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The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The purpose of this study was to determine the feasibility of serial quantitative 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) to monitor the response of cardiac sarcoidosis to treatment.

Methods and Results

A total of 38 PET scan intervals (54 PET scans) were obtained in 16 patients with cardiac sarcoidosis who underwent serial FDG PET during treatment. FDG-avid lesions of the heart were interpreted quantitatively using 4 PET parameters: maximum standardized uptake value (SUVmax), partial volume corrected mean standardized uptake value (SUVmean), partial volume corrected metabolic volume product (MVP), and global metabolic volume product (gMVP). Clinical response to treatment (improved, stable, or progressive disease) was evaluated by clinical symptoms, NYHA class, and EKG in all the patients. SUVmax, SUVmean, MVP, and gMVP had significantly decreased value on repeat PET in patients who were either stable or showed clinical improvement between two serial PET scans, while none of them had significant change on repeat PET in patients who were clinically worse. Correlation analysis between PET findings and clinical assessment revealed that the changes of SUVmax and SUVmean on repeat PET were negatively correlated with patient’s clinical outcome.

Conclusion

Our results indicated that serial FDG PET is feasible to determine the extent of disease activity and to quantitatively assess the response of cardiac sarcoidosis to therapy.

Spanish Abstract

Antecedentes

El propósito de este estudio fue determinar la factibilidad del estudio PET con FDG cuantitativo realizado en forma seriada para monitorear la respuesta de la sarcoidosis cardiaca al tratamiento.

Métodos y resultados

Se obtuvieron estudios PET en un total de 38 intervalos (54 estudios PET) en 16 pacientes con sarcoidosis cardiaca quienes fueron sometidos al estudio de PET FDG seriado durante su tratamiento. Las lesiones cardiacas ávidas de FDG fueron interpretadas cuantitativamente utilizando 4 parámetros de PET: el valor de captación máximo estandarizado (SUVmax por sus siglas en ingles), valor de captación promedio estandarizado corregido por volumen parcial (SUVmean por sus siglas en ingles), el producto volumen metabólico corregido por el volumen parcial (MVP por sus siglas en ingles) y el producto volumen metabólico global (gMVP por sus siglas en ingles). La respuesta clínica al tratamiento (mejoría, estable o progresión de la enfermedad) fue evaluada en base a los síntomas, la clase funcional de acuerdo a la clasificación de NYHA y ECG en todos los pacientes. Todas las variables cuantitativas SUVmax, SUVmean, MVP y gMVP habían disminuido su valor de forma significativa en el estudio PET de repetición en los pacientes estables o con mejoría clínica entre los dos estudios de PET seriados, mientras que ninguna de ellas tuvo un cambio significativo en el PET de repetición en los pacientes que cursaron con deterioro clínico. El análisis de correlación entre los resultados del PET y la evaluación clínica, reveló que los cambios en los valores SUVmáx y SUVmean en el PET de repetición se correlacionaron de forma negativa con el resultado clínico del paciente.

Conclusión

Nuestros resultados indican el estudio PET con FDG seriado es factible para determinar el grado de actividad de la enfermedad y para evaluar cuantitativamente la respuesta de sarcoidosis cardiaca al tratamiento.

Chinese Abstract

背景

本研究目的是探討FDG PET 连续定量分析應用在評估心脏结节病治疗效果的可行性。

方法和结果

共16 名患有心脏结节病并在治疗过程中以FDG PET扫描作為治療監測的病人。這16位病人接收了54次PET 扫描, 38 个PET 扫描间隔。心脏病灶的FDG PET 显像利用以下参数定量:最大标准摄取值 (SUVmax), 部分体积纠正的平均标准摄取值(SUVmean), 部分体积纠正的代谢体积产物 (MVP), 和整体代谢体积产物(gMVP) 。所有病人的治療效果均以临床症状, NYHA 级别, 及EKG 来评估, 分別為好转、稳定或恶化。对比两次连续的PET 扫描,對于好转和稳定的病人, 其SUV-max, SUVmean, MVP, 和gMVP 都有明显的降低; 然而,对于恶化的病人,这四个指标都没有改变。相关性分析显示SUVmax 和SUVmean 的改变与病人的临床治療反应呈负相关。

结论

FDG PET 连续定量分析可以用来定量评估心脏结节病的活动性以及治疗反应。

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Disclosure

The authors declared that they have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Koo-Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Pei-Ing Lee MD

  2. Department of Radiology, Philadelphia VA Medical Center, Philadelphia, PA, USA

    Gang Cheng MD, PhD

  3. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Gang Cheng MD, PhD & Abass Alavi MD, MD (Hon), PhD (Hon), DSc (Hon)

Authors
  1. Pei-Ing Lee MD
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  2. Gang Cheng MD, PhD
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  3. Abass Alavi MD, MD (Hon), PhD (Hon), DSc (Hon)
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Corresponding author

Correspondence to Gang Cheng MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-016-0721-y.

JNC thanks Erick Alexanderson MD, Carlos Guitar MD, and Diego Vences MD, UNAM, Mexico for their work in providing the Spanish abstract.

JNC thanks Haipeng Tang, MS, School of Computing, University of Southern Mississippi; Zhixin Jiang, MD, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Weihua Zhou, PhD, School of Computing, University of Southern Mississippi, for providing the Chinese abstract.

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Lee, PI., Cheng, G. & Alavi, A. The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis. J. Nucl. Cardiol. 24, 19–28 (2017). https://doi.org/10.1007/s12350-016-0682-1

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  • DOI: https://doi.org/10.1007/s12350-016-0682-1

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