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Diagnosis and staging of cardiac masses: additional value of CMR with 18F-FDG-PET compared to CMR with CECT

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Abstract

Purpose

Characterization of malignant cardiac masses is usually performed with cardiac magnetic resonance (CMR) and staging with whole-body contrast-enhanced computed tomography (CECT). In this study, our objective was to evaluate the role of 18Fluor-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) with CMR for both characterization and staging of cardiac masses.

Methods

Patients with cardiac masses who underwent CMR, CECT, and 18F-FDG-PET were retrospectively identified. For the characterization of cardiac masses, we calculated the respective performances of CMR alone, 18F-FDG-PET alone, and the combination of 18F-FDG-PET and CMR. For staging, we compared head-to-head the respective performances of 18F-FDG-PET and CECT. Histology served as gold standard for malignancy, and response to anticoagulation for thrombus.

Results

In a total of 28 patients (median age 60.5 years, 60.7% women), CMR accurately distinguished malignant from benign masses with sensitivity (Se) of 86.7%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 86.7%, and accuracy of 92.9%. 18F-FDG-PET demonstrated 93.3% Se, 84.6% Sp, 87.5% PPV, 91.7% NPV, and 89.3% accuracy. Combining CMR with 18F-FDG-PET allowed to benefit from the high sensitivity of 18F-FDG-PET (92.9%) and the excellent specificity of CMR (100%) for malignant diseases. For staging, 18F-FDG-PET outperformed CECT on per-patient (66.7% vs 55.6% correct diagnosis, respectively), per-organ (10 vs 7 organs, respectively), and per-lesion basis (> 29 vs > 25 lesions, respectively).

Conclusion

Combining 18F-FDG-PET with CMR improved the characterization of cardiac masses compared to each modality alone. Additionally, the diagnostic performance of 18F-FDG-PET was better than CECT for staging. This study suggests that the combination of CMR and 18F-FDG-PET is the most effective for the characterization of cardiac masses and the staging of these lesions.

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Abbreviations

18F-FDG:

18Fluor fluorodeoxyglucose

CECT:

Contrast-enhanced computed tomography

CT:

Computed tomography

CMR:

Cardiac magnetic resonance

MTV:

Metabolic tumor volume

PET:

Positron emission tomography

SUV:

Standard uptake value

SUVmax:

Maximal standard uptake value

SUVmean:

Mean standard uptake value

TBR:

Tumor-to-blood pool ratio

TLG:

Tumor lesion glycolysis

TMR:

Tumor-to-muscle ratio

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Author information

Author notes

  1. Fabien Hyafil, Khadija Benali, Richard Raffoul and François Rouzet contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Nidaa Mikail, Khadija Benali & François Rouzet

  2. Paris Diderot University, Inserm, 1148, Paris, France

    Nidaa Mikail, Lisa Males, Khadija Benali, Carsten Ehmer, Ahmed Ben Driss, Loukbi Saker, François Rouzet & Phalla Ou

  3. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland

    Nidaa Mikail & Alexia Rossi

  4. Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland

    Nidaa Mikail & Alexia Rossi

  5. Department of Cardiovascular Imaging, Department of Radiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Lisa Males, Carsten Ehmer, Ahmed Ben Driss, Loukbi Saker & Phalla Ou

  6. Department of Nuclear Medicine, DMU IMAGINA, Hopital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France

    Fabien Hyafil

  7. Department of Pathology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Lydia Deschamps

  8. Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Eric Brochet

  9. Department of Cardiac Surgery, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Soleiman Alkhoder & Richard Raffoul

Authors
  1. Nidaa Mikail
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  2. Lisa Males
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nidaa Mikail, Lisa Males, Khadija Benali, and Phalla Ou. The first draft of the manuscript was written by Nidaa Mikail and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nidaa Mikail.

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Mikail, N., Males, L., Hyafil, F. et al. Diagnosis and staging of cardiac masses: additional value of CMR with 18F-FDG-PET compared to CMR with CECT. Eur J Nucl Med Mol Imaging 49, 2232–2241 (2022). https://doi.org/10.1007/s00259-022-05709-9

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  • DOI: https://doi.org/10.1007/s00259-022-05709-9

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