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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References
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Eng J Med. 2007;357:2153–65.
Rybicki BA, Major M, Popovich J Jr, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5 year study in a health maintenance organization. Am J Epidemiol. 1997;145:234–41.
O’Regan A, Berman JS. Sarcoidosis. Ann Intern Med. 2012;156(9):ITC5-1, ITC5-2, ITC5-3, ITC5-4, ITC5-5, ITC5-6, ITC5-7, ITC5-8, ITC5-9, ITC5-10, ITC5-11, ITC5-12, ITC5-13, ITC5-14, ITC5-15; quiz ITC5-16.
Manabe O, Ohira H, Yoshinaga K, Sato T, Klaipetch A, Oyama-Manabe N, et al. Elevated F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis. Eur J Nucl Med Mol Imaging. 2013;40:1558–66.
Ohira H, Tsujino I, Yoshinaga K. (1)(8)F-fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2011;38:1558–66.
Youssef G, Leung E, Mylonas I, Nery P, Williams K, Wisenberg G, Beanlands RS, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 2012;53:241–8.
Roberts WC, McAllister HA Jr, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977;63:86–108.
Tavora F, Cresswell N, Li L, Ripple M, Solomon C, Burke A. Comparison of necropsy findings in patients with sarcoidosis dying suddenly from cardiac sarcoidosis versus dying suddenly from other causes. Am J Cardiol. 2009;104:571–7.
Hiraga H, Hiroe M, Iwai K. Guidelines for diagnosis of cardiac sarcoidosis: study report on diffuse pulmonary diseases (in Japanese). Tokyo: The Japanese Ministry of Health and Welfare; 1993. p. 2.
Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J. 2005;26:1538–43.
Ohira H, Tsujino I, Ishimaru S, Oyama N, Takei T, Tsukamoto E, et al. Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis. Eur J Nucl Med Mol Imaging. 2008;35:933–41.
Ishida Y, Yoshinaga K, Miyagawa M, Moroi M, Kondoh C, Kiso K, et al. Recommendations for F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology Recommendations. Ann Nucl Med. 2014;28(4):393–403.
Laffon E, Adhoute X, de Clermont H, Marthan R. Is liver SUV stable over time in (1)(8)F-FDG PET imaging? J Nucl Med Technol. 2011;39:258–63.
Machac J, Bacharach SL, Bateman TM, Bax JJ, Beanlands R, Bengel F, et al. Positron emission tomography myocardial perfusion and glucose metabolism imaging. J Nucl Cardiol. 2006;13:e121–51.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S5–S10.
Habersberger J, Manins V, Taylor AJ. Cardiac sarcoidosis. Intern Med J. 2008;38:270–7.
Manabe O, Oyama-Manabe N, Ohira H, Tsutsui H, Tamaki N. Multimodality evaluation of cardiac sarcoidosis. J Nucl Cardiol. 2012;19:621–4.
Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol. 2014;63:329–36.
Ohira H, Tsujino I, Sato T, Yoshinaga K, Manabe O, Oyama N, et al. Early detection of cardiac sarcoid lesions with (18)F-fluoro-2-deoxyglucose positron emission tomography. Intern Med. 2011;50:1207–9.
Okumura W, Iwasaki T, Toyama T, Iso T, Arai M, Oriuchi N, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med. 2004;45:1989–98.
Yamagishi H, Shirai N, Takagi M, Yoshiyama M, Akioka K, Takeuchi K, et al. Identification of cardiac sarcoidosis with (13)N-NH(3)/(18)F-FDG PET. J Nucl Med. 2003;44:1030–6.
Tahara N, Tahara A, Nitta Y, Kodama N, Mizoguchi M, Kaida H, et al. Heterogeneous myocardial FDG uptake and the disease activity in cardiac sarcoidosis. JACC Cardiovasc Imaging. 2010;3:1219–28.
Lobert P, Brown RK, Dvorak RA, Corbett JR, Kazerooni EA, Wong KK. Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT. Clin Radiol. 2013;68:e59–71.
Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics. 2011;31:1287–305.
Kluge R, Barthel H, Pankau H, Seese A, Schauer J, Wirtz H, et al. Different mechanisms for changes in glucose uptake of the right and left ventricular myocardium in pulmonary hypertension. J Nucl Med. 2005;46:25–31.
Doughan AR, Williams BR. Cardiac sarcoidosis. Heart. 2006;92:282–8.
Kim JS, Judson MA, Donnino R, Gold M, Cooper LT Jr, Prystowsky EN, Prystowsky S. Cardiac sarcoidosis. Am Heart J. 2009;157:9–21.
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