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Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy

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Abstract

Purpose

Apical wall thickening with an “ace-of-spades” configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET.

Methods

Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT.

Results

Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14–15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p < 0.01), apical asynergy (p = 0.08), and impaired coronary flow reserve (p < 0.05). There were no other factors correlated with the pattern or intensity of SSUA.

Conclusion

SSUA incidentally found in oncological FDG PET appeared to be associated with AHCM, especially in ischemic conditions. The moderate repeatability of SSUA was probably due to obscurity by physiological uptake.

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Acknowledgements

The authors thank colleagues at the Departments of Diagnostic Radiology and Cardiology involved in ECG, echocardiography, myocardial perfusion scan, and coronary computed tomography angiographic scan for this study. No grant support was received for this study.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Mari Katagiri, Tadaki Nakahara, Yuji Ogata, Yohji Matsusaka, Yu Iwabuchi, Yoshitake Yamada & Masahiro Jinzaki

  2. Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Mitsushige Murata & Keiichi Fukuda

Authors
  1. Mari Katagiri
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  2. Tadaki Nakahara
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  3. Mitsushige Murata
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  4. Yuji Ogata
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  5. Yohji Matsusaka
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  6. Yu Iwabuchi
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  7. Yoshitake Yamada
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  9. Masahiro Jinzaki
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Correspondence to Tadaki Nakahara.

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Katagiri, M., Nakahara, T., Murata, M. et al. Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy. Ann Nucl Med 31, 399–406 (2017). https://doi.org/10.1007/s12149-017-1167-2

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  • DOI: https://doi.org/10.1007/s12149-017-1167-2

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