Top

Published in:

01-08-2014 | Original Article

Right ventricular ¹⁸F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis

Authors: Osamu Manabe, Keiichiro Yoshinaga, Hiroshi Ohira, Takahiro Sato, Ichizo Tsujino, Asuka Yamada, Noriko Oyama-Manabe, Atsuro Masuda, Keiichi Magota, Masaharu Nishimura, Nagara Tamaki

Published in: Annals of Nuclear Medicine | Issue 7/2014

Abstract

Purpose

Cardiac sarcoidosis is most commonly found in the left ventricular (LV) free wall. Presence in the right ventricle (RV) is less common but might be useful for detecting cardiac involvement of sarcoidosis. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET has been used to detect LV regions with cardiac sarcoidosis. However, the same has not been done for RV involvement. The aims of the current study were to evaluate RV ¹⁸F-FDG uptake and its relationship to the distribution of LV wall ¹⁸F-FDG-positive segments in the LV, and to evaluate whether patients with positive RV ¹⁸F-FDG uptake met the 1993 diagnostic criteria of the Japanese Ministry of Health and Welfare (JMHW) guidelines regarding sarcoidosis with suspected cardiac involvement.

Method

Fifty-nine biopsy-proven extra-cardiac sarcoidosis patients (age 56.1 ± 14.7 years) with suspected cardiac involvement based on abnormal electrocardiography or echocardiography findings underwent fasting ¹⁸F-FDG PET or PET/CT. The LV wall was divided into 17 segments and RV uptake was also evaluated.

Result

Among 59 patients, 35 (59.3 %) showed some abnormal ¹⁸F-FDG uptake in the RV and/or LV wall. With respect to the RV wall, 13 (22.0 %) showed abnormal ¹⁸F-FDG uptake. The number of LV-involved segments was 4.8 ± 2.4 in the patients with RV ¹⁸F-FDG uptake, which was significantly higher than in the patients without RV uptake, 1.8 ± 2.2 (P < 0.0001). Patients with RV uptake more frequently met the diagnostic criteria of the 1993 JMHW guidelines (n = 27), than did those without RV uptake (84.6 vs. 34.8 %, P = 0.0033).

Conclusion

¹⁸F-FDG PET identified RV involvement less frequently than LV involvement in this study population. However, patients who had RV uptake showed a greater number of LV-involved segments and met the JMHW diagnostic criteria more frequently. Although RV uptake is less frequent, ¹⁸F-FDG RV uptake may be useful in diagnosing cardiac involvement in sarcoidosis.

Clinical trial registration

UMIN000006533.

Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Eng J Med. 2007;357:2153–65.CrossRef

Rybicki BA, Major M, Popovich J Jr, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5 year study in a health maintenance organization. Am J Epidemiol. 1997;145:234–41.PubMedCrossRef

O’Regan A, Berman JS. Sarcoidosis. Ann Intern Med. 2012;156(9):ITC5-1, ITC5-2, ITC5-3, ITC5-4, ITC5-5, ITC5-6, ITC5-7, ITC5-8, ITC5-9, ITC5-10, ITC5-11, ITC5-12, ITC5-13, ITC5-14, ITC5-15; quiz ITC5-16.

Manabe O, Ohira H, Yoshinaga K, Sato T, Klaipetch A, Oyama-Manabe N, et al. Elevated F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis. Eur J Nucl Med Mol Imaging. 2013;40:1558–66.PubMed

Ohira H, Tsujino I, Yoshinaga K. (1)(8)F-fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2011;38:1558–66.

Youssef G, Leung E, Mylonas I, Nery P, Williams K, Wisenberg G, Beanlands RS, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 2012;53:241–8.PubMedCrossRef

Roberts WC, McAllister HA Jr, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977;63:86–108.PubMedCrossRef

Tavora F, Cresswell N, Li L, Ripple M, Solomon C, Burke A. Comparison of necropsy findings in patients with sarcoidosis dying suddenly from cardiac sarcoidosis versus dying suddenly from other causes. Am J Cardiol. 2009;104:571–7.PubMedCrossRef

Hiraga H, Hiroe M, Iwai K. Guidelines for diagnosis of cardiac sarcoidosis: study report on diffuse pulmonary diseases (in Japanese). Tokyo: The Japanese Ministry of Health and Welfare; 1993. p. 2.

10.

Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J. 2005;26:1538–43.PubMedCrossRef

11.

