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

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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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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The effect of PPAR-γ agonist on 18F-FDG PET imaging for differentiating tumors and inflammation lesions

Nuclear Medicine and Biology ◽

10.1016/j.nucmedbio.2014.08.013 ◽

2015 ◽

Vol 42 (2) ◽

pp. 85-91 ◽

Cited By ~ 2

Author(s):

Su-Jin Cheong ◽

Chang-Moon Lee ◽

Eun-Mi Kim ◽

Seok Tae Lim ◽

Myung-Hee Sohn ◽

...

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Ppar Γ ◽

18F Fdg

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1-[11C]-acetate PET imaging in head and neck cancer—a comparison with 18F-FDG-PET: implications for staging and radiotherapy planning

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-006-0298-9 ◽

2006 ◽

Vol 34 (5) ◽

pp. 651-657 ◽

Cited By ~ 22

Author(s):

Aijun Sun ◽

Jens Sörensen ◽

Mikael Karlsson ◽

Ingela Turesson ◽

Bengt Langström ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Pet Imaging ◽

Fdg Pet ◽

Radiotherapy Planning ◽

18F Fdg

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Impact of dual-time-point 18F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-007-0584-1 ◽

2007 ◽

Vol 35 (2) ◽

pp. 246-252 ◽

Cited By ~ 85

Author(s):

Khaled Alkhawaldeh ◽

Gonca Bural ◽

Rakesh Kumar ◽

Abass Alavi

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Pulmonary Nodules ◽

Partial Volume Correction ◽

Solitary Pulmonary Nodules ◽

Partial Volume ◽

Volume Correction ◽

18F Fdg ◽

Dual Time Point ◽

Time Point

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Patient-specific optimisation of administered activity and acquisition times for 18F-FDG PET imaging

EJNMMI Research ◽

10.1186/s13550-016-0250-3 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 7

Author(s):

Fred Wickham ◽

Helena McMeekin ◽

Maria Burniston ◽

Daniel McCool ◽

Deborah Pencharz ◽

...

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Patient Specific ◽

18F Fdg ◽

Administered Activity

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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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