Determination of optimum periods between onset of suspected acute myocarditis and ¹⁸F-fluorodeoxyglucose positron emission tomography in the diagnosis of inflammatory left ventricular myocardium.
OBJECTIVE
To determine optimum periods for (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) examination in subjects with suspected acute myocarditis, we compared (18)F-FDG PET with endomyocardial biopsy (EMB) using the latest definition of (18)F-FDG PET for inflammatory left ventricular (LV) myocardium.


METHODS
Retrospective analysis of 29 subjects (18 male, 48 ± 18 years) who have symptoms or LV dysfunction underwent both (18)F-FDG PET (Advance NXi, GE-Healthcare) under fasting conditions and EMB from LV posterior wall within 3 months.


RESULTS
When we defined (18)F-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 (18)F-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 (18)F-FDG PET for detecting inflammatory LV posterior wall demonstrated 17 days 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 (18)F-FDG PET for detecting inflammatory LV posterior wall on EMB were all 100% when (18)F-FDG PET was performed at 1-14 days after onset of suspected acute myocarditis.


CONCLUSIONS
In our definition, (18)F-FDG PET showed excellent agreement with EMB for detecting active inflammatory LV posterior wall in subjects with clinically suspected active acute myocarditis. If possible, (18)F-FDG PET should be performed within 14 days after the onset to maintain high diagnostic accuracy compared with EMB.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Koya
K
Ozawa
Nobusada
N
Funabashi
Michiko
M
Daimon
Hiroyuki
H
Takaoka
Hiroyuki
H
Takano
Masae
M
Uehara
Yoshio
Y
Kobayashi
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors
D019788:Fluorodeoxyglucose F18
(18)F-fluorodeoxyglucose positron emission tomography; Acute myocarditis; Inflammatory left ventricular myocardium; Optimum periods