Dr. Maria Trivieri works at Mount Sinai as an assistant professor in the cardiology department. Her specialties are cardiology and cardiovascular disease. In this podcast Dr. Trivieri discusses Pulmonary Artery 18F-Fluorodeoxyglucose Uptake by PET/CMR as a Marker of Pulmonary Hypertension in Sarcoidosis.

https://www.jacc.org/doi/10.1016/j.jcmg.2021.05.023

Abstract \sObjectives
This study looked at whether 18F-FDG uptake in the pulmonary artery (PA) is linked to hypertension and if it correlates with elevated pulmonary pressures.

Background

PET with 18F-fluorodeoxyglucose (FDG) in combination with computed tomography or cardiac magnetic resonance (CMR) has been used to detect inflammation in the systemic circulation's major arteries. The link between pulmonary hypertension and inflammation of the pulmonary system's vasculature is poorly understood (PH).

Methods

18F-FDG uptake in the PA was quantified using the maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR) in a single-center cohort of 175 patients with suspected cardiac sarcoidosis who underwent hybrid thoracic PET/CMR and compared to available results from right heart catheterization (RHC) or transthoracic echocardiography (TTE).

Results

Thirty-three of the individuals had significant 18F-FDG uptake in the PA wall. The mean PA pressure was considerably greater in the group with PA 18F-FDG uptake compared to the group without uptake (34.4 7.2 mm Hg vs 25.6 9.3 mm Hg; P = 0.003), and 9 (90 percent) of patients with PA 18F-FDG uptake had PH when a mean PA pressure limit of 25 mm Hg was adopted (P 0.05). Signs of PH were evident in a substantially higher percentage of patients with PA 18F-FDG uptake in the TTE subgroup (14 [51.9 percent] vs 37 [29.8 percent]; P 0.05). Based on RHC-derived PA pressures, qualitative assessment of 18F-FDG absorption in the PA wall demonstrated a sensitivity of 33% and specificity of 96% for distinguishing patients with PH. SUVmax and TBR in the PA wall were found to be related to PA pressure as measured by RHC and/or TTE.

Conclusions

We show that PET/CMR absorption of 18F-FDG in the PA is linked to PH and that its intensity is related to PA pressure.