What Is the Optimal Method on Myocardial Suppression in FDG PET/CT Evaluation of Cardiac Sarcoidosis?

Lü, Yang; Sweiss, Nadera J.; Macapinlac, Homer A.

doi:10.1097/rlu.0000000000003777

Cited by 3 publications

(3 citation statements)

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“…Over the years, our group has published our experiences of using a 72-hour ketogenic diet, that is, a high-fat, high-protein, very low-carbohydrate diet; the preparation protocol for sarcoidosis patients receiving FDG PET/CT evaluation, with a simple interpretation algorithm, avoided the complex and debatable interpretation, as well as the controversy "focalon-diffuse" pattern. [2][3][4][5][6][7] Our approach was also supported by other groups' findings. 8,9 As illustrated in this rare case of extensive biventricular CS, the 72-hour ketogenic diet preparation can satisfactorily suppress physiological myocardial uptake of FDG, and enable FDG PET/CT evaluation of CS.…”

supporting

confidence: 87%

“…Many preimaging preparation strategies have been developed to suppress physiological myocardial FDG uptake, including use of heparin, long fasting, overnight high-fat, low-carbohydrate diet modification, and combinations of these approaches. Over the years, our group has published our experiences of using a 72-hour ketogenic diet, that is, a high-fat, high-protein, very low-carbohydrate diet; the preparation protocol for sarcoidosis patients receiving FDG PET/CT evaluation, with a simple interpretation algorithm, avoided the complex and debatable interpretation, as well as the controversy "focalon-diffuse" pattern [2][3][4][5][6][7]. Our approach was also supported by other groups' findings 8,9.…”

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confidence: 99%

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Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol

2022

Clin Nucl Med

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A 49-year-old man had right bundle-branch block, with decreased left ventricle ejection fraction of 43%. Cardiac MRI demonstrated abnormal multifocal delayed gadolinium enhancement involving both ventricles. Cardiac sarcoidosis was further confirmed at cardiac biopsy. Dedicated FDG PET/CT with 72-hour ketogenic diet preparation to suppress physiological myocardial uptake of FDG was performed for disease evaluation. PET/CT revealed multifocal abnormal uptake in both ventricles concordant with cardiac MRI findings, in addition to hypermetabolic lymphadenopathy. Six months later, posttreatment PET/CTwith the same 72-hour ketogenic diet preparation showed good response with resolution of active inflammation.

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confidence: 87%

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confidence: 99%

Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol

2022

Clin Nucl Med

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“…The SNMMI recommends high-fat (>35 g) and low-carbohydrate (<3 g) meals the day before the study with fasting for 4–12 h prior to PET/CT to achieve myocardial suppression of FDG uptake [ 12 ]. A 24 h diet restriction has shown mixed results with anywhere from 24.5 to 41.7% of individuals having an indeterminate PET/CT result [ 13 ▪ , 14 ▪▪ ]. When a high-fat, high-protein, and low-carbohydrate diet was extended to 72 h prior to the PET/CT scan, the indeterminate rate was 3.6% [ 15 ].…”

Section: Introduction To Pet Imaging Tracers and Preparationmentioning

confidence: 99%

The role of PET in the management of sarcoidosis

Vender¹,

Aldahham

Gupta

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewPET has emerged as method to determine the location and extent of disease activity in sarcoidosis. As most clinicians do not routinely utilize PET in the management of sarcoidosis, an understanding of the imaging technique is needed to comprehend the impact that PET abnormalities have on diagnosis, prognosis, and treatment.Recent findingsAlthough PET can detect inflammation because of sarcoidosis throughout the body, it is most often utilized for the diagnosis of cardiac sarcoidosis for which it may provide information about prognosis and adverse events. Whenever PET is combined with cardiac magnetic resonance (CMR), clinicians may be able to increase the diagnostic yield of imaging. Furthermore, PET abnormalities have the potential to be utilized in the reduction or augmentation of therapy based on an individual's response to treatment. Although various biomarkers are used to monitor disease activity in sarcoidosis, an established and reproducible relationship between PET and biomarkers does not exist.SummaryPET has the potential to improve the diagnosis of sarcoidosis and alter treatment decisions but prospective trials are needed to define the role of PET while also standardizing the performance and interpretation of the imaging modality.

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Advances in Diagnostic Imaging for Cardiac Sarcoidosis

Manabe

Oyama‐Manabe

Aikawa

et al. 2021

JCM

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Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS.

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What Is the Optimal Method on Myocardial Suppression in FDG PET/CT Evaluation of Cardiac Sarcoidosis?

Abstract: Based on the recent publications, including large cohort retrospective study and prospective clinical trial data, we are commenting on the optimal methods on myocardial suppression in FDG PET/CT evaluation of patients with suspected cardiac sarcoidosis.

Cited by 3 publications

References 10 publications

Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol

Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol

The role of PET in the management of sarcoidosis

Advances in Diagnostic Imaging for Cardiac Sarcoidosis

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