PT  - JOURNAL ARTICLE
AU  - Ohira, Hiroshi
AU  - Ardle, Brian Mc
AU  - deKemp, Robert A.
AU  - Nery, Pablo
AU  - Juneau, Daniel
AU  - Renaud, Jennifer M.
AU  - Klein, Ran
AU  - Clarkin, Owen
AU  - MacDonald, Karen
AU  - Leung, Eugene
AU  - Nair, Girish
AU  - Beanlands, Rob
AU  - Birnie, David
TI  - Inter- and Intraobserver Agreement of <sup>18</sup>F-FDG PET/CT Image Interpretation in Patients Referred for Assessment of Cardiac Sarcoidosis
AID  - 10.2967/jnumed.116.187203
DP  - 2017 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 1324--1329
VI  - 58
IP  - 8
4099  - http://jnm.snmjournals.org/content/58/8/1324.short
4100  - http://jnm.snmjournals.org/content/58/8/1324.full
SO  - J Nucl Med2017 Aug 01; 58
AB  - Recent studies have reported the usefulness of 18F-FDG PET in aiding with the diagnosis and management of patients with cardiac sarcoidosis (CS). However, image interpretation of 18F-FDG PET for CS is sometimes challenging. We sought to investigate the inter- and intraobserver agreement and explore factors that led to important discrepancies between readers. Methods: We studied consecutive patients with no significant coronary artery disease who were referred for assessment of CS. Two experienced readers masked to clinical information, imaging reports, independently reviewed 18F-FDG PET/CT images. 18F-FDG PET/CT images were interpreted according to a predefined standard operating procedure, with cardiac 18F-FDG uptake patterns categorized into 5 patterns: none, focal, focal on diffuse, diffuse, and isolated lateral wall or basal uptake. Overall image assessment was classified as either consistent with active CS or not. Results: One hundred scans were included from 71 patients. Of these, 46 underwent 18F-FDG PET/CT with a no-restriction diet (no-restriction group), and 54 underwent 18F-FDG PET/CT with a low-carbohydrate, high-fat and protein-permitted diet (low-carb group). There was agreement of the interpretation category in 74 of 100 scans. The κ-value of agreement among all 5 categories was 0.64, indicating moderate agreement. For overall clinical interpretation, there was agreement in 93 of 100 scans (κ = 0.85). When scans were divided into the preparation groups, there was a trend toward higher agreement in the low-carb group versus the no-restriction group (80% vs. 67%, P = 0.08). Regarding the overall clinical interpretation, there was also a trend toward greater agreement in the low-carb group versus the no-restriction group (96% vs. 89%, P = 0.08). Conclusion: The interobserver agreement of cardiac 18F-FDG uptake image patterns was moderate. However, agreement was better regarding overall interpretation of CS. Detailed prescan dietary preparation seemed to improve interobserver agreement.