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18F-FDG uptake of the right ventricle is an important predictor of histopathologic diagnosis by endomyocardial biopsy in patients with cardiac sarcoidosis

  • Kazunori Omote
  • Masanao NayaEmail author
  • Kazuhiro Koyanagawa
  • Tadao Aikawa
  • Osamu Manabe
  • Toshiyuki Nagai
  • Kiwamu Kamiya
  • Yoshiya Kato
  • Hirokazu Komoriyama
  • Masato Kuzume
  • Nagara Tamaki
  • Toshihisa Anzai
Original Article

Abstract

Background

The aim of this study was to determine whether right ventricle (RV) 18F-fluorodeoxyglucose (FDG) uptake can predict positive findings of endomyocardial biopsy (EMB) in patients with cardiac sarcoidosis (CS).

Methods

70 consecutive patients with clinically diagnosed CS who had undergone FDG PET were registered in the present study. Patients without EMB (n = 42) were excluded. Ultimately, 28 patients were studied. EMB samples were obtained from the RV septum. We evaluated the FDG uptake on six segments (RV, left ventricle anterior, septal, lateral, inferior, and apex).

Results

Positive EMB was found in six patients (21%). Patients were divided into two groups according to positive (n = 12 [43%]) or negative (n = 16 [57%]) RV FDG uptake. Patients with positive RV FDG uptake had a significantly higher frequency of positive EMB than those without (42% vs. 6%, P = 0.024). On the other hand, there was no EMB-predictive value for the FDG uptakes in the other five segments, the cardiac metabolic volume, total lesion glycolysis, left ventricular ejection fraction, or any electrocardiogram findings.

Conclusions

FDG uptake of the RV but no other heart segment was associated with positive EMB in CS patients. The presence of RV FDG uptake could improve the rate of positive EMB up to 42% in patients with CS.

Keywords

Cardiac sarcoidosis endomyocardial biopsy 18F-fluorodeoxyglucose positron emission tomography right ventricle 

Abbreviations

CMV

Cardiac metabolic volume

CS

Cardiac sarcoidosis

EMB

Endomyocardial biopsy

FDG

18F-fluorodeoxyglucose

LV

Left ventricle

LVEF

Left ventricular ejection fraction

PET

Positron emission tomography

RV

Right ventricle

SUV

Standardized uptake value

TLG

Total lesion glycolysis

Notes

Acknowledgements

The authors are grateful to Dr Tomoko Mitsuhashi and Dr Ken Kuwahara for their support with the histologic evaluation. The authors are also grateful to Kota Ohno, PhD, for statistical support.

Disclosure

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 4 (DOCX 13 kb)
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Supplementary material 5 (PPTX 488 kb)

