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The response of FDG uptake to immunosuppressive treatment on FDG PET/CT imaging for cardiac sarcoidosis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Immunosuppression is used to treat cardiac sarcoidosis, despite limited data. FDG PET/CT is used for detecting cardiac inflammation in patients with CS, yet there is variability in interpretation of FDG PET/CT. Our aim was to compare quantitative and qualitative interpretation of FDG PET/CT for CS in defining the FDG response to immunosuppression.

Methods and Results

Patients with CS (N = 43 total studies from 17 patients) had serial FDG PET/CT studies before/after immunosuppression. FDG uptake was analyzed qualitatively (visually; FDG-positive segments) and quantitatively (SUVmax; cardiac metabolic volume and activity (CMV, CMA); volume above SUV thresholds 2.7 and 4.1 g/mL). Complete resolution of FDG uptake was common using CMA (10/17), CMV (10/17), but a 2.7 g/mL SUV threshold (13/17) and SUVmax (14/17) were more likely to define partial responses. In six patients imaged after a reduction in immunosuppression, 4/6 had a rebound quantitative FDG uptake.

Conclusions

Quantitative interpretation of FDG PET/CT in CS can detect changes in FDG uptake in response to immunosuppression. Further studies are needed to see if quantitative changes in FDG uptake are associated with improved outcomes.

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Abbreviations

CS:

Cardiac sarcoidosis

CMA:

Cardiac metabolic activity

CMV:

Cardiac metabolic volume

FDG:

Fluorodeoxyglucose

PET:

Positron emission tomography

SUV:

Standardized uptake values

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Relationship with industry

Dr Miller has consulting relationships with GE, Inc. and Bracco, Inc and research funding from Bracco, Inc., which are unrelated to the current study.

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Authors and Affiliations

  1. Section of Cardiovascular Medicine, Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    Azadeh Ahmadian MD & Frederick L. Ruberg MD

  2. Section of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    Praveen Govender MD & Jeffrey Berman MD

  3. Department of Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA

    Sumeet Pawar MBBS

  4. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Edward J. Miller MD, PhD

Authors
  1. Azadeh Ahmadian MD
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  2. Sumeet Pawar MBBS
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  3. Praveen Govender MD
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  4. Jeffrey Berman MD
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  5. Frederick L. Ruberg MD
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  6. Edward J. Miller MD, PhD
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Corresponding author

Correspondence to Edward J. Miller MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-016-0624-y.

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Ahmadian, A., Pawar, S., Govender, P. et al. The response of FDG uptake to immunosuppressive treatment on FDG PET/CT imaging for cardiac sarcoidosis. J. Nucl. Cardiol. 24, 413–424 (2017). https://doi.org/10.1007/s12350-016-0490-7

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  • DOI: https://doi.org/10.1007/s12350-016-0490-7

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