18F-FDG-PET in Finnish patients with clinical suspicion of cardiac sarcoidosis: Female sex and history of atrioventricular block increase the prevalence of positive PET findings

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as “possible” or “rejected” IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the ‘imaging specialist’. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.

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The prevalence of cardiac sarcoidosis is underestimated: [18F]FDG-PET is the answer

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.071 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

J Borges-Rosa ◽

M Oliveira-Santos ◽

R Silva ◽

J Lopes De Almeida ◽

L Goncalves ◽

...

Keyword(s):

Heart Failure ◽

Fdg Pet ◽

Cardiac Involvement ◽

Cardiac Sarcoidosis ◽

Clinical Manifestations ◽

European Population ◽

Response To Therapy ◽

Histological Diagnosis ◽

18F Fdg

Abstract Funding Acknowledgements Type of funding sources: None. Background Overt cardiac involvement is reported in 5% of patients with sarcoidosis, although autopsy and imaging studies suggest higher prevalence, worldwide variation. The role of 18F-fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) in non-invasive diagnosis and follow-up has increased in the last decade. Purpose Our goal is to describe the prevalence, clinical manifestations and outcomes of cardiac sarcoidosis (CS), diagnosed through [18F]FDG-PET, in a southern European population. Methods We included all patients with histological diagnosis of extracardiac sarcoidosis screened with [18F]FDG-PET between 2009 and 2020. We collected data on clinical manifestations, cardiac magnetic resonance (CMR) results, and mortality outcomes and compared those with and without cardiac involvement. We applied the criteria for the diagnosis of CS from Heart Rhythm Society. Results Of the 400 patients screened with [18F]FDG-PET, 128 had a histological diagnosis of extracardiac sarcoidosis (54.7% females, mean age 51.0 ± 14.2 years). None underwent endomyocardial biopsy. Ten patients had a pattern of [18F]FDG uptake consistent with CS defined as diffuse (n = 5), focal (n = 3), and focal on diffuse (n = 2). Of the 128 patients, 14 also underwent CMR, which identified 2 subjects with positive findings in both modalities and 3 additional patients: focal (n = 1), multifocal mid-wall (n = 2), focal mid-wall (n = 2), and multifocal subepicardial (n = 1) delayed gadolinium enhancement. Overall, 13 patients (10.2%) fulfilled the criteria for probable CS (53.8% female, mean age 56.2 ± 12.6 years), all with multiorgan involvement, mostly lung and lymph nodes (each 92%), followed by skin and central nervous system (each 15%). Median left ventricle ejection fraction was 62% [55-65] and there were cardiac manifestations of CS in 6 patients (46%): sick sinus syndrome (n = 2), complete heart block (n = 1), frequent premature ventricular complexes (n = 1), ventricular tachycardia plus heart failure (n = 1), and bifascicular block plus heart failure (n = 1). Eleven patients (85%) with probable CS were medicated with immunosuppressant drugs: corticosteroids (n = 9), methotrexate (n = 4), and azathioprine (n = 2). Four patients with previous [18F]FDG screening were revaluated after treatment, each showing no cardiac uptake. After a mean follow-up of 4.0 ± 1.0 years, mortality was three-fold higher in patients with cardiac involvement, despite the absence of statistical significance (15% vs. 5%, P = 0.151). Conclusions In a southern European population with histological extracardiac sarcoidosis, the prevalence of cardiac involvement was 10.2%, most asymptomatic. [18F]FDG-PET improves the diagnostic yield and plays an important role in monitoring response to therapy. The higher mortality trend in those with CS needs to be ascertained in longer follow-up.

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P307Efficacy and adverse effects of strict pretest preparation for 18F-FDG PET/CT for assessment of cardiac sarcoidosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez148.035 ◽

2019 ◽

Vol 20 (Supplement_3) ◽

Author(s):

H Ohira ◽

K Yoshinaga ◽

S Sakiyama ◽

T Nakaya ◽

J Nakamura ◽

...

Keyword(s):

Adverse Effects ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Effectiveness of prolonged fasting 18f-FDG PET-CT in the detection of cardiac sarcoidosis

Journal of Nuclear Cardiology ◽

10.1007/s12350-009-9110-0 ◽

2009 ◽

Vol 16 (5) ◽

pp. 801-810 ◽

Cited By ~ 123

Author(s):

Rumman Langah ◽

Kenneth Spicer ◽

Mulugeta Gebregziabher ◽

Leonie Gordon

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Prolonged Fasting ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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18F-FDG PET/CMR in cardiac sarcoidosis: A wild card in the deck?

