Nuclear cardiology in the literature: A selection of recent, original research papers

Abstract

Emanuela Concetta D’Angelo, Pasquale Paolisso, Giovanni Vitale, Alberto Foà, Luca Bergamaschi, Ilenia Magnani, Giulia Saturi, Andrea Rinaldi, Sebastiano Toniolo, Matteo Renzulli, Domenico Attinà, Luigi Lovato, Giacomo Maria Lima, Rachele Bonfiglioli, Stefano Fanti, Ornella Leone, Maristella Saponara, Maria Abbondanza Pantaleo, Paola Rucci, Luca Di Marco, Davide Pacini, Carmine Pizzi, and Nazzareno Galiè Bologna, Italy JACC Cardiovasc Imaging. 2020 Nov;13(11):24002411 Context: Accurate assessment of the type and extent of cardiac masses is essential for guiding therapeutic decision making. Hybrid imaging approaches have the ability to provide better characterization of cardiac masses. Methods and Results: The authors determined the diagnostic accuracy of cardiac CT and F-FDG PET/ CT in categorizing cardiac masses, in a cohort of 60 cases who underwent cardiac CT and F-FDG PET/CT out of a larger cohort of 223 patients with echocardiographically identified cardiac masses. After diagnostic studies, patients were categorized into 4 subtypes: pseudotumors, primary benign cardiac tumors, primary malignant cardiac tumors, or secondary cardiac tumors. All masses (except for a minority of thrombotic lesions) underwent histological confirmation by 2 experienced pathologists following biopsy, surgical resection, or autopsy. Normal anatomic variants and patients with clinical and lab data of active infective endocarditis were excluded. Cardiac CTs were evaluated by 2 independent expert radiologists who were blinded to clinical information, and 8 morphological CT signs were defined for each mass: dimension, density, pre-contrast characteristics, presence of calcification, contrast enhancement, irregular tumor margin, invasion, and pericardial effusion. PET/CT attenuation-corrected images were assessed by 2 nuclear medicine physicians for standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) (product of MTV and SUVmean). Allcause mortality was determined from review of medical records. A cutoff of C 5 CT signs perfectly identified malignant masses with a positive predictive value (PPV) of 100%, whereas a cutoff of B 2 CT signs excluded malignant masses with a negative predictive value of 100%. Among masses with 3 or 4 pathological CT signs, the occurrence of at least 1 abnormal F-FDG PET/CT parameter increased both the specificity and PPV to 100%. The number of CT signs significantly predicted mortality with a hazard ratio of 1.342 (95% CI 1.101 to 1.636), where each sign lead to a 34.2% increment in mortality risk. SUVmax was the only PET/CT parameter that independently predicted mortality with a hazard ratio of 3.145 (95% CI 1.341 to 7.373). These results show the high accuracy of CT features for characterization of cardiac masses, and the ability of FDG PET/ CT to enhance identification of malignant masses and improve diagnostic certainty after an indeterminate cardiac CT. Significance: This report highlights the integration of two imaging techniques, cardiac CT and FDG PET/ Reprint requests: Saurabh Malhotra, MD, MPH, FASNC, Division of Cardiology, Cook County Health, Chicago, IL ; saurabh.malhotra@ cookcountyhhs.org J Nucl Cardiol 2021;28:395–7. 1071-3581/$34.00 Copyright 2021 American Society of Nuclear Cardiology.