Delayed 18F-fluorodeoxyglucose PET/CT imaging improves detection of cardiac involvement in sarcoidosis
Delayed 18F-fluorodeoxyglucose PET/CT imaging improves detection of cardiac involvement in sarcoidosis
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延迟 18F-氟脱氧葡萄糖 PET/CT 成像可改善结节病心脏受累的检测
DOI：
10.1007/s12350-021-02815-3
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发表时间：
2021
影响因子：
2.4
通讯作者：
Oyama-Manabe Noriko
中科院分区：
文献类型：
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作者：
Kato Sakura;Aikawa Tadao;Ibe Tatsuro;Manabe Osamu;Oyama-Manabe Noriko
一位47岁女性，因意外发现双侧肺门淋巴结肿大及类固醇治疗的虹膜炎来我院就诊。经支气管肺泡灌洗和经支气管肺活检进行支气管镜检查的组织病理学评价后，她被诊断为全身性结节病，并被转诊给心脏病专家进行心脏受累筛查。心电图显示正常窦性心律，无任何传导异常（图1）。超声心动图显示左心室大小和功能正常;然而，使用专用软件进行的心血管磁共振特征跟踪分析显示基底下间隔壁的周向应变降低（图2A，箭头;壁段和局部应变值以相同颜色显示; VideoS 1）。晚期钆增强成像显示位于同一区域的心外膜下高增强（图2 B，箭头）。为了监测疾病活动，患者在禁食20小时并准备低碳水化合物饮食后接受18 F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描。在60分钟时，在心肌中未观察到18F-FDG摄取（图3 AC），而在18F-FDG给药后120分钟延迟相位图像中，在基底下间隔壁中观察到心肌18F-FDG摄取（图3 DF），表明活动性心脏结节病。18 F-FDG PET在检测心脏结节病的活动性炎症方面具有高灵敏度; 1然而，18 F-FDG PET可能很难检测到小的或不太活跃的心脏病变。心脏中的血池活动也可能干扰心肌18F-FDG摄取的解释。据报道，延迟18F-FDG PET成像可改善对血池活性降低引起的血管18F-FDG摄取的解释。2根据2018年日本核能协会的数据，
A 47-year-old woman with incidentally detected bilateral hilar lymphadenopathy and steroid-treated iritis presented to our hospital. After histopathological evaluation of bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy, she was diagnosed with systemic sarcoidosis and was referred to a cardiologist for screening cardiac involvement. Electrocardiography showed normal sinus rhythm without any conduction abnormality (Figure 1). Echocardiography showed normal left ventricular size and function; however, cardiovascular magnetic resonance feature tracking analysis using dedicated software revealed reduced circumferential strain in the basal inferoseptal wall (Figure 2 A, arrows; segments of the walls and regional strain values are presented with the same color; VideoS1). Late gadolinium enhancement imaging showed subepicardial hyperenhancement located in the same area (Figure 2 B, arrow). For monitoring the disease activity, she underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography after 20 hours fasting with low-carbohydrate diet preparation. No 18F-FDG uptake was seen in the myocardium at 60 minutes (Figure 3 AC), while myocardial 18F-FDG uptake was observed in the basal inferoseptal wall at the 120-minute delayed phase images after 18F-FDG administration (Figure 3 DF), indicating active cardiac sarcoidosis. 18F-FDG PET has a high sensitivity in detecting active inflammation in cardiac sarcoidosis; 1 however, it may be difficult for 18F-FDG PET to detect small or less active cardiac lesions. Blood-pool activity in the heart may also disturb the interpretation of myocardial 18F-FDG uptake. Delayed 18F-FDG PET imaging has been reported to improve the interpretation of vascular 18F-FDG uptake caused by decreasing blood-pool activity. 2 According to the 2018 Japanese Society of Nuclear