Abstract
Background
Cardiac uptake on oncologic FDG PET/CT can be unpredictable. Focal or mass-like cardiac uptake not confined to normal pattern is a real challenge for interpretation due to great variability in physiologic uptake and rarity of either primary or metastatic cardiac neoplasms.
Methods and Results
Eight patients with suspicious mass-like cardiac uptake on oncologic FDG PET/CT were retrospectively analyzed with correlation to cardiac workups including contrast CT, echocardiography, and repeat PET/CT. Four patients had real cardiac lesions or metastases. Focal uptake was benign and might represent papillary muscle in the other four. SUVmax ratio between the cardiac focus and surrounding background cardiac uptake was statistically higher in the true-positive group than that in the false-positive group. In addition, the patients with true-positive cardiac uptake had more diffuse distant metastases compared to those with false-positive cardiac uptake.
Conclusions
Focal suspicious cardiac uptake on oncology FDG PET/CT warranted further evaluation. SUVmax ratio between the cardiac focus and surrounding background cardiac uptake and status of distant metastases might help to differentiate malignant from benign nature of the focal cardiac uptake on FDG PET/CT. Focal uptake of the right ventricle on oncologic FDG PET/CT is more likely suggestive of a neoplasm.
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Abbreviations
- FDG PET/CT:
-
18F-fluorodeoxyglucose positron emission tomography/computed tomography
- SUVmax :
-
Maximum standardized uptake value
References
Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 2010;40:294-315.
Neely JR, Rovetto MJ, Oram JF. Myocardial utilization of carbohydrate and lipids. Prog Cardiovasc Dis 1972;15:289-329.
Kaneta T, Hakamatsuka T, Takanami K, Yamada T, Takase K, Sato A, et al. Evaluation of the relationship between physiological FDG uptake in the heart and age, blood glucose level, fasting period, and hospitalization. Ann Nucl Med 2006;20:203-8.
de Groot M, Meeuwis AP, Kok PJ, Corstens FH, Oyen WJ. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging 2005;32:98-101.
Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics 2011;31:1287-305.
Shimotsu Y, Ishida Y, Fukuchi K, Hayashida K, Toba M, Hamada S, et al. Fluorine-18-fluorodeoxyglucose PET identification of cardiac metastasis arising from uterine cervical carcinoma. J Nucl Med 1998;39:2084-7.
Orcurto MV, Delaloye AB, Letovanec I, Martins Favre M, Prior JO. Detection of an asymptomatic right-ventricle cardiac metastasis from a small-cell lung cancer by F-18-FDG PET/CT. J Thorac Oncol 2009;4:127-30.
Biancheri I, Zsigmond R, Angoue O, Blagosklonov O, Klingelschmitt S, Legalery P, et al. F-18 FDG PET identification of right atrium metastasis from a vesical carcinoma. Clin Nucl Med 2007;32:812-5.
Pinnamaneni N, Muthukrishnan A. Left ventricular myocardium metastasis in a patient with primary renal cell carcinoma detected by 18F-FDG PET/CT. Clin Nucl Med 2012;37:e181-3.
Liu T, Khan S, Behr S, Aparici CM. Diagnosis of cardiac metastasis from endometrial cancer by F-18 FDG-PET/CT. Nucl Med Mol Imaging 2014;48:237-40.
Puranik AD, Purandare NC, Sawant S, Agrawal A, Shah S, Jatale P, et al. Asymptomatic myocardial metastasis from cancers of upper aero-digestive tract detected on FDG PET/CT: a series of 4 cases. Cancer Imaging 2014;14:16.
Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics 2001;21:439-49.
Nose H, Otsuka H, Otomi Y, Terazawa K, Takao S, Iwamoto S, et al. The physiological uptake pattern of (18)F-FDG in the left ventricular myocardium of patients without heart disease. J Med Invest 2014;61:53-8.
Yi JE, Yoon HJ, Yoon HJ. Cardiac and pericardial (18)F-FDG uptake on oncologic PET/CT: comparison with echocardiographic findings. J Cardiovasc Imaging 2018;26:93-102.
Lin EC. Isolated papillary muscle uptake on FDG PET/CT. Clin Nucl Med 2007;32:76-8.
Fukuchi K, Ohta H, Matsumura K, Ishida Y. Benign variations and incidental abnormalities of myocardial FDG uptake in the fasting state as encountered during routine oncology positron emission tomography studies. Br J Radiol 2007;80:3-11.
Lichtenberger JP 3rd, Reynolds DA, Keung J, Keung E, Carter BW. Metastasis to the heart: a radiologic approach to diagnosis with pathologic correlation. AJR Am J Roentgenol 2016;207:764-72.
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Liu, Y. Focal mass-like cardiac uptake on oncologic FDG PET/CT: Real lesion or atypical pattern of physiologic uptake?. J. Nucl. Cardiol. 26, 1205–1211 (2019). https://doi.org/10.1007/s12350-018-01524-8
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DOI: https://doi.org/10.1007/s12350-018-01524-8