The role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in the differential diagnosis of pericardial disease

Abstract

This study aimed to assess the role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) in the differential diagnosis of pericardial disease. The diagnosis is often troublesome because pericardial fluid analysis or biopsy does not always provide answers. 18FDG-PET/CT can visualize both inflammation and malignancy and offers a whole-body assessment. Patients who visited the Pericardial Disease Clinic of Samsung Medical Center with an 18FDG-PET/CT order code were extracted. Exclusion criteria were as follows: (1) the purpose of the differential diagnosis was not pericardial disease; (2) the patient had a known advanced-stage malignancy; (3) the patient already have confirmative diagnosis using a serology, pericardial effusion analysis or biopsy. The analysis included 107 patients. The most common final diagnosis was idiopathic (n = 46, 43.0%), followed by tuberculosis (n = 30, 28.0%) and neoplastic (n = 11, 10.3%). A maximum standardized uptake value (SUVmax) ≥ 5 typically indicates tuberculosis or neoplastic pericarditis except in just one case of autoimmune pericarditis); especially all of the SUVmax scores ≥ 10 had tuberculosis. The diagnostic yield of pericardial biopsy was very low (10.2%). Interestingly, all of the pericardium with an SUVmax < 4.4 had nondiagnostic results. In contrast, targeted biopsies based on 18FDG uptake demonstrated a higher diagnostic yield (38.7%) than pericardium. The sensitivity of 18FDG-PET/CT was 63.6%. The specificity was 71.9%. The positive predictive value was 20.6%. The negative predictive value 94.5%, and the accuracy was 71.0% for excluding malignancy based upon the FDG uptake patterns. It is possible to explore the differential diagnosis in some patients with difficult pericardiocentesis or pericardial biopsy in a noninvasive manner using on the SUVmax or uptake patterns. In addition, the biopsy strategy depending on 18FDG uptake is helpful to achieve biopsy more safely and with a higher yield. 18FDG-PET may enhance the diagnostic efficacy in patients with pericardial disease.

Pericardial Effusion during Proton Therapy in a Patient with Chemorefractory Hodgkin Lymphoma

“…Patients should be evaluated with electrocardiography, echocardiography (definitive diagnosis), and an X-ray to rule out cardiac tamponade [ 8 ]. When PCE is in the presence of HL, F-18 FDG PET/CT holds a high negative predictive value of 94.5% and can be used to help rule out malignant causes [ 10 ]. Progression to cardiac tamponade holds a 1-year mortality rate of 79% in the setting of malignancy and 27% in those with PCE attributed to nonmalignant causes.…”

Cardiac Tamponade as First Manifestation of Multiple Myeloma: a Case Report With Literature Review

“…Positron emission tomography with 18Fuorodeoxyglucose (18F-FDG) and computed tomography (PET-CT) are used in valid scores established in differentiating malignant pleural effusion from benign effusions [21,22]. However, the literature on the use of PET/CT in pericardial disease remains very limited, and this area warrants further investigation [22,23].…”

Molecular Imaging of Tuberculosis

“…103 Imaging is often relied upon for diagnosing TB pericarditis due to the invasiveness of pericardial biopsy, and, more importantly, the high risk of sampling error during biopsy. 104 Interestingly, patients with low SUVmax of pericardial lesion on FDG PET/CT are more likely to have non-diagnostic pericardial biopsy results. 104 FDG uptake in the pericardium must be differentiated from other causes of pericarditis, including idiopathic (the most common form of pericarditis in the developed countries and often due to viral etiology), neoplastic, or due to pathogens other than MTB.…”

“…104 Interestingly, patients with low SUVmax of pericardial lesion on FDG PET/CT are more likely to have non-diagnostic pericardial biopsy results. 104 FDG uptake in the pericardium must be differentiated from other causes of pericarditis, including idiopathic (the most common form of pericarditis in the developed countries and often due to viral etiology), neoplastic, or due to pathogens other than MTB. 103,104 TB pericarditis is associated with the most intense pericardial FDG uptake compared with other causes of pericarditis.…”

“…104 FDG uptake in the pericardium must be differentiated from other causes of pericarditis, including idiopathic (the most common form of pericarditis in the developed countries and often due to viral etiology), neoplastic, or due to pathogens other than MTB. 103,104 TB pericarditis is associated with the most intense pericardial FDG uptake compared with other causes of pericarditis. 104 TB pericarditis is more commonly associated with FDG-avid mediastinal and supraclavicular lymphadenopathy compared with idiopathic pericarditis.…”