Diagnosis of Silent Myocardial Ischemia During the Staging of HIV-Associated Lymphoma With FDG PET/CT

Abstract

Fasting 18F fluoro-deoxy-glucose positron emission tomography examinations are routinely performed for the staging of HIV-associated lymphomas. In addition to possible comorbidity factors, the chronic inflammation that occurs in HIV-infected patients together with the metabolic side effects of antiretroviral therapy increases the risk for coronary artery disease. Moreover, HIV-infected patients are likely to develop polyneuropathies due to the viral infection or to the side effects of long-term protease or nucleoside reverse transcription inhibitor treatments.We report a case that illustrates the need to suspect the diagnosis of silent myocardial ischemia among HIV-positive patients with myocardial F-18 fluoro-deoxy-glucose uptake involving a coronary artery territory.

Should patients with an incidental finding of focal myocardial 18FDG uptake be screened by myocardial perfusion scintigraphy?

“…Garcia et al showed a further correlation between myocardial vessel calcifications and the frequency of focal 18 FDG myocardial uptake [26]. Finding of unknown ischemia on an MPS performed after finding a focal 18 FDG uptake has been described in a case report [27].…”

Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?

“…To our knowledge, all but one of the myocardial scintigraphic studies in HIV-infected patients have investigated only endothelial or vasomotor function [37,38] or have investigated a single clinical case [39]. The only clinical study of myocardial perfusion using gated SPECT in HIVinfected patients under highly active antiretroviral therapy is that of Catzin-Kuhlmann et al and the finding was negative [23].…”

Hypermetabolic subcutaneous fat in patients on highly active anti-retroviral therapy treatment: Subtle finding with implications

“…[1] FDG PET/CT study has evolved not only as a tool to improve our understanding of the pathogenesis of HIV-1 infection, but also in diagnosis, staging, restaging, and monitoring therapeutic response in the opportunistic infections and malignancies. [2789101112] Furthermore, increased FDG uptake in subcutaneous adipose tissue has been demonstrated in diagnosed cases of LD. [213] The awareness of this uptake pattern is important when evaluating FDG PET in patients undergoing HAART.…”