Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA.
Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Cardiovasc Imaging. 2022 Nov;15(11):1944-1955. doi: 10.1016/j.jcmg.2022.05.015. Epub 2022 Aug 17.
Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.
This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P < 0.01). After a median follow-up of 4.7 (IQR: 3.1-7.8) years, patients who were biopsy-proven (vs non-biopsy-proven; P = 0.029) and with preserved left ventricular function (P = 002) were less likely to experience major adverse cardiac events. Outcomes based on treatment response status (CTR vs PTR vs NR; P = 0.23) were not significantly different.
Among patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.
疑似心肌结节病患者常进行氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）成像，以评估基线和治疗开始后的疾病活动。
本研究旨在探讨免疫抑制治疗和活检状态对达到完全治疗反应（CTR）、部分治疗反应（PTR）或无反应（NR）对心肌 FDG-PET/CT 的影响。
本研究分析了 83 例疑似心肌结节病患者（年龄 53±1.8 岁，71%为男性，69%为白人，61%有活检证实的结节病病史），这些患者均为初治患者，基线时有心肌 FDG 证据，并在治疗开始后进行重复 PET 成像。通过视觉评估 CTR，使用总糖酵解活性进行视觉和定量评估以测量 PTR/NR。还评估了患者死亡、持续性室性心律失常和心力衰竭入院的发生情况。
总体而言，59 例患者（71%）在随访扫描时达到 CTR/PTR（30%/41%）（P=0.04）。总糖酵解活性和 PTR/NR 的视觉估计具有极好的一致性（κ=0.86[95%CI：0.72-0.99]；P<0.0001）。在仅接受泼尼松治疗的患者中，中高剂量起始泼尼松的患者中 CTR/PTR 发生率最高（P<0.01）。在回归模型中，中度泼尼松起始剂量（P=0.03）与达到 CTR/PTR 的相关性强于高剂量起始泼尼松（P=0.03）。然而，后者患者在起始剂量和随访扫描之间的减药速度更快（P<0.01）。中位随访 4.7（IQR：3.1-7.8）年后，与未行活检的患者相比，活检证实的患者（P=0.029）和左心室功能保留的患者（P=0.02）发生重大不良心脏事件的可能性较小。基于治疗反应状态（CTR 与 PTR 与 NR；P=0.23）的结局无显著差异。
在疑似结节病且有心肌炎症证据的患者中，FDG-PET 的治疗反应是可变的，但使用中高强度泼尼松剂量时，更常见的是良好的反应。活检证实的患者和收缩功能保留的患者在随访期间发生不良结局的可能性较小。
