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

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

Journal of Nuclear Cardiology ◽

10.1007/s12350-019-01788-8 ◽

2019 ◽

Cited By ~ 1

Author(s):

Sanjay Divakaran ◽

Michael T. Osborne

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

18F Fdg ◽

The Impact

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Cardiac Tuberculosis on 18F-FDG PET Imaging—A Great Masquerader of Cardiac Sarcoidosis

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1739379 ◽

2021 ◽

Author(s):

Sumati Sundaraiya ◽

Abubacker Sulaiman ◽

Adhithyan Rajendran

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Granulomatous Inflammation ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Whole Body ◽

Left Ventricular Myocardium ◽

Fdg Uptake ◽

18F Fdg

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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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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Comparison of 18F-FDG and 67Ga-citrate in sarcoidosis imaging

Nuklearmedizin ◽

10.3413/nukmed-0085 ◽

2008 ◽

Vol 47 (01) ◽

pp. 18-23 ◽

Cited By ~ 26

Author(s):

M. Wehrschuetz ◽

B. Bisail ◽

M. Woltsche ◽

T. Schwarz ◽

H. Lanz ◽

...

Keyword(s):

Fdg Pet ◽

Complete Agreement ◽

Pet Tracer ◽

Positron Emission ◽

Significant Difference ◽

Kappa Value ◽

18F Fdg ◽

Primary Assessment ◽

67Ga Citrate

SummaryAim: 67Ga citrate has been used long and successfully to diagnose and stage sarcoidosis. 18F-fluorodeoxyglucose (18F-FDG) has been suggested as a positron emission tomography (PET) tracer for sarcoidosis imaging. This study aimed to analyze possible advantages of 18F-FDG-PET over 67Ga citrate scintigraphy during the primary assessment of patients with sarcoidosis. Patients and methods: Twentyfour patients (11 men, 13 women, aged 52 years ±12.4) with histologically proven sarcoidosis were investigated with 18F-FDG and 67Ga citrate. Equipment included a fullring PET scanner (ECAT EXACT HR+, Siemens/CTI, Knoxville TN, USA) and a double-headed gamma camera (ECAM, Siemens, Illinois, USA) for scintigraphy. The mean time difference between the two studies was 6.5 days (range: 5–8 days). Results: There was a significant difference in the detection of pulmonary and nonpulmonary sarcoidosis lesions between planar 67Ga citrate scans and 18F-FDG-PET images (<0.0021). A total of 64 lesions were detected with 67Ga citrate scans in the thorax and elsewhere with a mean of 2.6 lesions (4%) per patient, while 85 lesions were found with 18F-FDG-PET, with a mean of 3.5 lesions (4.1%) per patient. There was complete agreement between 18F-FDG and 67Ga citrate in thoracic manifestations in four (16.6%) patients, and in non-thoracic manifestations in five (20.8%) patients. The interobserver variability showed a kappa value of 0.79. Conclusion: 67Ga citrate and 18F-FDG are useful tracers for diagnostic evaluation of thoracic sarcoidosis. 18F-FDG seems to be more suitable for imaging the mediastinum, the bi-hilar lymph nodes, the posterior regions of the lungs and non-thoracic lesions. Further prospective studies are needed to clarify the role of both tracers in early diagnosis and staging of sarcoidosis, and to resolve questions concerning medical treatment and follow-up.

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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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Multiple PET tracers for use in the classification of gliomas according to the 2016 WHO criteria

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa172 ◽

2020 ◽

Author(s):

Keisuke Miyake ◽

Kenta Suzuki ◽

Tomoya B Ogawa ◽

Daisuke Ogawa ◽

Tetsuhiro Hatakeyama ◽

...

Keyword(s):

Who Classification ◽

Standardized Uptake Value ◽

Metabolic Tumor Volume ◽

Who Criteria ◽

Pet Tracers ◽

Pet Tracer ◽

Positron Emission ◽

18F Fdg ◽

Classification Of Gliomas

Abstract Background The molecular diagnosis of gliomas such as isocitrate dehydrogenase (IDH) status (wild-type [wt] or mutation [mut]) is especially important in the 2016 WHO classification. Positron emission tomography (PET) has afforded molecular and metabolic diagnostic imaging. The present study aimed to define the interrelationship between the 2016 WHO classification of gliomas and the integrated data from PET images using multiple tracers, including 18F-fluorodeoxyglucose ( 18F-FDG), 11C-methionine ( 11C-MET), 18F-fluorothymidine ( 18F-FLT), and 18F-fluoromisonidazole ( 18F-FMISO). Methods This retrospective, single-center study comprised 113 patients with newly diagnosed glioma based on the 2016 WHO criteria. Patients were divided into four glioma subtypes (Mut, Codel, Wt, and glioblastoma multiforme [GBM]). Tumor standardized uptake value (SUV) divided by mean normal cortical SUV (tumor-normal tissue ratio [TNR]) was calculated for 18F-FDG, 11C-MET, and 18F-FLT. Tumor-blood SUV ratio (TBR) was calculated for 18F-FMISO. To assess the diagnostic accuracy of PET tracers in distinguishing glioma subtypes, a comparative analysis of TNRs and TBR as well as the metabolic tumor volume (MTV) were calculated by Scheffe’s multiple comparison procedure for each PET tracer following the Kruskal–Wallis test. Results The differences in mean 18F-FLT TNR and 18F-FMISO TBR were significant between GBM and other glioma subtypes (p < 0.001). Regarding the comparison between Gd-T1WI volumes and 18F-FLT MTVs or 18F-FMISO MTVs, we identified significant differences between Wt and Mut or Codel (p < 0.01). Conclusion Combined administration of four PET tracers might aid in the preoperative differential diagnosis of gliomas according to the 2016 WHO criteria.

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