Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT

Abstract

Distinct from cardiac PET performed with preparation to control physiological FDG uptake in the myocardium, standard FDG-PET/CT performed with 4–6 h of fasting will show variation in myocardial FDG uptake. For this reason, important signs of myocardial and pericardial abnormality revealed by myocardial FDG uptake tend to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. This review demonstrates the mechanism of FDG uptake in the myocardium, discusses the factors affecting uptake, and provides notable image findings that may suggest underlying disease.

Imaging Inflammation in Patients and Animals: Focus on PET Imaging the Vulnerable Plaque

“…In addition, uptake of FDG in the heart, an organ of high metabolic activity, can present challenges in assessing inflammation [19,20]. This becomes of concern in the coronary arteries, where spillover from the physiologic activity of the heart obscures detection and accurate quantification of FDG uptake and plaque inflammation [19].…”

The future of cardiac disease assessment using 18F-FDG PET/CT

“…However, the patterns of physiological 18 F-FDG accumulation are variable, and the normal variants include crista terminalis and lipomatous hypertrophy of the interatrial septum. In addition, Minamimoto reported the physiological uptake in detail, facilitating our understanding [4]. Sometimes 18 F-FDG uptake is observed in the atrial wall and in the right ventricle, which might be associated with atrial fibrillation and ventricular pressure overload in patients with pulmonary hypertension, respectively.…”

“…1). A review by Minamimoto presented an intriguing issue of myocardial and pericardial abnormalities using 18 F-FDG PET/computed tomography (CT) [4].…”

“…18 F-FDG PET/CT has diagnostic potential for various myocardial conditions (Table 1). Given the potential diagnostic challenges imposed on radiologists and nuclear medicine physicians, this article provides information regarding the physiological and abnormal uptake in the myocardium [4]. 18 F-FDG accumulation is observed not only in CS but also in other heart diseases, such as coronary artery disease, hypertrophic cardiomyopathy, takotsubo cardiomyopathy, and cardiac tumors, even under conditions that suppress physiological 18 F-FDG uptake.…”

“…18 F-FDG accumulation is observed not only in CS but also in other heart diseases, such as coronary artery disease, hypertrophic cardiomyopathy, takotsubo cardiomyopathy, and cardiac tumors, even under conditions that suppress physiological 18 F-FDG uptake. 18 F-FDG uptake in these diseases is sometimes difficult to distinguish from that in CS or from physiological uptake [4,9,10]. In order to point out the abnormal 18 F-FDG uptake in the cardiac lesion, it is essential to increase our knowledge and experience even during daily oncologic interpretation of PET/CT.…”