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Diagnostic performance of F-18 FDG PET for detection of cardiac sarcoidosis; A systematic review and meta-analysis

  • Seong-Jang KimEmail author
  • Kyoungjune Pak
  • Keunyoung Kim
Original Article

Abstract

Objective

The purpose of the current study was to investigate the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for diagnosis of cardiac sarcoidosis (CS) through a systematic review and meta-analysis.

Methods

The PubMed and EMBASE database, from the earliest available date of indexing through 31 March 31, 2018, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT for CS. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic (SROC) curves.

Results

Across 17 studies (891 patients), the pooled sensitivity was 0.84 [95% confidence interval (95% CI) 0.71-0.91] with heterogeneity (I2 = 77.5) and a pooled specificity of 0.83 (95% CI 0.74-0.89) with heterogeneity (I2 = 80.0). Likelihood ratio (LR) syntheses gave an overall LR+ of 4.9 (95% CI 3.3-7.3) and LR− of 0.2 (95% CI 0.11-0.35). The pooled diagnostic odds ratio was 27 (95% CI 14-55). Hierarchical SROC curve indicates that the area under the curve was 0.90 (95% CI 0.87-0.92). Meta-regression showed that combined myocardial perfusion imaging was the source of heterogeneity.

Conclusion

The current meta-analysis showed the moderate sensitivity and specificity of F-18 FDG PET or PET/CT for diagnosis of CS. The presence of combined myocardial perfusion imaging could improve diagnostic accuracy of F-18 FDG PET or PET/CT for diagnosis of CS. At present, the literature regarding the use of F-18 FDG PET for detection of CS remains limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of F-18 FDG PET for diagnosis of CS.

Keywords

F-18 FDG PET/CT sarcoidosis diagnosis 

Abbreviations

CS

Cardiac sarcoidosis

DORs

Diagnostic odds ratio

EMB

Endomyocardial biopsy

FDG

Fluorodeoxyglucose

FLT

Fluorothymidine

JMHW

Japanese Ministry of Health and Welfare

PET

Positron emission tomography

PET/CT

Positron emission tomography/computed tomography

SUVmax

Maximum standardized uptake value

Notes

Author’s Contribution

Protocol/project development: Kim SJ, Pak K. Data collection or management: Kim SJ, Kim K, Pak K. Data analysis: Kim SJ, Kim K. Manuscript writing/editing; Kim SJ, Pak K, and Kim K.

Disclosures

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.

Ethical Approval

Institutional Review Board approval was not required because we only performed data analysis based on the published studies.

Informed Consent

Written informed consent was not required for this study because it is a meta-analysis based on the studies that have been published.

Supplementary material

12350_2018_1582_MOESM1_ESM.pptx (422 kb)
Supplementary material 1 (PPTX 422 kb) Supplementary Figure 1. Forest plots of diagnostic performance of F-18 FDG PET or PET/CT based on the use of myocardial perfusion imaging.
12350_2018_1582_MOESM2_ESM.jpg (822 kb)
Supplementary material 2 (JPEG 821 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Seong-Jang Kim
    • 1
    • 2
    • 3
    Email author
  • Kyoungjune Pak
    • 4
  • Keunyoung Kim
    • 4
  1. 1.Department of Nuclear MedicinePusan National University Yangsan HospitalYangsanKorea
  2. 2.BioMedical Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanKorea
  3. 3.Department of Nuclear Medicine, College of MedicinePusan National UniversityYangsanKorea
  4. 4.Department of Nuclear MedicinePusan National University HospitalPusanKorea

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