Assessment of cardiac tumors by 18F-FDG PET/CT imaging: Histological correlation and clinical outcomes

  • Jingjing Meng
  • Honglei Zhao
  • Yongmin Liu
  • Dong Chen
  • Marcus Hacker
  • Yongxiang Wei
  • Xiang Li
  • Xiaoli ZhangEmail author
  • Michael C. Kreissl



To evaluate the diagnostic value of 18F-FDG PET/CT in distinguishing benign versus malignant cardiac tumors as well as to assess its prognostic value.


We analyzed 38 patients with cardiac tumors who underwent 18F-FDG PET/CT and followed for median 8.5 ± 12.5 months. SUVmax and TBRmax (maximum tumor-to-background ratio) by receiver-operating characteristic (ROC) curve analysis were used to obtain threshold for the diagnosis of malignancy as defined by histology (n = 38). Survival was assessed and correlated with the dignity of the lesions and PET parameters.


Optimal cut-off values indicating malignancy were as follows: SUVmax = 3.44, with 100% sensitivity and 92.9% specificity, and TBRmax = 1.55, with 95.8% sensitivity and 92.9% specificity. A significant difference of 18F-FDG uptake was observed between primary benign (n = 14, SUVmax = 2.35 ± 1.31, TBRmax = 1.05 ± 0.50) compared to primary malignant cardiac tumors (n = 11, SUVmax = 8.90 ± 4.23, TBRmax = 3.82 ± 1.44) as well as cardiac metastases and lymphoma (n = 13, SUVmax = 14.37 ± 8.05, TBRmax = 6.19 ±  3.38) (all P < .001). Survival rate was significantly lower in patients with malignant as compared to benign cardiac tumors (P < .05). Regression analysis revealed that the lesion dignity determined by the cut-off value of SUVmax was an independent predictor for death in patients with cardiac tumors (P < .05).


18F-FDG uptake in cardiac tumors can differentiate between benign and malignant cardiac tumors and predicts survival.


Cardiac tumor 18F-FDG PET/CT diagnosis cardiac metastasis prognosis 







Cardiac magnetic resonance imaging


Diffuse large B-cell lymphoma


Positron emission tomography/computed tomography


Periodic acid-schiff


Receiver-operating characteristic


Maximum standardized uptake value


Maximum tumor-to-background ratio


Volume of interest



The authors have indicated that they have no financial conflict of interest.

Supplementary material

12350_2019_2022_MOESM1_ESM.docx (25 kb)
Supplementary material 1 Summary for TwitterThis is a retrospectively study for evaluating the diagnostic value of 18F-FDG PET/CT in distinguishing benign versus malignant cardiac tumors, as well as to assess its prognostic value. We analyzed 38 patients with cardiac tumors who underwent 18F-FDG PET/CT and followed for median: 8.5±12.5months. SUVmax and TBRmax (maximum tumor to background ratio) by receive-operating characteristic curve analysis were used to obtain threshold for the diagnosis of malignancy as defined by histology. The cut-off value of SUVmax=3.44, with 100% sensitivity and 92.9% specificity, and the cut-off value TBRmax=1.55, with 95.8% sensitivity and 92.9% specificity. Malignant tumors as categorized by SUVmax≥3.44 or TBRmax≥1.55 was associated with significantly higher mortality as compared to benign tumors with SUVmax<3.44 or TBRmax<1.55 (P=0.018 and P=0.002, respectively). The univariate Cox regression analysis revealed the lesion dignity as determined by the cut-off value of SUVmax (HR 95% CI: 7.834 [1.016-60.411], P=0.048) was an independent predictor for death in patients with cardiac tumors, so was the pathological diagnosis (HR 95% CI: 9.275 [1.201-71.645], P=0.033). 18F-FDG PET/CT should be included in the diagnostic algorithm for cardiac tumors to distinguish the malignancy. 18F-FDG uptake, independently predicted death in cardiac tumors and might serve as a valuable predictive tool. (DOCX 23 kb)
12350_2019_2022_MOESM2_ESM.pptx (60.4 mb)
Supplementary material 2 (PPTX 61881 kb)


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Copyright information

© American Society of Nuclear Cardiology 2020

Authors and Affiliations

  • Jingjing Meng
    • 1
  • Honglei Zhao
    • 2
  • Yongmin Liu
    • 2
  • Dong Chen
    • 3
  • Marcus Hacker
    • 4
  • Yongxiang Wei
    • 1
  • Xiang Li
    • 1
    • 4
  • Xiaoli Zhang
    • 1
    Email author
  • Michael C. Kreissl
    • 5
  1. 1.Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of Cardiac Surgery, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
  3. 3.Department of Pathology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
  4. 4.Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided TherapyMedical University of ViennaViennaAustria
  5. 5.Division of Nuclear Medicine, Department of Radiology and Nuclear MedicineUniversity Hospital MagdeburgMagdeburgGermany

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