セリザワ ナオキ   SERIZAWA Naoki
  芹澤 直紀
   所属   医学部 医学科(東京女子医科大学病院)
   職種   助教
言語種別 英語
発表タイトル The incidence and clinical significance of 18F-fluorodeoxyglucose re-uptake on cardiac positron emission tomography in patient with cardiac sarcoidosis after receiving corticosteroid therapy
会議名 ESC CONGRESS 2017
主催者 European Society of Cardiology
学会区分 国際学会及び海外の学会
発表形式 口頭
講演区分 一般
発表者・共同発表者◎SERIZAWA Naoki, MOMOSE Mitsuru, FUKUSHIMA Kenji, NOMURA Arata, SHIGA Tsuyoshi, HAGIWARA Nobuhisa
発表年月日 2017/08/29
開催地
(都市, 国名)
Barcelona, SPAIN
概要 Background: 18F-fluorodeoxyglucose positron emission tomography (FDG) is useful for diagnosis and monitoring of cardiac sarcoidosis (CS) because of high sensitivity. However, its specificity is relatively low. Physiological uptake of FDG by heart tissue often interferes with the accurate activity of CS. We sometimes experience cases that show the FDG re-uptake without disease exacerbation at follow-up period after corticosteroid therapy.

Purpose: We assessed the incidence and significance of FDG re-uptake by accurately quantifying FDG uptake through the evaluating myocardial damage by imaging modality and clinical exacerbation in patient with CS receiving corticosteroid therapy during follow-up.

Methods: Detecting FDG re-uptake and recurrence of CS, we performed serial FDG (after >24hrs with low carbohydrate diet and 18hrs fasting and heparin administration), cardiovascular magnetic resonance (CMR) or TL and/or BMIPP single photon emission computed tomography (SPECT) for CS patients before and after corticosteroid therapy during titration period. Maximum standardized uptake value (SUVmax) in the entire myocardium was obtained from FDG. FDG re-uptake was defined as an increase in SUVmax compared to the latest exam, and CS recurrence, as having CMR/SPECT or clinical exacerbation associated with FDG re-uptake, or progression of FDG re-uptake without decreasing corticosteroid.

Results: For 43 patients with CS followed by a total of 129 serial FDG exams (median 3 per patient), FDG re-uptake was found in 16 patients (37%) and 18 sessions (14%). Patients with re-uptake were significantly lower baseline LVEF than those without (39±5% vs. 46±10%, p=0.018). Meanwhile, 9 out of 16 patients with FDG re-uptake (56%) had recurrence of CS (2 exacerbation of cardiac imaging findings, 5 clinical exacerbation and 2 further progression of FDG re-uptake without decreasing corticosteroid). Among re-uptake patients, dose of corticosteroid at the time of FDG re-uptake and latest SUVmax were similar among patients with and without recurrence (9±4mg vs. 7±4mg, p=0.289 and 2.7±0.9 vs. 2.1±0.6, p=0.200, respectively). However, CS patients with recurrence had significantly higher SUVmax at follow-up than those without (5.0±1.3 vs. 3.2±0.9, p=0.008). Furthermore, Both TL and BMIPP defect score at diagnosis were tended to be higher in CS patients with recurrence than those without (19±12 vs. 7±6, p=0.069 and 24±13 vs. 6±5, p=0.060, respectively). Best cut-off value of SUVmax for detecting recurrence of CS by ROC curve analysis was SUVmax >3.5 (AUC0.875, sensitivity100%, specificity67%).

Conclusions: FDG re-uptake was common in advanced CS, and CS recurrence occurred in approximately half of patients with FDG re-uptake during follow-up. Higher FDG re-uptake might suggest CS recurrence. Conversely, lower FDG re-uptake might be clinical insignificance. Further investigation is needed to improve diagnostic accuracy and examine the impact on disease prognosis.