Ishiyama Mitsutomi, Soine Laurie A, Vesselle Hubert J
Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
EJNMMI Res. 2017 Aug 18;7(1):67. doi: 10.1186/s13550-017-0315-y.
Cardiac sarcoidosis is associated with major adverse cardiac events including cardiac arrest, for which anti-inflammatory treatment is indicated. Oral corticosteroid is the mainstay among treatment options; however, adverse effects are a major concern with long-term use. It would be beneficial for providers to predict treatment response and prognosis for proper management strategy of sarcoidosis, though it remains challenging. Fluorine (F)-18 fluorodeoxyglucose (FDG)-positron emission tomography(PET)/computed tomography(CT) has an advantage over anatomical imaging in providing semi-quantitative functional parameters such as standard uptake value (SUV), metabolic volume, and total lesion glycolysis (TLG), which are well-established biomarkers in oncology. However, the relationship between these parameters and treatment response has not been fully investigated in cardiac sarcoidosis. Also, the prognostic value of extracardiac active inflammation noted on FDG-PET/CT in the setting of cardiac sarcoidosis is unclear. The aim of this retrospective study was to investigate the prognostic value of semi-quantitative values of both cardiac and extracardiac disease sites derived from FDG-PET/CT in predicting treatment course in cardiac sarcoidosis.
Sixteen consecutive patients with suspected cardiac sarcoidosis, who demonstrated abnormal myocardial activity on cardiac-inflammation FDG-PET/CT encompassing the entire chest/upper abdomen and subsequently underwent corticosteroid therapy for diagnosis of active cardiac sarcoidosis, were included. Semi-quantitative values of hypermetabolic lesions were derived from all visualized organ system and were compared to daily corticosteroid dose at 6 months.
Of the 16 patients, 81.3% (13/16) of the patients showed extracardiac involvement. The lesion with the greatest SUV was identified in the heart in 11 patients (68.7%), in the liver in 1 patient (6.3%), and in lymph nodes in 4 patients (25%). The maximum SUV across all visualized organ systems including the heart were 8.8 ± 3.1 for the patients with corticosteroid dose ≤ 10 mg and 12.5 ± 3.3 for those with > 10 mg (P = 0.04). Metabolic volume and TLG across all visualized organ systems or any values in the heart alone showed no significant statistical difference between the two groups.
Maximum SUV across all involved organ-systems of the chest and upper abdomen, not that of the heart alone, could be a predictor of treatment course of steroid therapy at 6 months in patients with active cardiac sarcoidosis.
心脏结节病与包括心脏骤停在内的主要不良心脏事件相关，对此需进行抗炎治疗。口服糖皮质激素是治疗选择中的主要手段；然而，长期使用会带来主要的不良影响。对于医疗人员而言，预测治疗反应和预后以制定结节病的合理管理策略将是有益的，尽管这仍然具有挑战性。氟（F）-18氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）在提供诸如标准摄取值（SUV）、代谢体积和总病变糖酵解（TLG）等半定量功能参数方面优于解剖成像，这些参数在肿瘤学中是成熟的生物标志物。然而，在心脏结节病中，这些参数与治疗反应之间的关系尚未得到充分研究。此外，在心脏结节病背景下，FDG-PET/CT上显示的心脏外活动性炎症的预后价值尚不清楚。这项回顾性研究的目的是调查源自FDG-PET/CT的心脏和心脏外疾病部位的半定量值在预测心脏结节病治疗过程中的预后价值。
连续纳入16例疑似心脏结节病患者，这些患者在涵盖整个胸部/上腹部的心脏炎症FDG-PET/CT上显示心肌活动异常，随后接受糖皮质激素治疗以诊断活动性心脏结节病。从所有可视化的器官系统中得出高代谢病变的半定量值，并与6个月时的每日糖皮质激素剂量进行比较。
16例患者中，81.3%（13/16）的患者存在心脏外受累。SUV最高的病变在11例患者（68.7%）的心脏中被发现，1例患者（6.3%）在肝脏中，4例患者（25%）在淋巴结中。包括心脏在内的所有可视化器官系统的最大SUV，糖皮质激素剂量≤10mg的患者为8.8±3.1，>10mg的患者为12.5±3.3（P=0.04）。所有可视化器官系统的代谢体积和TLG或仅心脏中的任何值在两组之间均无显著统计学差异。
对于活动性心脏结节病患者，胸部和上腹部所有受累器官系统的最大SUV，而非仅心脏的最大SUV，可能是6个月时类固醇治疗疗程的预测指标。
