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PET/CT morphology and cardiac conduction disorders help discriminate primary cardiac lymphoma from primary cardiac sarcoma

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Primary cardiac lymphoma (PCL) and primary cardiac sarcoma (PCS) are similar in clinical presentation but differ in management and outcomes. We aim to explore the role of PET morphology and clinical characteristics in distinguishing PCL from PCS.

Methods

Pretreatment 18F-FDG PET/CT and contrast-enhanced CT were performed in PCL (n = 14) and PCS (n = 15) patients. Patient demographics, overall survival, and progression-free survival were reviewed. PET/CT morphological and metabolic features were extracted. Specifically, R_Kurtosis, a PET-morphology parameter reflecting the tumor expansion within the heart, was calculated.

Results

Compared with PCS, PCL occurred at an older age, resulted in more cardiac dysfunctions and arrhythmias, and showed higher glucometabolism (SUVmax, SUVpeak, SUVmean, MTV, and TLG). Curative treatments improved survival for PCL but not for PCS. Multivariable logistic regression identified R_Kurtosis (OR = 27.025, P = .007) and cardiac conduction disorders (OR = 37.732, P = .016) independently predictive of PCL, and classification and regression tree analysis stratified patients into three subgroups: R_Kurtosis ≥ 0.044 (probability of PCL 88.9%), R_Kurtosis < 0.044 with conduction disorders (80.0%), and R_Kurtosis < 0.044 without conduction disorders (13.3%).

Conclusion

PET-derived tumor expansion pattern (R_Kurtosis) and cardiac conduction disorders were helpful in distinguishing PCL from PCS, which might assist the clinical management.

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Abbreviations

PCS:

Primary cardiac sarcoma

PCL:

Primary cardiac lymphoma

CECT:

Contrast-enhanced CT

MTV:

Metabolic tumor volume

TLG:

Total lesion glycolysis

OS:

Overall survival

PFS:

Progression-free survival

HR:

Hazard ratio

CART:

Classification and regression tree

LVEF:

Left ventricular ejection fraction

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Acknowledgments

This work was supported by the fund from the National Natural Science Foundation of China (81971645) and Guangdong Provincial People's Hospital (KY0120211130).

Author contribution

LJ, XW, HY, and JQ designed the study. Data collection was performed by HY, JQ, and XW, while data curation was performed by HY, QJ, XW, and FZ. Data analysis was performed by HY and LWCC, of which LWCC is the certified statistician who suggested and supervised all statistical analyses utilized in this study. The manuscript was written and edited by HY, LJ, and KWHC. All authors read and approved the final manuscript.

Disclosures

Hui Yuan, Jia Qiu, Keith W. H. Chiu, Lawrence W. C. Chan, Fen Zhang, Xiaojuan Wei, and Lei Jiang declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were approved by the Ethics Committee at Guangdong Provincial People's Hospital, and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Author information

Author notes

  1. Hui Yuan and Jia Qiu have contributed equally to this work.

Authors and Affiliations

  1. PET Center, Department of Nuclear Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China

    Hui Yuan MD, PhD & Lei Jiang MD, PhD

  2. Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Jia Qiu MD, PhD

  3. Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China

    Keith W. H. Chiu MBChB

  4. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Lawrence W. C. Chan PhD

  5. Department of Pathology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Fen Zhang MD

  6. Division of Lymphoma, Department of Clinical Oncology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China

    Xiaojuan Wei MD

  7. Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Lei Jiang MD, PhD

Authors
  1. Hui Yuan MD, PhD
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Corresponding authors

Correspondence to Xiaojuan Wei MD or Lei Jiang MD, PhD.

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Yuan, H., Qiu, J., Chiu, K.W.H. et al. PET/CT morphology and cardiac conduction disorders help discriminate primary cardiac lymphoma from primary cardiac sarcoma. J. Nucl. Cardiol. 29, 2866–2877 (2022). https://doi.org/10.1007/s12350-022-03042-0

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  • DOI: https://doi.org/10.1007/s12350-022-03042-0

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