Coulden Richard A, Sonnex Emer P, Abele Jonathan T, Crean Andrew M
Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.A.C., E.P.S., J.T.A.); and Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (A.M.C.).
Radiol Cardiothorac Imaging. 2020 Aug 27;2(4):e190140. doi: 10.1148/ryct.2020190140. eCollection 2020 Aug.
To compare the contributions of cardiac MRI and PET in the diagnosis and management of cardiac sarcoidosis (CS), with particular reference to quantitative measures.
This is a retrospective, observational study of 31 patients (mean age, 45.7 years) with proven extracardiac sarcoidosis and possible CS who were investigated with fluorine 18 fluorodeoxyglucose (FDG) PET/CT and cardiac MRI. Patients were treated at physicians' discretion with repeat combined imaging after an interval of 102-770 days (median, 228 days).
Significant myocardial FDG uptake was shown on visit 1 (myocardial maximum standardized uptake value [SUV] > 3.6) in 17 of 22 patients who were subsequently treated. Myocardial SUV decreased at follow-up (6.5 to 4.0; < .01) and was matched by significant decreases in FDG-avid lung and mediastinal node disease. A volumetric measure of myocardium above a threshold SUV (cardiac metabolic volume) decreased from a mean of 42.5 to a mean of 4.1 ( < .001). This was associated with significant improvement in the left ventricular ejection fraction (LVEF) (45.8 increasing to 50.9; < .031). There was no change in volume of late gadolinium enhancement at treatment. Patients who were untreated showed no change in any FDG PET or cardiac MRI parameter.
Myocardial FDG uptake in patients suspected of having CS is presumed to represent active inflammation. When treated with corticosteroids, this resolved or regressed at follow-up, with an improvement in LVEF and FDG-avid thoracic disease. Patients who were untreated showed no change in any parameter. Quantification of FDG-avid myocardium using cardiac metabolic volume is proposed as a useful objective measure for assessing response to therapy.© RSNA, 2020See also commentary by Gutberlet in this issue.
比较心脏磁共振成像（MRI）和正电子发射断层显像（PET）在心脏结节病（CS）诊断和管理中的作用，尤其关注定量测量。
这是一项对31例患者（平均年龄45.7岁）的回顾性观察研究，这些患者已证实患有心脏外结节病且可能患有CS，接受了氟18氟脱氧葡萄糖（FDG）PET/CT和心脏MRI检查。患者由医生酌情决定在102 - 770天（中位数为228天）的间隔后重复进行联合成像检查。
在随后接受治疗的22例患者中，17例在首次就诊时显示心肌FDG摄取显著（心肌最大标准化摄取值[SUV] > 3.6）。随访时心肌SUV下降（从6.5降至4.0；P <.01），同时FDG摄取阳性的肺部和纵隔淋巴结病变也显著减少。高于SUV阈值的心肌容积测量值（心脏代谢容积）从平均42.5降至平均4.1（P <.001）。这与左心室射血分数（LVEF）显著改善相关（从45.8升至50.9；P <.031）。治疗时晚期钆增强容积无变化。未接受治疗的患者在任何FDG PET或心脏MRI参数上均无变化。
疑似患有CS的患者心肌FDG摄取被认为代表活动性炎症。接受皮质类固醇治疗后，随访时这种情况得到缓解或消退，LVEF和FDG摄取阳性的胸部疾病均有改善。未接受治疗的患者任何参数均无变化。建议使用心脏代谢容积对FDG摄取阳性的心肌进行定量，作为评估治疗反应的有用客观指标。© RSNA，2020另见本期Gutberlet的评论。
