Hybrid Magnetic Resonance Imaging and Positron Emission Tomography With Fluorodeoxyglucose to Diagnose Active Cardiac Sarcoidosis
Hybrid Magnetic Resonance Imaging and Positron Emission Tomography With Fluorodeoxyglucose to Diagnose Active Cardiac Sarcoidosis
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DOI：
10.1016/j.jcmg.2017.02.021
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发表时间：
2018-01-01
影响因子：
14
通讯作者：
Kovacic, Jason C.
中科院分区：
文献类型：
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作者：
Dweck, Marc R.;Abgral, Ronan;Kovacic, Jason C.
目的探讨18F-氟代脱氧葡萄糖(FDG)心脏磁共振(CMR)和正电子发射断层扫描(PET)对活动性心脏结节病的诊断价值。患者在视觉上可分为磁共振(MR)型(与FDG摄取增加完全一致的特征性LGE)、MR+PET-(特征性LGE但不增加FDG)、MR-PET-(既不具有特征性LGE也不增加FDG)和MR-PET+(缺乏特征性LGE时FDG摄取量增加)，并进一步描述为ACS+(MR+PET+)或ACS-(MR+PET-、MR-PET-、MR-PET+)。FDG摄取采用动态Patlak分析的最大靶/正常心肌比率和净摄取率(K-I)进行量化。受试者操作特征方法被用于识别急性冠脉综合征的成像生物标志物。结果25例患者(男性12例，年龄54.9+/-9.8岁)，8例MR+PET+，提示有急性冠脉综合征；1例MR+PET+，符合非活动性心肌结节病；8例MR-PET-，无心脏结节病的影像证据。8例MR-PET阳性患者(6例心肌FDG整体摄取，2例病灶弥漫性摄取)；与MR+PET+患者相比，显示明显的KI值和高信号的最大标准化摄取值。在对照组中也观察到类似的整体(n=9)和弥漫性局灶性(n=2)FDG摄取高信号模式，提示生理性心肌摄取。急性冠脉综合征+组的最大靶/正常心肌比值较高(p<；0.001)，受试者工作特性分析显示曲线下面积为0.98，最佳最大靶/正常心肌比阈值为1.2(约登指数：0.94)。结论CMR/PET显像对急性冠脉综合征的诊断具有重要意义，在单次扫描中提供了有关损伤和疾病活动的增量信息。(C)2018年，由美国心脏病学院基金会提供。
OBJECTIVES The purpose of this study was to explore the diagnostic usefulness of hybrid cardiac magnetic resonance (CMR) and positron emission tomography (PET) using F-18-fluorodeoxyglucose (FDG) for active cardiac sarcoidosis.BACKGROUND Active cardiac sarcoidosis (aCS) is underdiagnosed and has a high mortality.METHODS Patients with clinical suspicion of aCS underwent hybrid CMR/PET with late gadolinium enhancement (LGE) and FDG to assess the pattern of injury and disease activity, respectively. Patients were categorized visually as magnetic resonance (MR) thornPETthorn (characteristic LGE aligning exactly with increased FDG uptake), MR+PET - (characteristic LGE but no increased FDG), MR - PET - (neither characteristic LGE nor increased FDG), and MR - PET + (increased FDG uptake in absence of characteristic LGE) and further characterized as aCS + (MR+PET+) or aCS - (MR+PET -, MR - PET -, MR - PET+). FDG uptake was quantified using maximum target-to-normal-myocardium ratio and the net uptake rate (K-i) from dynamic Patlak analysis. Receiver-operating characteristic methods were used to identify imaging biomarkers for aCS. FDG PET was assessed using computed tomography/PET in 19 control subjects with healthy myocardium.RESULTS A total of 25 patients (12 males; 54.9 +/- 9.8 years of age) were recruited prospectively; 8 were MR+PET+, suggestive of aCS; 1 was MR+PET +, consistent with inactive cardiac sarcoidosis; and 8 were MR - PET -, with no imaging evidence of cardiac sarcoidosis. Eight patients were MR - PET+ (6 with global myocardial FDG uptake, 2 with focal-on-diffuse uptake); they demonstrated distinct Ki values and hyperintense maximum standardized uptake value compared with MR+PET+ patients. Similar hyperintense patterns of global (n = 9) and focal-on-diffuse (n = 2) FDG uptake were also observed in control patients, suggesting physiological myocardial uptake. Maximum target-to-normal-myocardium ratio values were higher in the aCS + group (p < 0.001), demonstrating an area under the curve of 0.98 on receiver-operating characteristic analysis for the detection of aCS, with an optimal maximum target-to-normal myocardium ratio threshold of 1.2 (Youden index: 0.94).CONCLUSIONS CMR/PET imaging holds major promise for the diagnosis of aCS, providing incremental information about both the pattern of injury and disease activity in a single scan. (c) 2018 by the American College of Cardiology Foundation.