Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 28;5(5):e220292.
doi: 10.1148/ryct.220292. eCollection 2023 Oct.

Combined FDG PET/MRI versus Standard-of-Care Imaging in the Evaluation of Cardiac Sarcoidosis

Constantin A Marschner  1 , Faisal Aloufi  1 , Matthew Aitken  1 , Edward Cheung  1 , Paaladinesh Thavendiranathan  1 , Robert M Iwanochko  1 , Meyer Balter  1 , Yasbanoo Moayedi  1 , Juan Duero Posada  1 , Kate Hanneman  1
Affiliations

Combined FDG PET/MRI versus Standard-of-Care Imaging in the Evaluation of Cardiac Sarcoidosis

Constantin A Marschner et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To compare combined cardiac fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/MRI with standard-of-care evaluation using cardiac MRI, 18F-FDG PET/CT, and SPECT perfusion imaging in suspected cardiac sarcoidosis (CS) with respect to radiation dose, imaging duration, and diagnostic test performance.

Materials and methods: Consecutive patients with suspected CS undergoing clinical evaluation with cardiac 18F-FDG PET/CT and gated rest technetium 99m sestamibi SPECT perfusion imaging were prospectively recruited between November 2017 and May 2021 for parallel assessment with combined cardiac 18F-FDG PET/MRI on the same day (ClinicalTrials.gov identifier, NCT03356756). Total effective radiation dose and imaging duration were compared between approaches (combined cardiac PET/MRI vs separate cardiac MRI, PET/CT, and SPECT). MRI findings were initially interpreted without PET data, and then PET and late gadolinium enhancement images were fused and interpreted together. Final diagnosis of CS was established using Japanese Ministry of Health and Welfare guidelines.

Results: Forty participants (mean age, 54 years ± 14 [SD]; 26 [65%] male participants) were included, 14 (35%) with a final diagnosis of CS. Compared with separate cardiac MRI, PET/CT, and SPECT perfusion imaging, combined cardiac PET/MRI had 52% lower total radiation dose (8.0 mSv ± 1.2 vs 16.8 mSv ± 1.6, P < .001) and 43% lower total imaging duration (122 minutes ± 15 vs 214 minutes ± 26, P < .001). Combined PET/MRI had the highest area under the curve for diagnosis of CS (0.84) with 96% specificity and 71% sensitivity for colocalized FDG uptake and late gadolinium enhancement in a pattern typical for CS.

Conclusion: In the evaluation of suspected CS, combined cardiac 18F-FDG PET/MRI had a lower radiation dose, shorter imaging duration, and higher diagnostic performance compared with standard-of-care imaging.Clinical trial registration no. NCT03356756Keywords: Cardiac Sarcoidosis, 18F-FDG PET/MRI, 18F-FDG PET/CT, SPECT Perfusion Imaging, Cardiac MRI, Standard-of-Care Imaging Supplemental material is available for this article. © RSNA, 2023.

Keywords: 18F-FDG PET/CT; 18F-FDG PET/MRI; Cardiac MRI; Cardiac Sarcoidosis; SPECT Perfusion Imaging; Standard-of-Care Imaging.

PubMed Disclaimer

Conflict of interest statement

Disclosures of conflicts of interest: C.A.M. No relevant relationships. F.A. No relevant relationships. M.A. No relevant relationships. E.C. No relevant relationships. P.T. No relevant relationships. R.M.I. No relevant relationships. M.B. Advisory board member for AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, and Valeo Pharma; honoraria paid to company from AstraZeneca, Boehringer Ingelheim, GSK, and Valeo Pharma. Y.M. No relevant relationships. J.D.P. Quality improvement grant from Pfizer; honoraria from Abbott Laboratories; clinical expert for the Canadian Agency for Drugs and Technologies in Health in the review of medical therapies seeking indication approval for heart failure; leadership roles with the Transplant Performance Measurement and Evaluation Committee and the Pan-Canadian Organ Donation and Transplantation Data and Performance Reporting System with the Canadian Institute for Health Information. K.H. Funding from Peter Munk Cardiac Centre Innovation Fund and the University of Toronto Joint Department of Medical Imaging academic incentive fund; payment from Sanofi; editorial board member for Radiology and Radiology: Cardiothoracic Imaging.