References

  1. 1.
    Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153-65.CrossRefGoogle Scholar
  2. 2.
    Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol 2014;63:329-36.CrossRefGoogle Scholar
  3. 3.
    Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Muller-Quernheim J. Sarcoidosis. Lancet 2014;383:1155-67.CrossRefGoogle Scholar
  4. 4.
    Chiu CZ, Nakatani S, Zhang G, Tachibana T, Ohmori F, Yamagishi M, et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005;95:143-6.CrossRefGoogle Scholar
  5. 5.
    Nagai T, Nagano N, Sugano Y, Asaumi Y, Aiba T, Kanzaki H, et al. Effect of Corticosteroid Therapy on Long-Term Clinical Outcome and Left Ventricular Function in Patients With Cardiac Sarcoidosis. Circ J 2015;79:1593-600.CrossRefGoogle Scholar
  6. 6.
    Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm 2014;11:1305-23.CrossRefGoogle Scholar
  7. 7.
    Uemura A, Morimoto S, Hiramitsu S, Kato Y, Ito T, Hishida H. Histologic diagnostic rate of cardiac sarcoidosis: evaluation of endomyocardial biopsies. Am Heart J 1999;138:299-302.CrossRefGoogle Scholar
  8. 8.
    Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J 2005;26:1538-43.CrossRefGoogle Scholar
  9. 9.
    Manabe O, Oyama-Manabe N, Ohira H, Tsutsui H, Tamaki N. Multimodality evaluation of cardiac sarcoidosis. J Nucl Cardiol 2012;19:621-4.CrossRefGoogle Scholar
  10. 10.
    Mc Ardle BA, Leung E, Ohira H, Cocker MS, deKemp RA, DaSilva J, et al. The role of F18-fluorodeoxyglucose positron emission tomography in guiding diagnosis and management in patients with known or suspected cardiac sarcoidosis. J Nucl Cardiol 2013;20:297-306.CrossRefGoogle Scholar
  11. 11.
    Manabe O, Yoshinaga K, Ohira H, Sato T, Tsujino I, Yamada A, et al. Right ventricular 18F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis. Ann Nucl Med 2014;28:656-63.CrossRefGoogle Scholar
  12. 12.
    Simonen P, Lehtonen J, Kandolin R, Schildt J, Marjasuo S, Miettinen H, et al. F-18-fluorodeoxyglucose positron emission tomography-guided sampling of mediastinal lymph nodes in the diagnosis of cardiac sarcoidosis. Am J Cardiol 2015;116:1581-5.CrossRefGoogle Scholar
  13. 13.
    Terasaki F, Yoshinaga K. New guidelines for diagnosis of cardiac sarcoidosis in Japan. Ann Nucl Cardiol 2017;3:42-5.CrossRefGoogle Scholar
  14. 14.
    Schiller NB, Acquatella H, Ports TA, Drew D, Goerke J, Ringertz H, et al. Left ventricular volume from paired biplane two-dimensional echocardiography. Circulation 1979;60:547-55.CrossRefGoogle Scholar
  15. 15.
    Langah R, Spicer K, Gebregziabher M, Gordon L. Effectiveness of prolonged fasting 18F-FDG PET-CT in the detection of cardiac sarcoidosis. J Nucl Cardiol 2009;16:801-10.CrossRefGoogle Scholar
  16. 16.
    Machac J, Bacharach SL, Bateman TM, Bax JJ, Beanlands R, Bengel F, et al. Positron emission tomography myocardial perfusion and glucose metabolism imaging. J Nucl Cardiol 2006;13:e121-51.CrossRefGoogle Scholar
  17. 17.
    Manabe O, Yoshinaga K, Ohira H, Masuda A, Sato T, Tsujino I, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial (18)F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol 2016;23:244-52.CrossRefGoogle Scholar
  18. 18.
    Hirata K, Kobayashi K, Wong KP, Manabe O, Surmak A, Tamaki N, et al. A semi-automated technique determining the liver standardized uptake value reference for tumor delineation in FDG PET-CT. PLoS ONE 2014;9:e105682.CrossRefGoogle Scholar
  19. 19.
    Manabe O, Kroenke M, Aikawa T, Murayama A, Naya M, Masuda A et al. Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake. J Nucl Cardiol 2017.Google Scholar
  20. 20.
    Ishiyama M, Soine LA, Vesselle HJ. Semi-quantitative metabolic values on FDG PET/CT including extracardiac sites of disease as a predictor of treatment course in patients with cardiac sarcoidosis. EJNMMI Res 2017;7:67.CrossRefGoogle Scholar
  21. 21.
    Tavora F, Cresswell N, Li L, Ripple M, Solomon C, Burke A. Comparison of necropsy findings in patients with sarcoidosis dying suddenly from cardiac sarcoidosis versus dying suddenly from other causes. Am J Cardiol 2009;104:571-7.CrossRefGoogle Scholar
  22. 22.
    Tuominen H, Haarala A, Tikkakoski A, Kahonen M, Nikus K, Sipila K. 18-FDG-PET in a patient cohort suspected for cardiac sarcoidosis: Right ventricular uptake is associated with pathological uptake in mediastinal lymph nodes. J Nucl Cardiol 2018.Google Scholar
  23. 23.
    Kim JS, Judson MA, Donnino R, Gold M, Cooper LT Jr, Prystowsky EN, et al. Cardiac sarcoidosis. Am Heart J 2009;157:9-21.CrossRefGoogle Scholar
  24. 24.
    Doughan AR, Williams BR. Cardiac sarcoidosis. Heart. 2006;92:282-8.CrossRefGoogle Scholar
  25. 25.
    Kandolin R, Lehtonen J, Graner M, Schildt J, Salmenkivi K, Kivisto SM, et al. Diagnosing isolated cardiac sarcoidosis. J Intern Med 2011;270:461-8.CrossRefGoogle Scholar
  26. 26.
    Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology Eur Heart J. 2007;28:3076-93.CrossRefGoogle Scholar
  27. 27.
    Koiwa H, Tsujino I, Ohira H, Yoshinaga K, Otsuka N, Nishimura M. Images in cardiovascular medicine: imaging of cardiac sarcoid lesions using fasting cardiac 18F-fluorodeoxyglucose positron emission tomography: an autopsy case. Circulation 2010;122:535-6.CrossRefGoogle Scholar
  28. 28.
    Holzmann M, Nicko A, Kuhl U, Noutsias M, Poller W, Hoffmann W, et al. Complication rate of right ventricular endomyocardial biopsy via the femoral approach: a retrospective and prospective study analyzing 3048 diagnostic procedures over an 11-year period. Circulation 2008;118:1722-8.CrossRefGoogle Scholar
  29. 29.
    Yilmaz A, Kindermann I, Kindermann M, Mahfoud F, Ukena C, Athanasiadis A, et al. Comparative evaluation of left and right ventricular endomyocardial biopsy: differences in complication rate and diagnostic performance. Circulation 2010;122:900-9.CrossRefGoogle Scholar
  30. 30.
    Slawek S, Araszkiewicz A, Gaczkowska A, Koszarska J, Celinski D, Grygier M, et al. Endomyocardial biopsy via the femoral access - still safe and valuable diagnostic tool. BMC Cardiovasc Disord 2016;16:222.CrossRefGoogle Scholar
  31. 31.
    Nery PB, Keren A, Healey J, Leug E, Beanlands RS, Birnie DH. Isolated cardiac sarcoidosis: establishing the diagnosis with electroanatomic mapping-guided endomyocardial biopsy. Can J Cardiol 2013;29:e1-3.Google Scholar

Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Kazunori Omote
    • 1
  • Masanao Naya
    • 1
    Email author
  • Kazuhiro Koyanagawa
    • 1
  • Tadao Aikawa
    • 1
  • Osamu Manabe
    • 2
  • Toshiyuki Nagai
    • 1
  • Kiwamu Kamiya
    • 1
  • Yoshiya Kato
    • 1
  • Hirokazu Komoriyama
    • 1
  • Masato Kuzume
    • 1
  • Nagara Tamaki
    • 3
  • Toshihisa Anzai
    • 1
  1. 1.Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Nuclear MedicineHokkaido University Graduate School of MedicineSapporoJapan
  3. 3.Department of RadiologyKyoto Prefectural University of MedicineKyotoJapan

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