Advertisement

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
ORIGINAL ARTICLE

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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

Keywords

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

Abbreviations

18F-FDG

18Fluorine-fluorodeoxyglucose

AUC

Area-under-the-curve

CMR

Cardiac magnetic resonance imaging

DLBCL

Diffuse large B-cell lymphoma

PET/CT

Positron emission tomography/computed tomography

PAS

Periodic acid-schiff

ROC

Receiver-operating characteristic

SUVmax

Maximum standardized uptake value

TBRmax

Maximum tumor-to-background ratio

VOI

Volume of interest

Notes

Disclosure

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)

References

  1. 1.
    Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, et al. Survival after resection of primary cardiac tumors: A 48-year experience. Circulation 2008;118:S7-15.CrossRefGoogle Scholar
  2. 2.
    Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics 2001;21:439-49.CrossRefGoogle Scholar
  3. 3.
    Reynen K. Cardiac myxomas. N Engl J Med 1995;333:1610-7.CrossRefGoogle Scholar
  4. 4.
    Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol 2007;60:27-34.CrossRefGoogle Scholar
  5. 5.
    Hoffmeier A, Sindermann JR, Scheld HH, Martens S. Cardiac tumors–diagnosis and surgical treatment. Dtsch Arztebl Int 2014;111:205-11.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Donisan T, Balanescu DV, Lopez-Mattei JC, Kim P, Leja MJ, Banchs J, et al. In search of a less invasive approach to cardiac tumor diagnosis: Multimodality imaging assessment and biopsy. JACC Cardiovasc Imaging 2018;11:1191-5.CrossRefGoogle Scholar
  7. 7.
    Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: Radiologic-pathologic correlation. Radiographics 2000;20:1073-103; quiz 110-1, 112.CrossRefGoogle Scholar
  8. 8.
    Mousavi N, Cheezum MK, Aghayev A, Padera R, Vita T, Steigner M, et al. Assessment of cardiac masses by cardiac magnetic resonance imaging: Histological correlation and clinical outcomes. J Am Heart Assoc 2019;8:e007829.CrossRefGoogle Scholar
  9. 9.
    Barrington SF, Johnson PWM. (18)F-FDG PET/CT in lymphoma: Has imaging-directed personalized medicine become a reality? J Nucl Med 2017;58:1539-44.CrossRefGoogle Scholar
  10. 10.
    Laurens ST, Oyen WJ. Impact of fluorodeoxyglucose PET/computed tomography on the management of patients with colorectal cancer. PET Clin 2015;10:345-60.CrossRefGoogle Scholar
  11. 11.
    Ciarallo A, Marcus C, Taghipour M, Subramaniam RM. Value of fluorodeoxyglucose PET/computed tomography patient management and outcomes in thyroid cancer. PET Clin 2015;10:265-78.CrossRefGoogle Scholar
  12. 12.
    Werner RA, Schmid JS, Higuchi T, Javadi MS, Rowe SP, Markl B, et al. Predictive value of (18)F-FDG PET in patients with advanced medullary thyroid carcinoma treated with vandetanib. J Nucl Med 2018;59:756-61.CrossRefGoogle Scholar
  13. 13.
    Weber WA. Positron emission tomography as an imaging biomarker. J Clin Oncol 2006;24:3282-92.CrossRefGoogle Scholar
  14. 14.
    Rahbar K, Seifarth H, Schafers M, Stegger L, Hoffmeier A, Spieker T, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med 2012;53:856-63.CrossRefGoogle Scholar
  15. 15.
    Shao D, Wang SX, Liang CH, Gao Q. Differentiation of malignant from benign heart and pericardial lesions using positron emission tomography and computed tomography. J Nucl Cardiol 2011;18:668-77.CrossRefGoogle Scholar
  16. 16.
    Masuda A, Manabe O, Oyama-Manabe N, Naya M, Obara M, Sakakibara M, et al. Cardiac fibroma with high (18)F-FDG uptake mimicking malignant tumor. J Nucl Cardiol 2017;24:323-4.CrossRefGoogle Scholar
  17. 17.
    Burke A, Tavora F. The 2015 WHO classification of tumors of the heart and pericardium. J Thorac Oncol.Google Scholar
  18. 18.
    Rinuncini M, Zuin M, Scaranello F, Fejzo M, Rampin L, Rubello D, et al. Differentiation of cardiac thrombus from cardiac tumor combining cardiac MRI and 18F-FDG-PET/CT Imaging. Int J Cardiol 2016;212:94-6.CrossRefGoogle Scholar
  19. 19.
    Nensa F, Tezgah E, Poeppel TD, Jensen CJ, Schelhorn J, Kohler J, et al. Integrated 18F-FDG PET/MR imaging in the assessment of cardiac masses: A pilot study. J Nucl Med 2015;56:255-60.CrossRefGoogle Scholar
  20. 20.
    Liu G, Hu Y, Zhao Y, Yu H, Hu P, Shi H. Variations of the liver standardized uptake value in relation to background blood metabolism: An 2-[18F]Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography study in a large population from China. Medicine (Baltimore) 2018;97:e0699.CrossRefGoogle Scholar
  21. 21.
    Li X, Samnick S, Lapa C, Israel I, Buck AK, Kreissl MC, et al. 68Ga-DOTATATE PET/CT for the detection of inflammation of large arteries: Correlation with18F-FDG, calcium burden and risk factors. EJNMMI Res 2012;2:52.CrossRefGoogle Scholar
  22. 22.
    Dunet V, Halkic N, Prior JO, Anaye A, Meuli RA, Sempoux C, et al. Detection and viability of colorectal liver metastases after neoadjuvant chemotherapy: A multiparametric PET/CT-MRI study. Clin Nucl Med 2017;42:258-63.CrossRefGoogle Scholar
  23. 23.
    Ezziddin S, Adler L, Sabet A, Poppel TD, Grabellus F, Yuce A, et al. Prognostic stratification of metastatic gastroenteropancreatic neuroendocrine neoplasms by 18F-FDG PET: Feasibility of a metabolic grading system. J Nucl Med 2014;55:1260-6.CrossRefGoogle Scholar
  24. 24.
    Sharma A, Mohan A, Bhalla AS, Vishnubhatla S, Pandey AK, Bal CS, et al. Role of various semiquantitative parameters of 18F-FDG PET/CT studies for interim treatment response evaluation in non-small-cell lung cancer. Nucl Med Commun 2017;38:858-67.CrossRefGoogle Scholar
  25. 25.
    Pun SC, Plodkowski A, Matasar MJ, Lakhman Y, Halpenny DF, Gupta D et al. Pattern and prognostic implications of cardiac metastases among patients with advanced systemic cancer assessed with cardiac magnetic resonance imaging. J Am Heart Assoc 2016;5.Google Scholar
  26. 26.
    Dhull VS, Sharma P, Mukherjee A, Jana M, Bal C, Kumar R. 18F-FDG PET-CT for evaluation of cardiac angiosarcoma: A case report and review of literature. Mol Imaging Radionucl Ther 2015;24:32-6.CrossRefGoogle Scholar
  27. 27.
    Mkalaluh S, Szczechowicz M, Torabi S, Schmack B, Sabashnikov A, Dib B, et al. Surgical treatment of cardiac tumors: Insights from an 18-year single-center analysis. Med Sci Monit 2017;23:6201-9.CrossRefGoogle Scholar

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

Personalised recommendations