In the Journals

Fluorodeoxyglucose PET-CT scans useful for detecting cardiac sarcoidosis

Nadera J. Sweiss
Nadera J. Sweiss

Fluorodeoxyglucose PET-CT scans with pretest diet preparation detected extra-thoracic sarcoid in patients with cardiac sarcoidosis, according to a study published in the Journal of Nuclear Cardiology.

“Currently, the use of [PET-CT] scan is not a standard test in the diagnosis and follow-up in patients with sarcoidosis, and insurances do not approve this test as a diagnostic test in the patients with sarcoidosis,” Nadera J. Sweiss, MD, professor of rheumatology at University of Illinois at Chicago College of Medicine and director of the University of Illinois Hospital’s (UI Health) Bernie Mac Sarcoidosis Translational Advanced Research Center, told Cardiology Today. “Based on our study, not only we were able to diagnosis cardiac sarcoidosis using a PET-CT technique, but we were able to evaluate sarcoidosis in other sites of the body and provide a staging of the disease similar to the way we stage cancer.”

Researchers analyzed 191 fluorodeoxyglucose PET-CT scans, including three follow-up scans, from 188 patients (mean age, 52 years; 72% women) from December 2014 to December 2015. Some patients had known sarcoid prior to the study.

Patients followed a high-fat, high-protein and very low-carbohydrate diet 72 hours before the scan, which was published earlier in 2017 as a novel preparation to improve detection of cardiac sarcoidosis. Food permitted in this diet include nonprocessed meat, poultry and fish, nonprocessed cheese, unsweetened butter, vegetable and animal oil, coffee without sugar or milk, nonstarchy vegetables, water and other unsweetened beverages. Four hours before the scan, patients were asked to eat a breakfast containing fried bacon or chicken, at least two spoons of olive oil, an omelet with four eggs and either water or black coffee.

“The practice has changed when physicians order PET scans to look for cardiac sarcoidosis, and a 3-day diet is the standard right now compared to only doing 1-day diet or no specific diet before the scan, as we believe the 3-day diet improves the sensitivity and specificity and they decrease the false positive in diagnosing cardiac sarcoid, although it needed further validation,” Sweiss said.

The scans showed that 10% were positive, 3% were indeterminate and 86% were negative for cardiac sarcoidosis. Researchers saw that 40% of positive scans had results for both cardiac and extra-thoracic sarcoid and 60% only had findings for cardiac sarcoidosis.

“This makes an intriguing case for using [fluorodeoxyglucose] PET-CT over cardiac MRI for [cardiac sarcoidosis] evaluation given that the narrower field of view with [cardiac MRI] is likely to overlook these extra-thoracic sites of disease,” Darshan C. Patel, MD, MPH, of the department of radiology at University of Illinois at Chicago College of Medicine, and colleagues wrote. – by Darlene Dobkowski

For more information:

Nadera J. Sweiss, MD, can be reached at jmcarey@uic.edu.

Disclosure: Sweiss reports no relevant financial disclosures.

Nadera J. Sweiss
Nadera J. Sweiss

Fluorodeoxyglucose PET-CT scans with pretest diet preparation detected extra-thoracic sarcoid in patients with cardiac sarcoidosis, according to a study published in the Journal of Nuclear Cardiology.

“Currently, the use of [PET-CT] scan is not a standard test in the diagnosis and follow-up in patients with sarcoidosis, and insurances do not approve this test as a diagnostic test in the patients with sarcoidosis,” Nadera J. Sweiss, MD, professor of rheumatology at University of Illinois at Chicago College of Medicine and director of the University of Illinois Hospital’s (UI Health) Bernie Mac Sarcoidosis Translational Advanced Research Center, told Cardiology Today. “Based on our study, not only we were able to diagnosis cardiac sarcoidosis using a PET-CT technique, but we were able to evaluate sarcoidosis in other sites of the body and provide a staging of the disease similar to the way we stage cancer.”

Researchers analyzed 191 fluorodeoxyglucose PET-CT scans, including three follow-up scans, from 188 patients (mean age, 52 years; 72% women) from December 2014 to December 2015. Some patients had known sarcoid prior to the study.

Patients followed a high-fat, high-protein and very low-carbohydrate diet 72 hours before the scan, which was published earlier in 2017 as a novel preparation to improve detection of cardiac sarcoidosis. Food permitted in this diet include nonprocessed meat, poultry and fish, nonprocessed cheese, unsweetened butter, vegetable and animal oil, coffee without sugar or milk, nonstarchy vegetables, water and other unsweetened beverages. Four hours before the scan, patients were asked to eat a breakfast containing fried bacon or chicken, at least two spoons of olive oil, an omelet with four eggs and either water or black coffee.

“The practice has changed when physicians order PET scans to look for cardiac sarcoidosis, and a 3-day diet is the standard right now compared to only doing 1-day diet or no specific diet before the scan, as we believe the 3-day diet improves the sensitivity and specificity and they decrease the false positive in diagnosing cardiac sarcoid, although it needed further validation,” Sweiss said.

The scans showed that 10% were positive, 3% were indeterminate and 86% were negative for cardiac sarcoidosis. Researchers saw that 40% of positive scans had results for both cardiac and extra-thoracic sarcoid and 60% only had findings for cardiac sarcoidosis.

“This makes an intriguing case for using [fluorodeoxyglucose] PET-CT over cardiac MRI for [cardiac sarcoidosis] evaluation given that the narrower field of view with [cardiac MRI] is likely to overlook these extra-thoracic sites of disease,” Darshan C. Patel, MD, MPH, of the department of radiology at University of Illinois at Chicago College of Medicine, and colleagues wrote. – by Darlene Dobkowski

For more information:

Nadera J. Sweiss, MD, can be reached at jmcarey@uic.edu.

Disclosure: Sweiss reports no relevant financial disclosures.