Journal of Nuclear Cardiology ◽

10.1007/s12350-020-02427-3 ◽

2020 ◽

Author(s):

Carmela Nappi ◽

Andrea Ponsiglione ◽

Massimo Imbriaco ◽

Alberto Cuocolo

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Wild Card ◽

18F Fdg

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The Utility of Whole Body 18F-FDG PET-CT in Diagnosing Isolated Cardiac Sarcoidosis: The Western Australian Cardiac Sarcoid Study

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.07.007 ◽

2020 ◽

Vol 29 (1) ◽

pp. e1-e6 ◽

Cited By ~ 2

Author(s):

Lauren Giudicatti ◽

James Marangou ◽

David Nolan ◽

Lawrence Dembo ◽

Jay Baumwol ◽

...

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Whole Body ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Western Australian

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Utility of 18F-FDG PET in the diagnosis of cardiac sarcoidosis

Journal of Nuclear Cardiology ◽

10.1016/s1071-3581(99)90170-8 ◽

1999 ◽

Vol 6 (1) ◽

pp. S14

Author(s):

W OKUMURA

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

18F Fdg

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The Evaluation of Cardiac Sarcoidosis with 18F-FDG PET

Journal of Nuclear Medicine Technology ◽

10.2967/jnmt.115.158857 ◽

2015 ◽

Vol 44 (2) ◽

pp. 92-93 ◽

Cited By ~ 1

Author(s):

Z. Al-Faham ◽

P. Jolepalem ◽

C. Y. Oliver Wong

Keyword(s):

Fdg Pet ◽

Cardiac Sarcoidosis ◽

18F Fdg

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18F-FDG PET/CT uptake in COVID-19: case report of a patient with lung metastases after treatment of nasal cavity malignancy

10.21203/rs.3.rs-23861/v1 ◽

2020 ◽

Author(s):

Hongyan Feng ◽

Lihong Bu

Keyword(s):

Nucleic Acid ◽

Nasal Cavity ◽

Fdg Pet ◽

Lung Metastases ◽

Positive Real ◽

Pet Ct ◽

History Of ◽

18F Fdg ◽

Fdg Pet Ct ◽

Specific Symptoms

Abstract Background: In high COVID-19 prevalence region, COVID-19 disease may be incidental found in non-specific symptoms or asymptomatic patient with history of tumor who underwent 18F-FDG-PET/CT for standard oncologic indications.Case presentation: A 51-year-old woman with a 4-year history of adenoid cystic carcinoma of nasal cavity underwent 18F-FDG PET/CT for restaging during COVID-19 outbreak in Wuhan. Pneumonia lesions were characterized by 18F-FDG uptake ground-glass opacities (GGOs) and multifocal high 18F-FDG-avid patchy consolidation, and without lymph node involvement and pleural effusion. Furthermore, multiple 18F-FDG-positive lung and lumbar metastases were observed. Finally, a diagnosis of COVID-19 was made based on a positive real-time fluorescent polymerase chain reaction (RT-PCR) test of SARS-CoV-2 nucleic acid. Conclusion: The non-specific symptoms or asymptomatic cancer patients presenting 18F-FDG-positive GGOs and patchy consolidation lesions in lung may favor COVID-19, who should be quickly SARS-CoV-2 nucleic acid tested and monitored.

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The place of 18F FDG PET/CT in the management of patients with eosinophilic fasciitis: a case report

Reumatismo ◽

10.4081/reumatismo.2020.1353 ◽

2021 ◽

Vol 72 (4) ◽

pp. 252-254

Author(s):

N. Belfeki ◽

N. Louarn ◽

I. Chouchane ◽

A. Abbadi ◽

S. Diamantis

Keyword(s):

Fdg Pet ◽

Lower Limbs ◽

Eosinophilic Fasciitis ◽

Reactive Protein ◽

Pet Ct ◽

History Of ◽

Laboratory Examinations ◽

18F Fdg ◽

Fdg Pet Ct ◽

Rule Out

Eosinophilic fasciitis is a rare connective tissue disease with a clinical presentation of scleroderma-like disease. We report a case of a 36-year-old female patient with a 6-month history of progressive stiffness involving her forearms and legs with joint pain. Laboratory examinations showed hypereosinophilia and elevated C-reactive protein. 18F FDG PET/CT showed diffuse and symmetrical increased uptake in the fasciae of the upper and lower limbs, sparing both muscles and fat tissues. Guided biopsy and histologic examination confirmed the diagnosis of eosinophilic fasciitis. 18F FDG PET/CT is of great help in the diagnosis of eosinophilic fasciitis, as it can guide the biopsy where FDG uptake is strongest and also help rule out possible associated neoplasms.

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