Preparation is everything: The impact of a structured preparation protocol on cardiac 18F-FDG PET imaging for cardiac sarcoidosis

AbstractA young gentleman with suspected cardiac sarcoidosis and LV dysfunction whose CMR revealed multifocal subepicardial to mid myocardial linear enhancement in the left ventricular myocardium underwent cardiac 18F-FDG PET imaging. The images revealed patchy regions of increased FDG uptake involving the apical to mid anterolateral, mid to basal anteroseptal/ right ventricular and mildly increased FDG uptake in apical inferior segments of the LV myocardium concordant with CMR findings. Whole body PET CT imaging showed multiple hypermetabolic supra and infra diaphragmatic lymphadenopathy, with no pulmonary lesion identified. Biopsy from the left para aortic lymph node revealed necrotizing granulomatous inflammation consistent with tuberculosis. Based on the histopathological findings of the lymph nodes, diagnosis of cardiac tuberculosis was made, given the similar imaging appearances in both sarcoidosis and TB. This case highlights that cardiac TB although rare, should be included in the differential diagnosis in patients with suspected infiltrative cardiomyopathy, particularly in TB endemic regions.

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Evaluating the association between hybrid magnetic resonance positron emission tomography and cardiac-related outcomes in cardiac sarcoidosis

10.1101/2022.01.13.22269230 ◽

2022 ◽

Author(s):

MariaGiovanna Trivieri ◽

Philip M Robson ◽

Vittoria Vergani ◽

Gina LaRocca ◽

Angelica M Romero-Daza ◽

...

Keyword(s):

Clinical Outcome ◽

Pet Imaging ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Characteristic Curve ◽

Cardiac Resynchronization ◽

Pet Tracer ◽

Imaging Results ◽

18F Fdg

Objectives: To evaluate an extended hybrid MR/PET imaging strategy in cardiac sarcoidosis (CS) employing qualitative and quantitative assessment of PET tracer uptake, and to evaluate its association with cardiac-related outcomes. Background: Invasive endomyocardial biopsy is the gold standard to diagnose CS, but it has poor sensitivity due to the patchy distribution of disease. Imaging with hybrid late gadolinium enhancement (LGE) MR and 18F-fluorodexyglucose (18F-FDG) PET allows simultaneous assessment of myocardial injury and disease activity and has shown promise for improved diagnosis of active CS based on the combined positive imaging outcome, MR(+)PET(+). Methods: 148 patients with suspected CS were enrolled for hybrid MR/PET imaging. Patients were classified based on presence/absence of LGE (MR+/MR-), presence/absence of 18F-FDG (PET+/PET-), and pattern of 18F-FDG uptake (focal/diffuse) into the following categories: MR(+)PET(+)FOCAL, MR(+)PET(+)DIFFUSE, MR(+)PET(-), MR(-)PET(+)FOCAL, MR(-)PET(+)DIFFUSE, MR(-)PET(-). Patients classified as MR(+)PET(+)FOCAL were designated as having active CS [aCS(+)], while all others were considered as having inactive or absent CS and designated aCS(-). Quantitative values of standard uptake value (SUVmax), target-to-background ratio (TBRmax), target-to-normal-myocardium ratio (TNMRmax) and T2 were measured. Occurrence of a cardiac-related clinical outcome was defined as any of the following during the 6-month period after imaging: cardiac arrest, ventricular arrhythmia, complete heart block, need for cardiac resynchronization/defibrillator/pacemaker/monitoring device (CRT-D, ICD/WCD, or ILR). MR/PET imaging results were compared to the presence of the composite clinical outcome. Results: Patients designated aCS(+) had more than 4-fold increased odds of meeting the clinical endpoint compared to aCS(-) (unadjusted odds ratio 4.8; 95% CI 2.0-11.4; p<0.001). TNMRmax achieved an area under the receiver operating characteristic curve of 0.90 for separating aCS(+) from aCS(-). Conclusions: Hybrid MR/PET imaging with an extended image-based classification of CS was statistically associated with clinical outcomes in CS. TNMRmax had high sensitivity and excellent specificity for quantifying the imaging-based classification of active CS.

