Determination of optimum periods between onset of suspected acute myocarditis and 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of inflammatory left ventricular myocardium

• Published in: International journal of cardiology Vol. 169; no. 3; pp. 196 - 200
• Main Authors: Ozawa, Koya, Funabashi, Nobusada, Daimon, Michiko, Takaoka, Hiroyuki, Takano, Hiroyuki, Uehara, Masae, Kobayashi, Yoshio
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 05.11.2013; Elsevier
• Subjects: 18F-fluorodeoxyglucose positron emission tomography; Acute Disease; Acute myocarditis; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Female; Fluorodeoxyglucose F18; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Humans; Inflammation - diagnostic imaging; Inflammation - pathology; Inflammatory left ventricular myocardium; Male; Medical sciences; Middle Aged; Myocarditis - diagnostic imaging; Myocarditis - pathology; Myocarditis. Cardiomyopathies; Optimum periods; Positron-Emission Tomography - methods; Positron-Emission Tomography - standards; Retrospective Studies; Time Factors; Inflammatory left ventricular myocardium; Acute myocarditis; 18F-fluorodeoxyglucose positron emission tomography; Optimum periods; Radionuclide study; 2-deoxy-2-fluoroglucose; Acute; Cardiovascular disease; Period; Inflammation; Myocardial disease; Left ventricle; Myocarditis; Optimum; Heart disease; Myocardium; Circulatory system; Diagnosis; Cardiology; Positron emission tomography; F-fluorodeoxyglucose positron emission tomography; Emission tomography
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2013.08.098

To determine optimum periods for 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) examination in subjects with suspected acute myocarditis, we compared 18F-FDG PET with endomyocardial biopsy (EMB) using the latest definition of 18F-FDG PET for inflammatory left ventricular (LV) myocardium. Retrospective analysis of 29 subjects (18 male, 48±18years) who have symptoms or LV dysfunction underwent both 18F-FDG PET (Advance NXi, GE-Healthcare) under fasting conditions and EMB from LV posterior wall within 3months. When we defined 18F-FDG PET positive inflammatory LV posterior wall as ‘focal on diffuse’ pattern, sensitivity, specificity, and positive predictive values (PPV), and negative predictive values (NPV) of 18F-FDG PET for detecting active inflammatory LV posterior wall compared with EMB were 46.2, 81.3, 66.7, and 65.0%, respectively. Receiver operating characteristic curve of periods (days) between onset of clinically suspected acute myocarditis and performance of 18F-FDG PET for detecting inflammatory LV posterior wall demonstrated 17days as a best cut off values with area under the curve (0.497, P=0.982) with sensitivity=21.1% and specificity=100%. Sensitivity, specificity, PPV and NPV of 18F-FDG PET for detecting inflammatory LV posterior wall on EMB were all 100% when 18F-FDG PET was performed at 1–14days after onset of suspected acute myocarditis. In our definition, 18F-FDG PET showed excellent agreement with EMB for detecting active inflammatory LV posterior wall in subjects with clinically suspected active acute myocarditis. If possible, 18F-FDG PET should be performed within 14days after the onset to maintain high diagnostic accuracy compared with EMB.