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Use of 18F-FDG PET/CT texture analysis to diagnose cardiac sarcoidosis

  • Original Article
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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-fluorodeoxyglocose positron emission tomography (FDG PET) plays a significant role in the diagnosis of cardiac sarcoidosis (CS). Texture analysis is a group of computational methods for evaluating the inhomogeneity among adjacent pixels or voxels. We investigated whether texture analysis applied to myocardial FDG uptake has diagnostic value in patients with CS.

Methods

Thirty-seven CS patients (CS group), and 52 patients who underwent FDG PET/CT to detect malignant tumors with any FDG cardiac uptake (non-CS group) were studied. A total of 36 texture features from the histogram, gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), gray-level zone size matrix (GLZSM) and neighborhood gray-level difference matrix (NGLDM), were computed using polar map images. First, the inter-operator and inter-scan reproducibility of the texture features of the CS group were evaluated. Then, texture features of the patients with CS were compared to those without CS lesions.

Results

Twenty-eight of the 36 texture features showed high inter-operator reproducibility with intraclass correlation coefficients (ICCs) over 0.80. In addition, 17 of the 36 showed high inter-scan reproducibility with ICCs over 0.80. The SUVmax showed no difference between the CS and non-CS group [7.36 ± 2.77 vs. 8.78 ± 4.65, p = 0.45, area under the curve (AUC) = 0.60]. By contrast, 16 of the 36 texture features could distinguish CS from non-CS grsoup with AUC > 0.80. Multivariate logistic regression analysis after hierarchical clustering concluded that long-run emphasis (LRE; P = 0.0004) and short-run low gray-level emphasis (SRLGE; P = 0.016) were significant independent factors that could distinguish between the CS and non-CS groups. Specifically, LRE was significantly higher in CS than in non-CS (30.1 ± 25.4 vs. 11.4 ± 4.6, P < 0.0001), with high diagnostic ability (AUC = 0.91), and had high inter-operator reproducibility (ICC = 0.98).

Conclusions

The texture analysis had high inter-operator and high inter-scan reproducibility. Some of texture features showed higher diagnostic value than SUVmax for CS diagnosis. Therefore, texture analysis may have a role in semi-automated systems for diagnosing CS.

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Abbreviations

CMV:

Cardiac metabolic volume

CMA:

Cardiac metabolic activity

DA:

Descending aorta

FDG:

18F-fluorodeoxyglucose

HRS:

Heart Rhythm Society

JSSOG:

Japanese Society of Sarcoidosis and Other Granulomatous disorders

PET:

Positron emission tomography

SUVmax:

Maximum standardized uptake value

SUVmean:

Mean standardized uptake value

VOI:

Volume-of-interest

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Acknowledgements

We thank Eriko Suzuki, MT for her support of this study.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan

    Osamu Manabe, Kenji Hirata, Souichiro Hayashi, Yuuki Tomiyama & Keiichi Magota

  2. First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan

    Hiroshi Ohira & Ichizo Tsujino

  3. Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan

    Masanao Naya, Tadao Aikawa & Kazuhiro Koyanagawa

  4. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan

    Noriko Oyama-Manabe

  5. Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Science, Chiba, Japan

    Keiichiro Yoshinaga

  6. Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Nagara Tamaki

Authors
  1. Osamu Manabe
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  2. Hiroshi Ohira
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  12. Keiichiro Yoshinaga
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  13. Nagara Tamaki
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Corresponding author

Correspondence to Kenji Hirata.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration Helsinki and its later amendments or comparable ethical standards.

Conflict of interest

All authors have no conflicts of interest to disclose.

Informed consent

Written informed consent was obtained prior to the study for the CS patients and with a waiver of the need for written informed consent for the control group.

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Manabe, O., Ohira, H., Hirata, K. et al. Use of 18F-FDG PET/CT texture analysis to diagnose cardiac sarcoidosis. Eur J Nucl Med Mol Imaging 46, 1240–1247 (2019). https://doi.org/10.1007/s00259-018-4195-9

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  • DOI: https://doi.org/10.1007/s00259-018-4195-9

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