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Excellent suppression of physiological myocardial FDG activity in patients with cardiac sarcoidosis
Author(s) -
Sankaran Shyam S,
Kyprianou Katerina,
Cherk Martin H,
Nadebaum David P,
Beech Paul A,
Khor Robert,
Zimmet Hendrik,
Hare James L,
Larby Annabel,
Yap Kenneth SK,
Barber Thomas W
Publication year - 2021
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.13121
Subject(s) - medicine , cardiac sarcoidosis , sarcoidosis , nuclear medicine , cardiac pet , retrospective cohort study , radiology , positron emission tomography , cardiology
Abstract Introduction Suppression of physiological myocardial FDG activity is vital in patients undergoing PET/CT for assessment of known or suspected cardiac sarcoidosis. This study aims to evaluate the efficacy of physiological myocardial FDG suppression following a protocol change to a 24‐h high fat very low carbohydrate (HFVLC) diet and prolonged fast. Methods A retrospective review of patients undergoing FDG PET/CT for the evaluation of cardiac sarcoidosis was performed. Prior to June‐2018, patients were prepared with a single very high‐fat low carbohydrate meal followed by a 12–18 h fast (group 1). After June‐2018, a protocol change was initiated with patients prepared with a HFVLC diet for 24‐h followed by a 12–18 h fast (group 2). Focal myocardial activity was classified as positive, absent activity as negative and diffuse/focal on diffuse activity as indeterminate. Results A total of 94 FDG PET/CT scans were included with 46 scans in group 1 and 48 scans in group 2. Studies were classified as positive, negative or indeterminate in 25 (54%), 7 (15%) and 14 (30%) scans in group 1 and in 13 (27%), 33 (69%) and 2 (4%) scans in group 2, respectively. In scans classified as negative, myocardial FDG activity was less than mediastinal blood pool activity in 5/7 (71%) scans in group 1 and 33/33 (100%) scans in group 2. Conclusion Excellent myocardial FDG suppression can be achieved using a 24‐h HFVLC diet and prolonged fast, resulting in a very low indeterminate scan rate in patients with known or suspected cardiac sarcoidosis.