Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Sci Rep. 2020 Dec 9;10(1):21524. doi: 10.1038/s41598-020-78581-y.
This study aimed to assess the role of F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the differential diagnosis of pericardial disease. The diagnosis is often troublesome because pericardial fluid analysis or biopsy does not always provide answers. FDG-PET/CT can visualize both inflammation and malignancy and offers a whole-body assessment. Patients who visited the Pericardial Disease Clinic of Samsung Medical Center with an FDG-PET/CT order code were extracted. Exclusion criteria were as follows: (1) the purpose of the differential diagnosis was not pericardial disease; (2) the patient had a known advanced-stage malignancy; (3) the patient already have confirmative diagnosis using a serology, pericardial effusion analysis or biopsy. The analysis included 107 patients. The most common final diagnosis was idiopathic (n = 46, 43.0%), followed by tuberculosis (n = 30, 28.0%) and neoplastic (n = 11, 10.3%). A maximum standardized uptake value (SUVmax) ≥ 5 typically indicates tuberculosis or neoplastic pericarditis except in just one case of autoimmune pericarditis); especially all of the SUVmax scores ≥ 10 had tuberculosis. The diagnostic yield of pericardial biopsy was very low (10.2%). Interestingly, all of the pericardium with an SUVmax < 4.4 had nondiagnostic results. In contrast, targeted biopsies based on FDG uptake demonstrated a higher diagnostic yield (38.7%) than pericardium. The sensitivity of FDG-PET/CT was 63.6%. The specificity was 71.9%. The positive predictive value was 20.6%. The negative predictive value 94.5%, and the accuracy was 71.0% for excluding malignancy based upon the FDG uptake patterns. It is possible to explore the differential diagnosis in some patients with difficult pericardiocentesis or pericardial biopsy in a noninvasive manner using on the SUVmax or uptake patterns. In addition, the biopsy strategy depending on FDG uptake is helpful to achieve biopsy more safely and with a higher yield. FDG-PET may enhance the diagnostic efficacy in patients with pericardial disease.
这项研究旨在评估 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在鉴别诊断心包疾病中的作用。由于心包液分析或活检并不总是能提供答案，因此心包疾病的诊断往往很棘手。FDG-PET/CT 可以可视化炎症和恶性肿瘤，并提供全身评估。从三星医疗中心心包疾病诊所提取了具有 FDG-PET/CT 医嘱代码的患者。排除标准如下：(1) 鉴别诊断的目的不是心包疾病；(2) 患者患有已知晚期恶性肿瘤；(3) 患者已经通过血清学、心包积液分析或活检进行了明确诊断。该分析包括 107 名患者。最常见的最终诊断是特发性（n=46，43.0%），其次是结核（n=30，28.0%）和肿瘤（n=11，10.3%）。最大标准化摄取值（SUVmax）≥5 通常提示结核或肿瘤性心包炎，除非仅有一例自身免疫性心包炎）；尤其是所有 SUVmax 评分≥10 的患者均患有结核。心包活检的诊断率非常低（10.2%）。有趣的是，所有 SUVmax<4.4 的心包均未得出诊断结果。相比之下，基于 FDG 摄取的靶向活检显示出比心包更高的诊断率（38.7%）。FDG-PET/CT 的敏感性为 63.6%。特异性为 71.9%。阳性预测值为 20.6%。阴性预测值为 94.5%，根据 FDG 摄取模式排除恶性肿瘤的准确率为 71.0%。使用 SUVmax 或摄取模式，可以对一些心包穿刺困难或心包活检困难的患者进行非侵入性的鉴别诊断。此外，根据 FDG 摄取情况制定的活检策略有助于更安全、更高产率地进行活检。FDG-PET 可能会提高心包疾病患者的诊断效果。
