Evaluation of FDG PET combined with cardiac MRI for the diagnosis and therapeutic monitoring of cardiac sarcoidosis

To compare combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-positron-emission tomography (PET) and cardiac magnetic resonance imaging (CMR) for the diagnosis and therapy monitoring of cardiac sarcoidosis (CS). Eighty patients with sarcoidosis and a suspicion of CS who underwent PET and CMR were inclu...

Full description

Saved in:
Bibliographic Details
Published in:Clinical radiology 2019-01, Vol.74 (1), p.81.e9-81.e18
Main Authors: Sgard, B., Brillet, P.-Y., Bouvry, D., Djelbani, S., Nunes, H., Meune, C., Valeyre, D., Soussan, M.
Format: Article
Language:English
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To compare combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-positron-emission tomography (PET) and cardiac magnetic resonance imaging (CMR) for the diagnosis and therapy monitoring of cardiac sarcoidosis (CS). Eighty patients with sarcoidosis and a suspicion of CS who underwent PET and CMR were included retrospectively. PET was undertaken after a low-carbohydrate–high-fat diet in all patients using a combined 16-section PET/computed tomography (CT) camera. PET was considered positive (PET+) in cases of focal or multifocal FDG uptake. CMR was considered positive (CMR+) in cases of subepicardial late gadolinium enhancement (LGE). A subgroup of 50 patients (50/80) was monitored during therapy and classified as responders or non-responders. Eighty-two percent of patients with PET+ (9/11) also had CMR+ imaging, with good spatial agreement (kappa=0,79; 95% confidence interval [CI]: 0.65–0.94). Twenty-seven percent (22/80) had residual physiological FDG uptake, with a standardised uptake value (SUV) not significantly different compared to the SUV from pathological uptake (6.4 versus 6 respectively, p=0,92). The clinical response was more frequent in patients with baseline PET+ compared to baseline PET– (80% versus 45%, p=0.07). PET findings improved in all cases under treatment (7/7), whereas LGE improved in only 33% of patients (3/9). Due to high risk of false-positive or undetermined findings, PET might be performed as a second-line study in cases of LGE, to assess inflammatory load. In addition, PET seems suitable to predict and assess response under therapy. •Semi-Quantitative analysis of FDG uptake is not a reliable criterion for the diagnosis of inflammatory cardiac sarcoidosis.•FDG uptake during cardiac sarcoidosis has a good spatial agreement with LGE-CMR.•The high risk of false positive results suggests that PET should be performed as a second-line test in case of LGE-CMR.•FDG PET is more sensitive than CMR for predicting therapeutic response in patients with CS.
ISSN:0009-9260
1365-229X
DOI:10.1016/j.crad.2018.09.015