Figures

None
Graphical abstract
Flowchart demonstrates participant selection. ICD = implantable cardioverter defibrillator, PM = pacemaker.
Figure 1:
Flowchart demonstrates participant selection. ICD = implantable cardioverter defibrillator, PM = pacemaker.
Images in a 52-year-old female participant with cardiac sarcoidosis. Standard-of-care imaging (top row) demonstrates a perfusion defect on SPECT images (top left) and corresponding fluorodeoxyglucose (FDG)–uptake on fluorine 18 (18F)–FDG PET/CT image (top right) at the interventricular septum (green arrows). On combined 18F-FDG PET/MR images (bottom row), there is nodular late gadolinium enhancement (LGE) at the interventricular septum (orange arrows) with corresponding FDG uptake (blue arrows).
Figure 2:
Images in a 52-year-old female participant with cardiac sarcoidosis. Standard-of-care imaging (top row) demonstrates a perfusion defect on SPECT images (top left) and corresponding fluorodeoxyglucose (FDG)–uptake on fluorine 18 (18F)–FDG PET/CT image (top right) at the interventricular septum (green arrows). On combined 18F-FDG PET/MR images (bottom row), there is nodular late gadolinium enhancement (LGE) at the interventricular septum (orange arrows) with corresponding FDG uptake (blue arrows).
Images in a 62-year-old female participant with extracardiac sarcoidosis but no cardiac involvement. Standard-of-care imaging (top row) demonstrates normal perfusion on SPECT images (top left) and no myocardial fluorodeoxyglucose (FDG) uptake on fluorine 18 (18F) FDG PET/CT image (top right). On combined 18F-FDG PET/MR images (bottom row), there is no late gadolinium enhancement (LGE) and no myocardial FDG uptake.
Figure 3:
Images in a 62-year-old female participant with extracardiac sarcoidosis but no cardiac involvement. Standard-of-care imaging (top row) demonstrates normal perfusion on SPECT images (top left) and no myocardial fluorodeoxyglucose (FDG) uptake on fluorine 18 (18F) FDG PET/CT image (top right). On combined 18F-FDG PET/MR images (bottom row), there is no late gadolinium enhancement (LGE) and no myocardial FDG uptake.
See this image and copyright information in PMC

References

    1. Cheung E , Ahmad S , Aitken M , et al . Combined simultaneous FDG-PET/MRI with T1 and T2 mapping as an imaging biomarker for the diagnosis and prognosis of suspected cardiac sarcoidosis . Eur J Hybrid Imaging 2021. ; 5 ( 1 ): 24 . - PMC - PubMed
    1. Kazmirczak F , Chen KA , Adabag S , et al . Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis . Circ Arrhythm Electrophysiol 2019. ; 12 ( 9 ): e007488 . - PMC - PubMed
    1. Gilotra N , Okada D , Sharma A , Chrispin J . Management of Cardiac Sarcoidosis in 2020 . Arrhythm Electrophysiol Rev 2020. ; 9 ( 4 ): 182 – 188 . - PMC - PubMed
    1. Blankstein R , Osborne M , Naya M , et al . Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis . J Am Coll Cardiol 2014. ; 63 ( 4 ): 329 – 336 . - PMC - PubMed
    1. Jones HA , Cadwallader KA , White JF , Uddin M , Peters AM , Chilvers ER . Dissociation between respiratory burst activity and deoxyglucose uptake in human neutrophil granulocytes: implications for interpretation of (18)F-FDG PET images . J Nucl Med 2002. ; 43 ( 5 ): 652 – 657 . - PubMed

Associated data

LinkOut - more resources