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Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

Besides cardiac sarcoidosis, FDG-PET is rarely used in the diagnosis of myocardial inflammation, while cardiac MRI (CMR) is the actual imaging reference for the workup of myocarditis. Using integrated PET/MRI in patients with suspected myocarditis, we prospectively compared FDG-PET to CMR and the feasibility of integrated FDG-PET/MRI in myocarditis.

Methods

A total of 65 consecutive patients with suspected myocarditis were prospectively assessed using integrated cardiac FDG-PET/MRI. Studies comprised T2-weighted imaging, late gadolinium enhancement (LGE), and simultaneous PET acquisition. Physiological glucose uptake in the myocardium was suppressed using dietary preparation.

Results

FDG-PET/MRI was successful in 55 of 65 enrolled patients: two patients were excluded due to claustrophobia and eight patients due to failed inhibition of myocardial glucose uptake. Compared with CMR (LGE and/or T2), sensitivity and specificity of PET was 74% and 97%. Overall spatial agreement between PET and CMR was κ = 0.73. Spatial agreement between PET and T2 (κ = 0.75) was higher than agreement between PET and LGE (κ = 0.64) as well as between LGE and T2 (κ = 0.56).

Conclusion

In patients with suspected myocarditis, FDG-PET is in good agreement with CMR findings.

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Abbreviations

CMR:

Cardiac magnetic resonance imaging

EGE:

Early gadolinium-enhancement

EMB:

Endomyocardial biopsy

FDG:

18F-fluorodeoxyglucose

LGE:

Late gadolinium-enhancement

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

ROI:

Region of interest

SUV:

Standardized uptake value

TBR:

Target to background ratio

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Disclosure

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Felix Nensa MD, Juliane Goebel MD, Kai Nassenstein MD & Thomas Schlosser MD

  2. Clinic for Cardiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany

    Julia Kloth MD & Ercan Tezgah MD

  3. Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany

    Thorsten D. Poeppel MD

  4. Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, 45147, Dusseldorf, Germany

    Philipp Heusch MD, MSc

Authors
  1. Felix Nensa MD
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  2. Julia Kloth MD
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  3. Ercan Tezgah MD
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  4. Thorsten D. Poeppel MD
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  5. Philipp Heusch MD, MSc
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  6. Juliane Goebel MD
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  7. Kai Nassenstein MD
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  8. Thomas Schlosser MD
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Corresponding author

Correspondence to Felix Nensa MD.

Additional information

See related editorial, doi:10.1007/s12350-016-0671-4.

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Nensa, F., Kloth, J., Tezgah, E. et al. Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI. J. Nucl. Cardiol. 25, 785–794 (2018). https://doi.org/10.1007/s12350-016-0616-y

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  • DOI: https://doi.org/10.1007/s12350-016-0616-y

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