Diagnostic value of quantitative assessment of cardiac 18 F-fluoro-2-deoxyglucose uptake in suspected cardiac sarcoidosis

Abstract

Objective

The identification of cardiac sarcoidosis is challenging as there is no gold standard consensually admitted for its diagnosis. The aim of this study was to evaluate the diagnostic value of the assessment of cardiac dynamic ¹⁸F-fluoro-2-deoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) and net influx constant (Ki) in patients suspected of cardiac sarcoidosis.

Methods

Data obtained from 30 biopsy-proven sarcoidosis patients suspected of cardiac sarcoidosis who underwent a 50-min list-mode cardiac dynamic ¹⁸F-FDG PET/CT after a 24 h high-fat and low-carbohydrate diet were analyzed. A normalized coefficient of variation of quantitative glucose influx constant, calculated as the ratio: standard deviation of the segmental Ki (min⁻¹)/global Ki (min⁻¹) was determined using a validated software (Carimas^® 2.4, Turku PET Centre). Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare criteria. Receiving operating curve analysis was performed to determine sensitivity and specificity of cardiac dynamic ¹⁸F-FDG PET/CT analysis to diagnose cardiac sarcoidosis.

Results

Six out of 30 patients (20%) were diagnosed as having cardiac sarcoidosis. Myocardial glucose metabolism was significantly heterogeneous in patients with cardiac sarcoidosis who showed significantly higher normalized coefficient of variation values compared to patients without cardiac sarcoidosis (0.513 ± 0.175 vs. 0.205 ± 0.081; p = 0.0007). Using ROC curve analysis, we found a cut-off value of 0.38 for the diagnosis of cardiac sarcoidosis with a sensitivity of 100% and a specificity of 91%.

Conclusions

Our results suggest that quantitative analysis of cardiac dynamic ¹⁸F-FDG PET/CT could be a useful tool for the diagnosis of cardiac sarcoidosis.