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. 2021 Feb;65(1):54-59.
doi: 10.1111/1754-9485.13121. Epub 2020 Oct 25.

Excellent suppression of physiological myocardial FDG activity in patients with cardiac sarcoidosis

Shyam S Sankaran  1 , Katerina Kyprianou  1 , Martin H Cherk  1   2 , David P Nadebaum  1 , Paul A Beech  1   3 , Robert Khor  1 , Hendrik Zimmet  2   4   5 , James L Hare  2   4   6 , Annabel Larby  7 , Kenneth Sk Yap  1   2 , Thomas W Barber  1   2
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Excellent suppression of physiological myocardial FDG activity in patients with cardiac sarcoidosis

Shyam S Sankaran et al. J Med Imaging Radiat Oncol. 2021 Feb.

Abstract

Introduction: Suppression of physiological myocardial FDG activity is vital in patients undergoing PET/CT for assessment of known or suspected cardiac sarcoidosis. This study aims to evaluate the efficacy of physiological myocardial FDG suppression following a protocol change to a 24-h high fat very low carbohydrate (HFVLC) diet and prolonged fast.

Methods: A retrospective review of patients undergoing FDG PET/CT for the evaluation of cardiac sarcoidosis was performed. Prior to June-2018, patients were prepared with a single very high-fat low carbohydrate meal followed by a 12-18 h fast (group 1). After June-2018, a protocol change was initiated with patients prepared with a HFVLC diet for 24-h followed by a 12-18 h fast (group 2). Focal myocardial activity was classified as positive, absent activity as negative and diffuse/focal on diffuse activity as indeterminate.

Results: A total of 94 FDG PET/CT scans were included with 46 scans in group 1 and 48 scans in group 2. Studies were classified as positive, negative or indeterminate in 25 (54%), 7 (15%) and 14 (30%) scans in group 1 and in 13 (27%), 33 (69%) and 2 (4%) scans in group 2, respectively. In scans classified as negative, myocardial FDG activity was less than mediastinal blood pool activity in 5/7 (71%) scans in group 1 and 33/33 (100%) scans in group 2.

Conclusion: Excellent myocardial FDG suppression can be achieved using a 24-h HFVLC diet and prolonged fast, resulting in a very low indeterminate scan rate in patients with known or suspected cardiac sarcoidosis.

Keywords: FDG PET/CT; cardiac imaging; cardiac sarcoidosis; diet; nuclear cardiology.

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