Ohira H, Tsujino I, Ishimaru S, Oyama N, Takei T, Tsukamoto E, et al. Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis. Eur J Nucl Med Mol Imaging. 2008;35:933–41.PubMed

12.

Ishida Y, Yoshinaga K, Miyagawa M, Moroi M, Kondoh C, Kiso K, et al. Recommendations for F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology Recommendations. Ann Nucl Med. 2014;28(4):393–403.PubMedCrossRef

13.

Laffon E, Adhoute X, de Clermont H, Marthan R. Is liver SUV stable over time in (1)(8)F-FDG PET imaging? J Nucl Med Technol. 2011;39:258–63.PubMedCrossRef

14.

Machac J, Bacharach SL, Bateman TM, Bax JJ, Beanlands R, Bengel F, et al. Positron emission tomography myocardial perfusion and glucose metabolism imaging. J Nucl Cardiol. 2006;13:e121–51.PubMedCrossRef

15.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S5–S10.

16.

Habersberger J, Manins V, Taylor AJ. Cardiac sarcoidosis. Intern Med J. 2008;38:270–7.PubMedCrossRef

17.

Manabe O, Oyama-Manabe N, Ohira H, Tsutsui H, Tamaki N. Multimodality evaluation of cardiac sarcoidosis. J Nucl Cardiol. 2012;19:621–4.PubMedCrossRef

18.

Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol. 2014;63:329–36.PubMedCrossRef

19.

Ohira H, Tsujino I, Sato T, Yoshinaga K, Manabe O, Oyama N, et al. Early detection of cardiac sarcoid lesions with (18)F-fluoro-2-deoxyglucose positron emission tomography. Intern Med. 2011;50:1207–9.PubMedCrossRef

20.

Okumura W, Iwasaki T, Toyama T, Iso T, Arai M, Oriuchi N, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med. 2004;45:1989–98.PubMed

21.

Yamagishi H, Shirai N, Takagi M, Yoshiyama M, Akioka K, Takeuchi K, et al. Identification of cardiac sarcoidosis with (13)N-NH(3)/(18)F-FDG PET. J Nucl Med. 2003;44:1030–6.PubMed

22.

Tahara N, Tahara A, Nitta Y, Kodama N, Mizoguchi M, Kaida H, et al. Heterogeneous myocardial FDG uptake and the disease activity in cardiac sarcoidosis. JACC Cardiovasc Imaging. 2010;3:1219–28.PubMedCrossRef

23.

Lobert P, Brown RK, Dvorak RA, Corbett JR, Kazerooni EA, Wong KK. Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT. Clin Radiol. 2013;68:e59–71.PubMedCrossRef

24.

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.PubMedCrossRef

25.

Kluge R, Barthel H, Pankau H, Seese A, Schauer J, Wirtz H, et al. Different mechanisms for changes in glucose uptake of the right and left ventricular myocardium in pulmonary hypertension. J Nucl Med. 2005;46:25–31.PubMed

26.

Doughan AR, Williams BR. Cardiac sarcoidosis. Heart. 2006;92:282–8.PubMedCentralPubMedCrossRef

27.

Kim JS, Judson MA, Donnino R, Gold M, Cooper LT Jr, Prystowsky EN, Prystowsky S. Cardiac sarcoidosis. Am Heart J. 2009;157:9–21.PubMedCrossRef

Title: Right ventricular 18F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis
Authors: Osamu Manabe
Keiichiro Yoshinaga
Hiroshi Ohira
Takahiro Sato
Ichizo Tsujino
Asuka Yamada
Noriko Oyama-Manabe
Atsuro Masuda
Keiichi Magota
Masaharu Nishimura
Nagara Tamaki
Publication date: 01-08-2014
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 7/2014
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-014-0860-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Right ventricular ¹⁸F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis

Abstract

Purpose

Method

Result

Conclusion

Clinical trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Method

Result

Conclusion

Clinical trial registration

Please log in to get access to this content

Other articles of this Issue 7/2014

A randomized study of the effect of carbonated water prior to myocardial SPECT

Contrast between hypervascularized liver lesions and hepatic parenchyma: early dynamic PET versus contrast-enhanced CT

Optimal radiation shielding for beta and bremsstrahlung radiation emitted by 89Sr and 90Y: validation by empirical approach and Monte Carlo simulations

Pulmonary sequestration: a 131I whole body scintigraphy false-positive result

The diagnostic role of 18F-FDG PET for primary central nervous system lymphoma

Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients: a SPECT/CT study