Original Article
Role of 18F-FDG PET/CT imaging in cardiac and pericardial masses

https://doi.org/10.1007/s12350-020-02510-9Get rights and content

Abstract

Background

Considering the few reported cardiac masses, PET/CT in the imaging workup of cardiac masses is not well established. This retrospective study analyzed the role of 18F-FDG PET/CT imaging in cardiac/pericardial masses.

Methods and results

Fifty-nine patients with newly diagnosed cardiac/pericardial masses who underwent PET/CT and transthoracic echocardiography (TTE) were recruited. Echocardiographic and PET/CT characteristics were evaluated for predictive value in differentiating malignant and non-malignant lesions using histologic confirmation as the gold standard. The McNemar test was used to test the differences in sensitivity between PET/CT and TTE. 18F-FDG PET/CT had higher sensitivity in determining the malignancy of cardiac/pericardial masses compared to TTE (sensitivity, 96.6% vs 72.4%, P = .039). However, when pericardial masses were excluded from the analysis, the difference in sensitivity between the two was not statistically significant (sensitivity, 95.6% vs 78.3%, P = .219). 18F-FDG PET/CT identified two malignant pericardial masses missed on TTE, changed the diagnostic orientation of TTE in 15 patients, and found seven patients with extracardiac lesions in 29 malignant patients.

Conclusions

PET/CT was an effective additional image modality in patients with suspected malignant cardiac mass for further confirmation and to screen for potential metastasis.

Introduction

Cardiac tumors are rare entities with high mortality.1,2 Surgical removal is the treatment option of most cases.3 Complete surgical resection can cure most benign heart lesions4 and is also an important treatment for local cardiac malignancies. Palliative surgery is only recommended to relieve rapidly progressing symptoms, in case of unresectable lesions or presence of metastases.5,6 Hence, proper differentiation among these masses and accurate staging of malignant tumors play a vital role in the treatment option.

The two most commonly used noninvasive diagnostic modalities to evaluate suspicious cardiac masses are echocardiography and magnetic resonance imaging (MRI).7, 8, 9, 10, 11 Transthoracic echocardiography (TTE) is the first diagnostic procedure, with a high sensitivity of 93.3%.12 Cardiac MRI provides further information about morphology, location and extent of the mass. CT is recommended for assessing infiltration into the pericardium or the heart itself13 and detecting calcifications,14 especially for patients with contraindications for MRI. However, it is still difficult to accurately discriminate between malignant and benign tumors. Several reports show that 18F-FDG PET/CT can aid noninvasive preoperative determination of malignancy15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 and may be helpful in detecting metastases of malignant cardiac tumors.28, 29, 30

However, there are limited data available on 18F-FDG PET/CT imaging in cardiac/pericardial masses. The aim of this study was to evaluate the ability of 18F-FDG PET/CT imaging in cardiac/pericardial masses in a relatively large sample size.

Section snippets

Patients

This study was approved by the institutional review board of our hospital and informed consent was waived due to its retrospective nature of the study. We retrospectively identified 59 patients referred for 18F-FDG PET/CT evaluation of newly diagnosed cardiac/pericardial masses from August 2010 to October 2019. All patients were referred to assess metabolism of the cardiac tumors and to screen for extracardiac tumor manifestations. The inclusion criteria were as follows: (1) patients underwent

18F-FDG PET/CT Imaging

18F-FDG PET/CT imaging was obtained by the following two PET/CT devices: Discovery VCT 64 (General Electric, Milwaukee, WI, USA) or uMI510 (United Imaging Healthcare, China). The patients performed a standard oncologic preparation without a high-fat/low-carbohydrate diet or heparin intervention. Patients were instructed to fast for at least 6 h, and their blood glucose levels were less than 150 mg/dL before 18F-FDG injection. Whole-body acquisition from head to proximal femora was started about

Patients’ Characteristics, Histology and Location

Fifty-nine patients (32 men, 27 women; mean age ± SD, 50 ± 13 years) according to the inclusion criteria were retrospectively enrolled in the final analysis. Histology served as ground truth. The histologic distributions and anatomic locations are summarized in Table 1.

Of these patients, 30 (50.8%) had nonmalignant lesions (benign tumors and tumor-like lesions), 23 (39.0%) had primary malignant tumors, and six (10.2%) had secondary malignant tumors. The common histologic types were myxoma

Discussion

There are several important findings in this study. First, we identified echocardiographic and PET/CT characteristics that were predictive of cardiac/pericardial malignancy, and especially PET/CT in a large sample size. Second, we demonstrated that 18F-FDG PET/CT was an effective additional image modality in patients with suspected malignant cardiac mass for further confirmation and to screen for potential metastasis, especially for pericardial masses.

Primary tumors of the heart are extremely

Conclusions

In conclusion, PET/CT was used to further delineate characteristics and metastasis for patients with echocardiography suspected malignancy or in more complicated cases. 18F-FDG PET/CT can improve the diagnostic workup of cardiac/pericardial masses in determining tumor malignancy. 18F-FDG PET/CT characteristics are predictive of malignant cardiac/pericardial neoplasm, including SUVmax, size, location in the pericardium, and pericardial effusion. Futhermore, 18F-FDG PET/CT imaging provides the

Acknowledgments

Supported by: Hongyan Yin was sponsored by a Young Scholar Grant from the National Natural Science Foundation of China (81501500) and Hongcheng Shi was supported by Shanghai Municipal Key Clinical Specialty (shslczdzk03401).

Disclosure

Hongyan Yin, Wujian Mao, Hui Tan, Na Zhu, Quan Wan, Jing Shi, Lin Qiu, Yan Xiu, Rongkui Luo, Haojun Yu, Hongcheng Shi have nothing to declare. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject

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    Hongyan Yin, Wujian Mao, and Hui Tan contributed equally to this paper.

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