Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis.
Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis.
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发表时间：
2004-12
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通讯作者：
W. Okumura;T. Iwasaki;T. Toyama;T. Iso;M. Arai;N. Oriuchi;K. Endo;T. Yokoyama;Tadashi Suzuki;M. Kurabayashi
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作者：
W. Okumura;T. Iwasaki;T. Toyama;T. Iso;M. Arai;N. Oriuchi;K. Endo;T. Yokoyama;Tadashi Suzuki;M. Kurabayashi
在禁食条件下使用 (18)F-FDG 进行未标记心脏 PET（禁食 (18)F-FDG PET）是一种用于识别心脏结节病和评估疾病活动性的有前途的技术。本研究的目的是从病理生理学角度探讨空腹 (18)F-FDG PET 在检测心脏结节病炎症病变中的有用性。方法将22例系统性结节病患者根据有无结节性心脏病分为2组，每组11例。心脏结节病根据日本厚生省诊断心脏结节病的指南进行诊断，闪烁扫描标准除外。所有患者均采用空腹 (18)F-FDG PET、(99m)Tc-甲氧基异丁基异腈 ((99m)Tc-MIBI) SPECT 和 (67)Ga 闪烁扫描进行核心脏成像。将PET和SPECT图像分为13个心肌节段，计算(18)F-FDG的标准化摄取值(SUV)，并评估每个节段的(99m)Tc-MIBI摄取的缺陷评分(DS)。总 SUV (T-SUV) 和总 DS (TDS) 计算为所有 13 个节段的测量值之和，并将空腹 (18)F-FDG PET 的诊断准确性与其他核成像方式进行比较。此外，使用 SUV 和 DS 进行分段比较研究，检查炎症活动与心肌损伤之间的病理生理关系。结果 在心脏结节病患者中，空腹 (18)F-FDG PET 显示异常心肌节段的频率高于 (99m)Tc-MIBI SPECT（每位患者异常节段的平均数量：6.6 +/- 3.0 与 3.0 +/- 3.2 [平均值 +/- SD]，P < 0.05）。空腹(18)F-FDG PET检测心脏结节病的敏感性为100%，显着高于(99m)Tc-MIBI SPECT(63.6%)或(67)Ga闪烁扫描(36.3%)。空腹 (18)F-FDG PET 的准确性明显高于 (67)Ga 闪烁扫描。 T-SUV与血清血管紧张素转换酶水平呈良好的线性相关（r=0.83，P<0.01），TDS与左心室射血分数呈显着负相关（r=-0.82，P<0.01）。在核扫描异常心肌节段中，SUV与DS呈显着负相关（r = -0.63，P < 0.0001）。结论 这项研究表明，空腹 (18)F-FDG PET 可以在晚期心肌损伤之前检测出心脏结节病的早期阶段，其中灌注异常较少且炎症活动较高。
UNLABELLED Cardiac PET using (18)F-FDG under fasting conditions (fasting (18)F-FDG PET) is a promising technique for identification of cardiac sarcoidosis and assessment of disease activity. The aim of this study was to investigate the usefulness of fasting (18)F-FDG PET in detecting inflammatory lesions of cardiac sarcoidosis from a pathophysiologic standpoint. METHODS Twenty-two patients with systemic sarcoidosis were classified into 2 groups of 11 each according to the presence or absence of sarcoid heart disease. Cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare guidelines for diagnosing cardiac sarcoidosis with the exception of scintigraphic criteria. Nuclear cardiac imaging with fasting (18)F-FDG PET, (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) SPECT, and (67)Ga scintigraphy were performed in all patients. PET and SPECT images were divided into 13 myocardial segments and the standardized uptake value (SUV) of (18)F-FDG was calculated and defect scores (DS) for (99m)Tc-MIBI uptake were assessed for each segment. The total SUV (T-SUV) and total DS (TDS) were calculated as the sum of measurements for all 13 segments, and the diagnostic accuracy of fasting (18)F-FDG PET was compared with that of the other nuclear imaging modalities. In addition, pathophysiologic relationships between inflammatory activity and myocardial damage were examined by segmental comparative study using the SUV and DS. RESULTS In patients with cardiac sarcoidosis, fasting (18)F-FDG PET revealed a higher frequency of abnormal myocardial segments than (99m)Tc-MIBI SPECT (mean number of abnormal segments per patient: 6.6 +/- 3.0 vs. 3.0 +/- 3.2 [mean +/- SD], P < 0.05). The sensitivity of fasting (18)F-FDG PET in detecting cardiac sarcoidosis was 100%, significantly higher than that of (99m)Tc-MIBI SPECT (63.6%) or (67)Ga scintigraphy (36.3%). The accuracy of fasting (18)F-FDG PET was significantly higher than (67)Ga scintigraphy. The T-SUV demonstrated a good linear correlation with serum angiotensin-converting enzyme levels (r = 0.83, P < 0.01), and the TDS showed a significant negative correlation with the left ventricular ejection fraction (r = -0.82, P < 0.01). In abnormal myocardial segments on the nuclear scan, the SUV showed a significant negative correlation with the DS (r = -0.63, P < 0.0001). CONCLUSION This study suggests that fasting (18)F-FDG PET can detect the early stage of cardiac sarcoidosis, in which fewer perfusion abnormalities and high inflammatory activity are noted, before advanced myocardial impairment.