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Quantitative Assessment of Cardiac Hypermetabolism and Perfusion for Diagnosis of Cardiac Sarcoidosis

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Quantitative assessment of cardiac hypermetabolism from 18Flourodeoxy glucose (FDG) positron emission tomography (PET) may improve diagnosis of cardiac sarcoidosis (CS). We assessed different approaches for quantification of cardiac hypermetabolism and perfusion in patients with suspected CS.

Methods and results

Consecutive patients undergoing 18FDG PET assessment for possible CS between January 2014 and March 2019 were included. Cardiac hypermetabolism was quantified using maximal standardized uptake value (SUVMAX), cardiometabolic activity (CMA) and volume of inflammation, using relative thresholds (1.3× and 1.5× left ventricular blood pool [LVBP] activity), and absolute thresholds (SUVMAX > 2.7 and 4.1). Diagnosis of CS was established using the Japanese Ministry of Health and Wellness criteria. In total, 69 patients were studied, with definite or possible CS in 29(42.0%) patients. CMA above 1.5× LVBP SUVMAX had the highest area under the receiver operating characteristic curve (AUC 0.92). Quantitative parameters using relative thresholds had higher AUC compared to absolute thresholds (p < 0.01). Interobserver variability was low for CMA, with excellent agreement regarding absence of activity (Kappa 0.970).

Conclusions

Quantitation with scan-specific thresholds has superior diagnostic accuracy compared to absolute thresholds. Based on the potential clinical benefit, programs should consider quantification of cardiac hypermetabolism when interpreting 18F-FDG PET studies for CS.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CS:

Cardiac sarcoidosis

FDG:

Fluorodeoxyglucose

JMHW:

Japanese Ministry of Health and Welfare

LVEF:

Left ventricular ejection fraction

LVBP:

Left ventricular blood pool

PET:

Positron emission tomography

ROC:

Receiver operating characteristic

SD:

Standard deviation

SRS:

Summed rest score

SUVMAX. :

Maximal standardized uptake value

TPD:

Total perfusion deficit

VOI:

Volume of inflammation

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Disclosures

The work was supported in part by the Miriam and Sheldon Adelson Medical Research Foundation. Drs. Berman, and Slomka participate in software royalties for QPS software at Cedars-Sinai Medical Center. Robert Miller, Sebastien Cadet, Payam Pournazari, Adele Pope, Evan Kransdorf, Michele A Hamilton, Jignesh Patel, Sean Hayes, John Friedman, Louise Thomson, and Balaji Tamarappoo have no relevant disclosures.

Funding

This research was supported in part by grant R01HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH) (PI: Piotr Slomka). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, A047N, Los Angeles, CA, 90048, USA

    Robert J. H. Miller MD, Sebastien Cadet MSc, Adele Pope MD, Sean Hayes MD, John Friedman MD, Louise Thomson MD, Balaji Tamarappoo MD, Daniel S. Berman MD & Piotr J. Slomka PhD

  2. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada

    Robert J. H. Miller MD & Payam Pournazari MD

  3. Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Evan Kransdorf MD, Michele A. Hamilton MD & Jignesh Patel MD

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  1. Robert J. H. Miller MD
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Correspondence to Piotr J. Slomka PhD.

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Miller, R.J.H., Cadet, S., Pournazari, P. et al. Quantitative Assessment of Cardiac Hypermetabolism and Perfusion for Diagnosis of Cardiac Sarcoidosis. J. Nucl. Cardiol. 29, 86–96 (2022). https://doi.org/10.1007/s12350-020-02201-5

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  • DOI: https://doi.org/10.1007/s12350-020-02201-5

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