FDG uptake patterns in isolated and systemic cardiac sarcoidosis

• Published in: Journal of nuclear cardiology 2023-06, Vol.30 (3), p.1065-1074
• Main Authors: Kaneko, Koichiro, Nagao, Michinobu, Yamamoto, Atsushi, Sakai, Akiko, Sakai, Shuji
• Format: Article
• Language: English
• Subjects: 18F-FDG PET/CT; Cardiology; Cardiomyopathies - metabolism; Energy Metabolism; Fluorodeoxyglucose F18; Humans; Imaging; Isolated cardiac sarcoidosis; Medical prognosis; Medicine; Medicine & Public Health; Metabolism; Myocarditis; Nuclear Medicine; Original Article; Positron Emission Tomography Computed Tomography - methods; Positron-Emission Tomography - methods; Prognosis; Radiology; Radiopharmaceuticals; Retrospective Studies; Sarcoidosis; Sarcoidosis - metabolism; Systemic cardiac sarcoidosis
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-022-03106-1

We aimed to investigate the pre-treatment characteristics and treatment responses of isolated and systemic cardiac sarcoidosis (ICS and SCS) from FDG-PET/CT studies and to compare the prognoses of the two groups. FDG-PET/CT images taken before and after treatment of 31 ICS and 91 SCS patients were analyzed retrospectively. Treatment response and recurrence were determined from the course of FDG-PET/CT. Treatment response and the incidence of both recurrence and major adverse cardiac events (MACE) were assessed in 16 ICS and 35 SCS patients who had been treated for more than 2 years. A focal uptake pattern was more often observed than a focal-on-diffuse uptake pattern in both the ICS (74.2%) and SCS (63.7%) groups. Right ventricular involvement was significantly more frequent in SCS than ICS (44.0% vs. 9.6%, p < .001). SUVmax, cardiac metabolic volume (CMV), and cardiac metabolic activity (CMA) were significantly higher in SCS than ICS (SUVmax, 9.1 ± 4.1 vs. 4.8 ± 2.1; CMV, 118.0 ± 111.3 ml vs. 68.3 ± 94.7 ml; CMA, 541.6 ± 578.7 MBq vs. 265.1 ± 396.0 MBq, p < .001). Treatment responses in the two groups were similar, and complete resolution of cardiac uptake after immunosuppressive treatment was obtained in 62.5% of ICS patients and 77.1% of SCS patients (not significantly different). Likewise, no significant difference was found in the incidence of recurrence (40.0% for ICS, 44.4% for SCS) or MACE (25.0% for ICS, 22.8% for SCS). SCS patients had more active and extensive CS lesions than ICS patients before treatment, but the two groups showed similar treatment responses and prognoses.