Other Imaging Techniques: Computed Tomography and Positron Emission Tomography

  • Martina Urbani
  • Eugenio Borsatti
  • Tanja Baresic


Both computed tomography (CT) and positron emission tomography (PET) may be useful in addition to echocardiography and magnetic resonance (MR) imaging to study cardiac tumors. CT scan may be used as an alternative imaging modality in patients who cannot undergo MR because it is contraindicated or in patients already examined with other noninvasive methods without obtaining adequate images. High-speed equipments with electrocardiographic (ECG) gating can provide images with resolution <1 mm; multiplanar and tridimensional reconstructions are also possible. PET is based on the detection of metabolic activity after injection of radionuclides. The most commonly used tracing in oncology is fluorodeoxyglucose (18F-FDG), which concentrates in tissue with high glucose metabolism. PET is usually performed together with computed tomography (PET/CT). To quantify the glucose metabolism, the maximum standardized uptake value (SUV) is used. Malignant tumors have usually a high SUV, which may increase with the proliferative index. Some other organs, such as the liver and heart, may have variable uptake according to different metabolic conditions. The myocardial 18FDG uptake may vary widely between different patients and – in the same patient – between different exams. In order to improve the accuracy of 18FDG-PET in cardiac tumor imaging, a carbohydrate- poor and fat-rich meal followed by a fasting period of 12–18 h is suggested before the exam.


  1. 1.
    Buckley O, Madan R, Kwong R, et al. Cardiac masses, part 1: imaging strategies and technical considerations. AJR Am J Roentgenol. 2011;197:W837–41.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Chu LC, Johnson PT, Halushka MK, Fishman EK. Multidetector CT of the heart: spectrum of benign and malignant cardiac masses. Emerg Radiol. 2012;19:415–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Rajiah P, Kanne JP, Kalahasti V, Schoenhagen P. Computed tomography of cardiac and pericardiac masses. J Cardiovasc Comput Tomogr. 2011;5:16–29.CrossRefPubMedGoogle Scholar
  4. 4.
    Kassop D, Donovan MS, Cheezum MK, et al. Cardiac masses on cardiac CT: a review. Curr Cardiovasc Imaging Rep. 2014;7:9281. Review.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hoey E, Ganeshan A, Nader K, et al. Cardiac neoplasms and pseudotumors: imaging findings on multidetector CT angiography. Diagn Interv Radiol. 2012;18:67–77.PubMedGoogle Scholar
  6. 6.
    Tokmak H, Demir N, Demirkol MO. Cardiac angiosarcoma: utility of [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography in evaluation of residue, metastases, and treatment response. Vasc Health Risk Manag. 2014;10:399–401.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics. 2011;31:1287–305.CrossRefPubMedGoogle Scholar
  8. 8.
    Rahbar K, Seifarth H, Schäfers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012;53:856–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Benz MR, Dry SM, Eilber FC, Allen-Auerbach MS, Tap WD, Elashoff D, Phelps ME, Czernin J. Correlation between glycolytic phenotype and tumor grade in soft-tissue sarcomas by 18F-FDG PET. J Nucl Med. 2010;51:1174–81.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Korn RL, Coates A, Millstine J. The role of glucose and FDG metabolism in the interpretation of PET studies. In: Lin EC, Alavi A, editors. PET and PET/CT. A clinical guide. 2nd ed. New York: Thieme; 2009.Google Scholar
  11. 11.
    Lin EC, Alavi A. Normal variants and benign findings. In: Lin EC, Alavi A, editors. PET and PET/CT. A clinical guide. 2nd ed. New York: Thieme; 2009.Google Scholar
  12. 12.
    Watanabe R, Tomita N, Takeuchi K, et al. SUVmax in FDG-PET and the biopsy site correlates with the proliferation potential of tumor cells in non-Hodgkin lymphoma. Leuk Lymphoma. 2010;51:279–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Kobayashi Y, Kumita S, Fukushima Y, et al. Significant suppression of myocardial (18)F-fluorodeoxyglucose uptake using 24-h carbohydrate restriction and a low-carbohydrate, high-fat diet. J Cardiol. 2013;62:314–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Manabe O, Yoshinaga K, Ohira H, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial (18)F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol. 2015 Aug 5.Google Scholar
  15. 15.
    Masuda A, Naya M, Manabe O, et al. Administration of unfractionated heparin with prolonged fasting could reduce physiological 18F-fluorodeoxyglucose uptake in the heart. Acta Radiol. 2015 Sep.Google Scholar
  16. 16.
    Loft A, Jensen KE, Löfgren J, Daugaard S, Petersen MM. PET/MRI for Preoperative Planning in Patients with Soft Tissue Sarcoma: A Technical Report of Two Patients. Case Rep Med. 2013;2013, 791078.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nensa F, Beiderwellen K, Heusch P, Wetter A. Clinical applications of PET/MRI: current status and future perspectives. Diagn Interv Radiol. 2014;20:438–47.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Martina Urbani
    • 1
  • Eugenio Borsatti
    • 2
  • Tanja Baresic
    • 2
  1. 1.Radiology UnitCRO-National Cancer InstituteAviano (PN)Italy
  2. 2.Nuclear Medicine UnitCRO-National Cancer InstituteAviano (PN)Italy

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