Department of Nuclear Medicine, University of Münster, Münster, Germany.
J Nucl Med. 2012 Jun;53(6):856-63. doi: 10.2967/jnumed.111.095364. Epub 2012 May 10.
In the diagnostic algorithm of cardiac tumors, the noninvasive determination of malignancy and metastatic spread is of major interest to stratify patients and to select and monitor therapies. In the diagnostic work-up, morphologic imaging modalities such as echocardiography or magnetic resonance tomography offer information on, for example, size, invasiveness, and vascularization. However, preoperative assessment of malignancy may be unsatisfactory. The aim of this study was to evaluate the diagnostic value of (18)F-FDG PET and the incremental diagnostic value of an optimized CT score in this clinical scenario.
(18)F-FDG PET/CT scans (whole-body imaging with low-dose CT) of 24 consecutive patients with newly diagnosed cardiac tumors were analyzed (11 men, 13 women; mean age ± SD, 59 ± 13 y). The maximum standardized uptake values (SUV(max)) of the tumors were measured. Patients were divided into 2 groups: benign cardiac tumors (n = 7) and malignant cardiac tumors (n = 17) (cardiac primaries [n = 8] and metastases [n = 9]). SUV(max) was compared between the 2 groups. Results were compared with contrast-enhanced CT, using standardized criteria of malignancy. Histology served as ground truth.
Mean SUV(max) was 2.8 ± 0.6 in benign cardiac tumors and significantly higher both in malignant primary and in secondary cardiac tumors (8.0 ± 2.1 and 10.8 ± 4.9, P < 0.01). Malignancy was determined with a sensitivity of 100% and specificity of 86% (accuracy, 96%), after a cutoff with high sensitivity (SUV(max) of 3.5) was chosen to avoid false-negatives. Morphologic imaging reached a sensitivity of 82% and a specificity of 86% (accuracy, 83%). Both false-positive and false-negative decisions in morphology could be corrected in all but 1 case using a metabolic threshold with an SUV(max) of 3.5. In addition, extracardiac tumor manifestations were detected in 4 patients by whole-body (18)F-FDG PET/CT.
(18)F-FDG PET/CT can aid the noninvasive preoperative determination of malignancy and may be helpful in detecting metastases of malignant cardiac tumors.
评估（18）F-FDG PET 的诊断价值，并在这种临床情况下评估优化 CT 评分的增量诊断价值。
分析 24 例新诊断为心脏肿瘤的连续患者的（18）F-FDG PET/CT 扫描（全身低剂量 CT 成像）（11 名男性，13 名女性；平均年龄 ± SD，59 ± 13 岁）。测量肿瘤的最大标准化摄取值（SUV(max)）。患者分为两组：良性心脏肿瘤（n = 7）和恶性心脏肿瘤（n = 17）（心脏原发性肿瘤[n = 8]和转移瘤[n = 9]）。比较两组之间的 SUV(max)。结果与恶性肿瘤的增强 CT 标准进行比较。组织学作为金标准。
良性心脏肿瘤的平均 SUV(max)为 2.8 ± 0.6，恶性原发性和继发性心脏肿瘤的 SUV(max)显著更高（分别为 8.0 ± 2.1 和 10.8 ± 4.9，P < 0.01）。选择高灵敏度截断值（SUV(max)为 3.5）以避免假阴性后，恶性肿瘤的诊断灵敏度为 100%，特异性为 86%（准确性为 96%）。形态学的敏感性为 82%，特异性为 86%（准确性为 83%）。使用 SUV(max)为 3.5 的代谢阈值，可以纠正形态学中的所有假阳性和假阴性决策，除 1 例外。此外，全身（18）F-FDG PET/CT 还在 4 例患者中检测到心脏外肿瘤表现。
（18）F-FDG PET/CT 可辅助术前非侵入性确定恶性肿瘤，并有助于检测恶性心脏肿瘤的转移。
