patients)
    18F-FDG PET99mTc-MIBI SPECT67Ga scintigraphy
    Sensitivity100 (11/11)63.6* (7/11)36.4† (4/11)
    Specificity90.9 (10/11)100 (11/11)100 (11/11)
    Accuracy95.5 (21/22)81.8 (18/22)68.2* (15/22)

    • ↵* P < 0.05 vs. 18F-FDG PET.

    • ↵† P < 0.01 vs. 18F-FDG PET.

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