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RELATIONSHIP BETWEEN CARDIAC 18F-FDG-PET IMAGING AND MYOCARDIAL OXIDATIVE STRESS IN PATIENTS WITH CARDIAC SARCOIDOSIS FOR THE CORTICOSTEROID THERAPY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60818-4 ◽

2014 ◽

Vol 63 (12) ◽

pp. A818

Author(s):

Shigeki Kobayashi ◽

Takeki Myoren ◽

Wakako Murakami ◽

Masakazu Fukuda ◽

Shinichi Okuda ◽

...

Keyword(s):

Oxidative Stress ◽

Corticosteroid Therapy ◽

Pet Imaging ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Myocardial Oxidative Stress ◽

18F Fdg

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The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on 18F-FDG PET Imaging of Lung Cancer

Journal of Nuclear Medicine ◽

10.2967/jnumed.116.173112 ◽

2016 ◽

Vol 57 (11) ◽

pp. 1692-1698 ◽

Cited By ~ 28

Author(s):

W. Grootjans ◽

F. Tixier ◽

C. S. van der Vos ◽

D. Vriens ◽

C. C. Le Rest ◽

...

Keyword(s):

Lung Cancer ◽

Pet Imaging ◽

Fdg Pet ◽

Respiratory Gating ◽

Image Noise ◽

Intratumor Heterogeneity ◽

18F Fdg ◽

The Impact

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Crossed Cerebellar Diaschisis in Alzheimer’s Disease

Current Alzheimer Research ◽

10.2174/1567205015666180913102615 ◽

2018 ◽

Vol 15 (13) ◽

pp. 1267-1275 ◽

Cited By ~ 1

Author(s):

F.E. Reesink ◽

D. Vállez García ◽

C.A. Sánchez-Catasús ◽

D.E. Peretti ◽

A.T. Willemsen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Left Hemisphere ◽

Pet Imaging ◽

Fdg Pet ◽

Pathophysiological Mechanism ◽

Crossed Cerebellar Diaschisis ◽

Amyloid Accumulation ◽

Cerebellar Diaschisis ◽

18F Fdg

Background: We describe the phenomenon of crossed cerebellar diaschisis (CCD) in four subjects diagnosed with Alzheimer’s disease (AD) according to the National Institute on Aging - Alzheimer Association (NIA-AA) criteria, in combination with 18F-FDG PET and 11C-PiB PET imaging. Methods: 18F-FDG PET showed a pattern of cerebral metabolism with relative decrease most prominent in the frontal-parietal cortex of the left hemisphere and crossed hypometabolism of the right cerebellum. 11C-PiB PET showed symmetrical amyloid accumulation, but a lower relative tracer delivery (a surrogate of relative cerebral blood flow) in the left hemisphere. CCD is the phenomenon of unilateral cerebellar hypometabolism as a remote effect of supratentorial dysfunction of the brain in the contralateral hemisphere. The mechanism implies the involvement of the cortico-ponto-cerebellar fibers. The pathophysiology is thought to have a functional or reversible basis but can also reflect in secondary morphologic change. CCD is a well-recognized phenomenon, since the development of new imaging techniques, although scarcely described in neurodegenerative dementias. Results: To our knowledge this is the first report describing CCD in AD subjects with documentation of both 18F-FDG PET and 11C-PiB PET imaging. CCD in our subjects was explained on a functional basis due to neurodegenerative pathology in the left hemisphere. There was no structural lesion and the symmetric amyloid accumulation did not correspond with the unilateral metabolic impairment. Conclusion: This suggests that CCD might be caused by non-amyloid neurodegeneration. The pathophysiological mechanism, clinical relevance and therapeutic implications of CCD and the role of the cerebellum in AD need further investigation.

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