Department of Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan.
JACC Cardiovasc Imaging. 2010 Dec;3(12):1219-28. doi: 10.1016/j.jcmg.2010.09.015.
This study evaluated the usefulness of fasting (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the diagnosis and management of cardiac sarcoidosis (CS) and compared it with FDG uptake in dilated cardiomyopathy (DCM).
Cardiac sarcoidosis may clinically present as DCM but is amenable to systemic corticosteroid therapy if disease activity is high. Although alterations of FDG uptake have been reported in CS, limited information is available on the quantitative estimates of FDG uptake.
Fasting FDG-PET was performed in 24 systemic sarcoidosis patients and was compared with 8 age-matched DCM patients. FDG-PET was also performed in 15 age-matched healthy control subjects. Twelve of the 24 sarcoidosis patients had cardiac involvement based on criteria established by the Japanese Ministry of Health and Welfare; the remaining 12 of 24 patients revealed no evidence of cardiac involvement. The myocardial FDG uptake was quantified by measuring the standardized uptake value in 17 myocardial segments in each subject. Coefficient of variation (COV), which equals the standard deviation of uptake divided by the average uptake of 17 segments, was calculated as an index of heterogeneity in the heart.
The FDG uptake was distinctly heterogeneous in CS patients. The COV value was significantly greater in CS patients (0.25 ± 0.05) than control subjects (0.14 ± 0.03, p < 0.01), sarcoidosis patients without cardiac involvement (0.14 ± 0.03, p < 0.01), or DCM patients (0.15 ± 0.02, p < 0.01). The COV value in DCM patients was similar to control subjects or sarcoidosis patients without cardiac involvement. The cutoff COV value for the diagnosis of CS was 0.18 (sensitivity: 100%; specificity: 97%). After corticosteroid therapy in CS patients, the COV value was decreased to 0.14 ± 0.06 (p < 0.05) and became essentially similar to the other groups.
Heterogeneous myocardial FDG uptake may be a useful diagnostic marker of disease activity for CS.
本研究旨在评估空腹（18）F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在心脏结节病（CS）的诊断和治疗中的作用，并与扩张型心肌病（DCM）的 FDG 摄取进行比较。
心脏结节病在临床上可能表现为 DCM，但如果疾病活动度高，可采用全身皮质类固醇治疗。尽管有报道称 CS 中 FDG 摄取发生了改变，但关于 FDG 摄取的定量评估信息有限。
对 24 例系统性结节病患者进行空腹 FDG-PET 检查，并与 8 例年龄匹配的 DCM 患者进行比较。还对 15 例年龄匹配的健康对照者进行了 FDG-PET 检查。根据日本厚生劳动省制定的标准，24 例结节病患者中有 12 例存在心脏受累；其余 24 例患者中，12 例无心脏受累证据。通过测量每个受试者 17 个心肌节段的标准化摄取值，定量评估心肌 FDG 摄取。变异系数（COV）等于摄取的标准差除以 17 个节段的平均摄取量，作为心脏异质性的指标。
CS 患者的 FDG 摄取明显不均匀。CS 患者的 COV 值（0.25±0.05）明显大于对照组（0.14±0.03，p<0.01）、无心脏受累的结节病患者（0.14±0.03，p<0.01）或 DCM 患者（0.15±0.02，p<0.01）。DCM 患者的 COV 值与对照组或无心脏受累的结节病患者相似。CS 的 COV 值诊断截断值为 0.18（敏感性：100%；特异性：97%）。CS 患者经皮质类固醇治疗后，COV 值降至 0.14±0.06（p<0.05），与其他组基本相似。
心肌 FDG 摄取不均匀可能是 CS 疾病活动的有用诊断标志物。
