Pulmonary Artery 18F-Fluorodeoxyglucose Uptake by PET/CMR as a Marker of Pulmonary Hypertension in Sarcoidosis

Alexander Maier; Steve Lin Liao; Thomas Lescure; Philip M Robson; Naoki Hirata; Samantha Sartori; Navneet Narula; Vittoria Vergani; Georgios Soultanidis; Adam Morgenthau; Jason C Kovacic; Maria Padilla; Jagat Narula; Adam Jacobi; Zahi A Fayad; Maria G Trivieri

doi:10.1016/j.jcmg.2021.05.023

Pulmonary Artery ¹⁸F-Fluorodeoxyglucose Uptake by PET/CMR as a Marker of Pulmonary Hypertension in Sarcoidosis

JACC Cardiovasc Imaging. 2022 Jan;15(1):108-120. doi: 10.1016/j.jcmg.2021.05.023. Epub 2021 Jul 14.

Authors

Alexander Maier¹, Steve Lin Liao², Thomas Lescure³, Philip M Robson³, Naoki Hirata³, Samantha Sartori⁴, Navneet Narula⁵, Vittoria Vergani³, Georgios Soultanidis³, Adam Morgenthau⁶, Jason C Kovacic⁷, Maria Padilla⁶, Jagat Narula⁴, Adam Jacobi⁸, Zahi A Fayad⁹, Maria G Trivieri¹⁰

Affiliations

¹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Division of Noninvasive Cardiovascular Imaging at the Icahn School of Medicine at Mount Sinai, New York, USA.
³ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Department of Pathology, New York University Langone Medical Center, New York, New York, USA.
⁶ Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁷ Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia.
⁸ Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁰ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: [email protected].

PMID: 34274283
DOI: 10.1016/j.jcmg.2021.05.023

Abstract

Objectives: This study investigated whether pulmonary artery (PA) ¹⁸F-FDG uptake is associated with hypertension, and if it correlates to elevated pulmonary pressures.

Background: ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with computed tomography or cardiac magnetic resonance (CMR) has been used to assess inflammation mostly in large arteries of the systemic circulation. Much less is known about inflammation of the vasculature of the pulmonary system and its relationship to pulmonary hypertension (PH).

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

Results: Thirty-three subjects demonstrated clear ¹⁸F-FDG uptake in the PA wall. In the subgroup of patients who underwent RHC (n = 10), the mean PA pressure was significantly higher in the group with PA ¹⁸F-FDG uptake compared with the group without uptake (34.4 ± 7.2 mm Hg vs 25.6 ± 9.3 mm Hg; P = 0.003), and 9 (90%) patients with PA ¹⁸F-FDG uptake had PH when a mean PA pressure cutoff of 25 mm Hg was used compared with 18 (45%) in the nonuptake group (P < 0.05). In the subgroup that underwent TTE, signs of PH were present in a significantly higher number of patients with PA ¹⁸F-FDG uptake (14 [51.9%] vs 37 [29.8%]; P < 0.05). Qualitative assessment of ¹⁸F-FDG uptake in the PA wall showed a sensitivity of 33% and specificity of 96% for separating patients with PH based on RHC-derived PA pressures. SUVmax and TBR in the PA wall correlated with PA pressure derived from RHC and/or TTE.

Conclusions: We demonstrate that ¹⁸F-FDG uptake by PET/CMR in the PA is associated with PH and that its intensity correlates with PA pressure.

Keywords: (18)F-FDG; PET/CMR; inflammation; pulmonary artery; pulmonary hypertension.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Fluorodeoxyglucose F18
Humans
Hypertension, Pulmonary* / diagnostic imaging
Hypertension, Pulmonary* / etiology
Magnetic Resonance Spectroscopy
Positron-Emission Tomography
Predictive Value of Tests
Pulmonary Artery
Radiopharmaceuticals
Sarcoidosis* / complications
Sarcoidosis* / diagnostic imaging
Sarcoidosis* / pathology

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18

Grants and funding

KL2 TR001435/TR/NCATS NIH HHS/United States