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Background  F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a promising modality for detecting active lesions of cardiac sarcoidosis (CS). However, determining whether  18 F-FDG uptake in the myocardium is physiological is challenging due to metabolic shift in myocardial cells. Although methods for inhibiting physiological myocardial  18 F-FDG uptake have been proposed, no standard methods exist. This study therefore aimed to compare the effect of an 18-h fast (long fasting (LF)) with heparin loading plus a 12-h fast (HEP) before  18 F-FDG PET scan.    Methods  We analyzed the effects of LF and HEP on the inhibition of physiological myocardial  18 F-FDG uptake in healthy subjects (18 in HEP and 19 in LF) and in patients with known or suspected CS (96 in HEP and 69 in LF). In CS, the lower uptake of  18 F-FDG in the myocardium was evaluated. A visual four-point scale was used to assess myocardial  18 F-FDG uptake in comparison with hepatic uptake (1 lower, 2 similar, 3 somewhat higher, 4 noticeably higher).    Results  Myocardial  18 F-FDG uptake was 1.68 ± 1.06 in LF and 3.17 ± 1.16 in HEP in healthy subjects ( p  < 0.0001), whereas it was 1.48 ± 0.99 in LF and 2.48 ± 1.33 in HEP in CS patients ( p  < 0.0001). Logistic regression and regression trees revealed the LF was the most effective in inhibiting myocardial  18 F-FDG uptake. In addition, serum free fatty acid levels on intravenous  18 F-FDG injection were a possible biomarker.    Conclusions  LF is effective in inhibiting myocardial  18 F-FDG uptake, and consequently, it could be useful for evaluating active lesions of CS in  18 F-FDG PET images.

Long fasting is effective in inhibiting physiological myocardial 18F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis