Fabien Hyafil1, Khadija Benali2,3, Richard Raffoul4, François Rouzet2,3, Nidaa Mikail5,6,7,8, Lisa Males3,9, Lydia Deschamps10, Eric Brochet11, Carsten Ehmer3,9, Ahmed Ben Driss3,9, Loukbi Saker3,9, Alexia Rossi12,13, Soleiman Alkhoder4, Phalla Ou3,9. 1. Department of Nuclear Medicine, DMU IMAGINA, Hopital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France. 2. Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 3. Paris Diderot University, Inserm, 1148, Paris, France. 4. Department of Cardiac Surgery, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 5. Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. nidaa.mikail@aphp.fr. 6. Paris Diderot University, Inserm, 1148, Paris, France. nidaa.mikail@aphp.fr. 7. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. nidaa.mikail@aphp.fr. 8. Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland. nidaa.mikail@aphp.fr. 9. Department of Cardiovascular Imaging, Department of Radiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 10. Department of Pathology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 11. Department of Cardiology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 12. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. 13. Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
Abstract
PURPOSE: Characterization of malignant cardiac masses is usually performed with cardiac magnetic resonance (CMR) and staging with whole-body contrast-enhanced computed tomography (CECT). In this study, our objective was to evaluate the role of 18Fluor-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) with CMR for both characterization and staging of cardiac masses. METHODS: Patients with cardiac masses who underwent CMR, CECT, and 18F-FDG-PET were retrospectively identified. For the characterization of cardiac masses, we calculated the respective performances of CMR alone, 18F-FDG-PET alone, and the combination of 18F-FDG-PET and CMR. For staging, we compared head-to-head the respective performances of 18F-FDG-PET and CECT. Histology served as gold standard for malignancy, and response to anticoagulation for thrombus. RESULTS: In a total of 28 patients (median age 60.5 years, 60.7% women), CMR accurately distinguished malignant from benign masses with sensitivity (Se) of 86.7%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 86.7%, and accuracy of 92.9%. 18F-FDG-PET demonstrated 93.3% Se, 84.6% Sp, 87.5% PPV, 91.7% NPV, and 89.3% accuracy. Combining CMR with 18F-FDG-PET allowed to benefit from the high sensitivity of 18F-FDG-PET (92.9%) and the excellent specificity of CMR (100%) for malignant diseases. For staging, 18F-FDG-PET outperformed CECT on per-patient (66.7% vs 55.6% correct diagnosis, respectively), per-organ (10 vs 7 organs, respectively), and per-lesion basis (> 29 vs > 25 lesions, respectively). CONCLUSION: Combining 18F-FDG-PET with CMR improved the characterization of cardiac masses compared to each modality alone. Additionally, the diagnostic performance of 18F-FDG-PET was better than CECT for staging. This study suggests that the combination of CMR and 18F-FDG-PET is the most effective for the characterization of cardiac masses and the staging of these lesions.
PURPOSE: Characterization of malignant cardiac masses is usually performed with cardiac magnetic resonance (CMR) and staging with whole-body contrast-enhanced computed tomography (CECT). In this study, our objective was to evaluate the role of 18Fluor-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) with CMR for both characterization and staging of cardiac masses. METHODS: Patients with cardiac masses who underwent CMR, CECT, and 18F-FDG-PET were retrospectively identified. For the characterization of cardiac masses, we calculated the respective performances of CMR alone, 18F-FDG-PET alone, and the combination of 18F-FDG-PET and CMR. For staging, we compared head-to-head the respective performances of 18F-FDG-PET and CECT. Histology served as gold standard for malignancy, and response to anticoagulation for thrombus. RESULTS: In a total of 28 patients (median age 60.5 years, 60.7% women), CMR accurately distinguished malignant from benign masses with sensitivity (Se) of 86.7%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 86.7%, and accuracy of 92.9%. 18F-FDG-PET demonstrated 93.3% Se, 84.6% Sp, 87.5% PPV, 91.7% NPV, and 89.3% accuracy. Combining CMR with 18F-FDG-PET allowed to benefit from the high sensitivity of 18F-FDG-PET (92.9%) and the excellent specificity of CMR (100%) for malignant diseases. For staging, 18F-FDG-PET outperformed CECT on per-patient (66.7% vs 55.6% correct diagnosis, respectively), per-organ (10 vs 7 organs, respectively), and per-lesion basis (> 29 vs > 25 lesions, respectively). CONCLUSION: Combining 18F-FDG-PET with CMR improved the characterization of cardiac masses compared to each modality alone. Additionally, the diagnostic performance of 18F-FDG-PET was better than CECT for staging. This study suggests that the combination of CMR and 18F-FDG-PET is the most effective for the characterization of cardiac masses and the staging of these lesions.
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