Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis

Abstract

Quantification of FDG uptake in CS correlates with lower EFs, clinical events, and immunosuppression treatment.

Joint SNMMI–ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring

“…69 The presence of defects in one or both of the perfusion or 18 F-FDG images is important diagnostically, prognostically, and therapeutically 46,68,70 and will be discussed in detail in the section ''Diagnostic and Prognostic Performance of Cardiac PET for CS.'' In brief, the combination of both abnormal perfusion and abnormal 18 F-FDG uptake appears to have the worst outcome.…”

“…In brief, the combination of both abnormal perfusion and abnormal 18 F-FDG uptake appears to have the worst outcome. 46,70 Although not validated in a randomized controlled trial, using 18 F-FDG positivity as one criterion 99 for immunosuppressive treatment of CS appears to be a reasonable approach based on the available literature and is discussed in more detail in the section ''Management of CS. ''…”

“…Although no data support use of one method over another, data do suggest that for quantifying treatment response, quantitative SUV metrics perform better than visual assessment of normalized images. 50,[70][71][72] To date, quantitative measures have not been correlated with clinical outcomes in large-scale studies. Furthermore, there is no SUV threshold that can distinguish CS from normal myocardium.…”

“…Reprinted with permission from Blankstein et al 46 NA, not applicable evaluated 31 patients with suspected CS, of whom 9 experienced events over a follow-up of 1.2 y. 70 The authors found that most adverse cardiac events occurred in individuals with abnormal 18 F-FDG uptake. These studies were also limited by their retrospective, singlecenter design.…”

Quantifying FDG uptake to diagnose cardiac device infections: When and how should we do it?

“…While this could be performed in some patients who have infected CIED, the majority of patients with CIED infections require device extraction rather than serial follow-up. This is in contrast to other conditions, such as treatment of malignancies, treatment of vasculitis, or treatment of cardiac sarcoidosis, 8,9 where the need to follow response to therapy is more relevant. In such scenarios, it is essential to use the same acquisition and image analysis techniques.…”