The response of FDG uptake to immunosuppressive treatment on FDG PET/CT imaging for cardiac sarcoidosis

Abstract

Quantitative interpretation of FDG PET/CT in CS can detect changes in FDG uptake in response to immunosuppression. Further studies are needed to see if quantitative changes in FDG uptake are associated with improved outcomes.

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

“…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.…”

The current status of quantitative SPECT/CT in the assessment of transthyretin cardiac amyloidosis

“…Further assessment of cardiac disease burden can be undertaken by measuring cardiac metabolic activity (CMA) and cardiac metabolic volume (CMV) which can be calculated from quantitative SPECT images using standard algorithms that identify voxels with uptake above certain thresholds within a defined volume of interest using techniques initially developed for total lesion glycolysis (TLG) and metabolic tumor volume (MTV) in oncology (Figure 1). These measurements have proven useful in FDG PET assessment of cardiac sarcoidosis 31 and would appear to carry promise for measuring cardiac amyloid burden. CMA and MTV are most reliably calculated when cardiac uptake is high, and so hold promise in assessing patients with known ATTR based solely on their cardiac uptake, offering a technical solution to the previously discussed grade 2 versus 3 issue.…”

Joint SNMMI–ASNC Expert Consensus Document on the Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring

“…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.…”