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Objective <p><sup>18</sup>F-Fludeoxyglucose (FDG) PET/CT is an effective tool for detecting active cardiac sarcoidosis (CS), but often has difficulty distinguishing CS lesions from physiological myocardial accumulation. We investigated the potential of the glucose metabolic rate (MR<sub>glc</sub>, mg/min/100mL) from four-dimensional FDG PET/CT in distinguishing between CS and physiological accumulation. Additionally, we compared CS delineation between MR<sub>glc</sub> and standardized uptake value (SUV).</p> Methods <p>A total of 192 individuals with CS or suspected CS who underwent four-dimensional FDG PET/CT after 18 h fasting was enrolled. Ultimately, 45 individuals with CS and 14 patients with physiological accumulation, with SUV<sub>mean</sub> ≥ 2.7 accumulation in the left ventricular myocardium, were analyzed. The SUV, MR<sub>glc</sub>, and the ratio of MR<sub>glc</sub> to SUV (MR<sub>glc</sub>/SUV) were calculated for each lesion with SUV<sub>mean</sub> ≥ 2.7 using data acquired between 30 and 50&#xa0;min on four-dimensional FDG PET/CT. In the CS group, lesion-to-normal myocardium contrast ratios on MR<sub>glc</sub> and SUV images were compared.</p> Results <p>A total of 127 lesions from 45 individuals with CS and 43 physiological accumulations from 14 individuals were analyzed. The SUV, MR<sub>glc,</sub> and MR<sub>glc</sub>/SUV for CS lesions were significantly lower than those for physiological accumulations (SUV, 4.26±1.35 vs. 6.06±3.28; MR<sub>glc</sub>, 1.91&#xa0;±&#xa0;1.02 vs. 3.78&#xa0;±&#xa0;2.11; MR<sub>glc</sub>/SUV, 0.43&#xa0;±&#xa0;0.14 vs. 0.63&#xa0;±&#xa0;0.14; p&#xa0;&lt;&#xa0;0.0001). Receiver operating characteristic analysis revealed that the ability to discriminate CS lesions from physiological accumulations yielded areas under the curves of 0.656, 0.808, and 0.849; sensitivities of 68, 76, and 73%; and specificities of 61, 72, and 84%, for SUV 4.525, MR<sub>glc</sub> 2.41, and MR<sub>glc</sub>/SUV 0.518. In the CS group, the contrast ratio of lesions was significantly greater on MR<sub>glc</sub> images than on SUV images (6.36&#xa0;±&#xa0;6.17 vs. 2.54&#xa0;±&#xa0;1.03, p&#xa0;&lt;&#xa0;0.0001).</p> Conclusions <p>MR<sub>glc</sub> from four-dimensional FDG PET/CT is a useful quantitative measure to distinguish CS lesions from physiological accumulation and enables better visualization of CS lesion contrast than SUV.</p>

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Diagnosis of cardiac sarcoidosis using glucose metabolic rate from four-dimensional 18F-FDG PET/CT

  • 期刊论文

  • 发表日期：

    2025年6月14日

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  • Yurie Shirai,
  • Michinobu Nagao,
  • Akihiro Inoue,
  • Atsushi Yamamoto,
  • Koichiro Kaneko,
  • Akiko Sakai,
  • Atsushi Suzuki,
  • Junichi Yamaguchi,
  • Shuji Sakai

摘要

Objective

18F-Fludeoxyglucose (FDG) PET/CT is an effective tool for detecting active cardiac sarcoidosis (CS), but often has difficulty distinguishing CS lesions from physiological myocardial accumulation. We investigated the potential of the glucose metabolic rate (MRglc, mg/min/100mL) from four-dimensional FDG PET/CT in distinguishing between CS and physiological accumulation. Additionally, we compared CS delineation between MRglc and standardized uptake value (SUV).

Methods

A total of 192 individuals with CS or suspected CS who underwent four-dimensional FDG PET/CT after 18 h fasting was enrolled. Ultimately, 45 individuals with CS and 14 patients with physiological accumulation, with SUVmean ≥ 2.7 accumulation in the left ventricular myocardium, were analyzed. The SUV, MRglc, and the ratio of MRglc to SUV (MRglc/SUV) were calculated for each lesion with SUVmean ≥ 2.7 using data acquired between 30 and 50 min on four-dimensional FDG PET/CT. In the CS group, lesion-to-normal myocardium contrast ratios on MRglc and SUV images were compared.

Results

A total of 127 lesions from 45 individuals with CS and 43 physiological accumulations from 14 individuals were analyzed. The SUV, MRglc, and MRglc/SUV for CS lesions were significantly lower than those for physiological accumulations (SUV, 4.26±1.35 vs. 6.06±3.28; MRglc, 1.91 ± 1.02 vs. 3.78 ± 2.11; MRglc/SUV, 0.43 ± 0.14 vs. 0.63 ± 0.14; p < 0.0001). Receiver operating characteristic analysis revealed that the ability to discriminate CS lesions from physiological accumulations yielded areas under the curves of 0.656, 0.808, and 0.849; sensitivities of 68, 76, and 73%; and specificities of 61, 72, and 84%, for SUV 4.525, MRglc 2.41, and MRglc/SUV 0.518. In the CS group, the contrast ratio of lesions was significantly greater on MRglc images than on SUV images (6.36 ± 6.17 vs. 2.54 ± 1.03, p < 0.0001).

Conclusions

MRglc from four-dimensional FDG PET/CT is a useful quantitative measure to distinguish CS lesions from physiological accumulation and enables better visualization of CS lesion contrast than SUV.