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

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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.

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Acknowledgments

The authors thank Hidehiko Omote, RT; Ken-ichi Nishijima, PhD; Daiske Abo, MSc; Kumi Ajiki, and Eriko Suzuki for their support for this study. This study was supported in part by grants from the Ministry of Education, Science and Culture Japan (Category B, No. 23390294, Category Young Investigator, No. 23790826), Hokkaido Heart Association for Research (H-23) (Sapporo, Japan), Adult Vascular Disease Research Foundation (#H22-23) (Kyoto, Japan), and North-Tech Research Foundation (#H23-S2-17, Sapporo, Japan). Dr. Yoshinaga is supported by the Imura Clinical Research Award (Adult Vascular Disease Research Foundation).

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Manabe, O., Yoshinaga, K., Ohira, H. et al. Right ventricular 18F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis. Ann Nucl Med 28, 656–663 (2014). https://doi.org/10.1007/s12149-014-0860-7

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  • DOI: https://doi.org/10.1007/s12149-014-0860-7

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