Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina.
JACC Cardiovasc Imaging. 2018 Feb;11(2 Pt 2):336-345. doi: 10.1016/j.jcmg.2017.04.020. Epub 2017 Aug 16.
This study sought to evaluate the incremental value of quantifying the extent and severity of myocardial perfusion and F-labeled fluorodeoxyglucose (FDG) abnormalities in predicting adverse outcomes among patients with suspicion for cardiac sarcoidosis (CS).
Positron emission tomography (PET) with FDG is a key component of the noninvasive assessment of patients with suspected CS. However, the optimal method for image interpretation has not been defined.
A retrospective analysis was performed of 203 patients who underwent perfusion and FDG-PET imaging to evaluate for CS. Imaging findings were scored by conventional 3-category methods (normal perfusion and metabolism, abnormal perfusion or metabolism, abnormal perfusion and metabolism) and by summed scores using the 17-segment model to represent extent and severity of disease. Heterogeneity of metabolism was quantified using the coefficient of variation (SD divided by the mean) of FDG uptake. Multivariable Cox models were developed to assess associations between imaging findings and adverse events (death, heart transplant, or ventricular arrhythmia requiring defibrillation).
The indication for FDG-PET was ventricular arrhythmia in 69 (34%), heart block in 16 (8%), cardiomyopathy in 54 (27%), and other indications in 64 (32%). There were 63 patients who developed adverse events over a mean follow-up of 1.8 years. After robust adjustment, only the summed score in segments with a perfusion-metabolism mismatch and the coefficient of variation were important prognostically (p = 0.029 and p = 0.041, respectively).
Quantitative measures of extent and severity of perfusion-metabolism mismatch and coefficient of variation of FDG uptake provide an incremental prognostic advantage in patients undergoing FDG-PET for CS. These results support the use of a more detailed analysis of imaging findings, as is conventional in coronary artery disease.
本研究旨在评估量化心肌灌注和 F 标记氟脱氧葡萄糖（FDG）异常程度和严重程度在预测疑似心脏结节病（CS）患者不良结局中的增量价值。
FDG 正电子发射断层扫描（PET）是疑似 CS 患者非侵入性评估的关键组成部分。然而，尚未定义最佳的图像解释方法。
对 203 例接受灌注和 FDG-PET 成像以评估 CS 的患者进行回顾性分析。通过常规的 3 类方法（正常灌注和代谢、异常灌注或代谢、异常灌注和代谢）和使用 17 节段模型的总和评分来对图像进行评分，以代表疾病的程度和严重程度。使用 FDG 摄取的变异系数（SD 除以平均值）来量化代谢异质性。采用多变量 Cox 模型评估成像发现与不良事件（死亡、心脏移植或需要除颤的室性心律失常）之间的关联。
FDG-PET 的指征是 69 例（34%）室性心律失常、16 例（8%）心脏阻滞、54 例（27%）心肌病和 64 例（32%）其他指征。在平均 1.8 年的随访中，有 63 例患者发生不良事件。经过稳健调整，仅灌注-代谢不匹配节段的总和评分和变异系数具有重要的预后意义（p = 0.029 和 p = 0.041）。
在进行 FDG-PET 检查时，灌注-代谢不匹配程度和 FDG 摄取变异系数的定量测量为 CS 患者提供了额外的预后优势。这些结果支持使用更详细的成像发现分析，这在冠状动脉疾病中是常规做法。
