Molecular and Genetic Medicine

Value of 18F-FDG Accumulation in Mediastinal and Hilar Lymph Nodes on 18F-FDG PET/CT: Relation to Recurrence of Cardiac Sarcoidosis

Abstract

Maruoka Y, Baba S, Isoda T, Kitamura Y, Nagao M, Ide T, Hiasa K, Sasaki M and Honda H

Purpose: 18F-fluorodeoxyglucose (¹⁸F-FDG) accumulation in the left ventricular (LV) wall detects active myocardial inflammatory lesions in cardiac sarcoidosis (CS), but the significance of ¹⁸F-FDG accumulation in mediastinal and hilar lymph nodes (LNs) remains unclear. We investigated the association between CS recurrence and ¹⁸F-FDG accumulation in the mediastinal and hilar LNs, using positron emission tomography/computed tomography (PET/CT).

Materials and Methods: We retrospectively analyzed the records of 68 patients diagnosed with CS, who underwent ¹⁸F-FDG PET/CT before beginning treatment. The minimum follow-up period was 24 months. Patients were assigned to the recurrence (n=18) or no recurrence group (n=50) based on follow-up examinations. The 18FFDG PET/CT maximum standardized uptake value (SUV_max) was measured in the LV wall, right ventricular (RV) wall, and mediastinal and hilar LNs. The association of CS recurrence was analyzed using Cox proportional hazards models. Recurrence-free survival (RFS) curves were made using the Kaplan-Meier method.

Results: In univariate analysis, sex, BNP, LVEF, and the SUV_max in the LV wall, RV wall, and mediastinal and hilar LNs were significant risk factors for CS recurrence. In multivariate analysis, only the SUV_max in the mediastinal and hilar LNs was a significant risk factor for CS recurrence. RFS rates were significantly higher in patients with an SUV_max<4.1 vs. ≥ 4.1 (log-rank value=36.0, p<0.01).

Conclusion: The mediastinal and hilar LN SUV_max was an independent risk factor for CS recurrence after treatment. ¹⁸F-FDG accumulation in mediastinal and hilar LNs on ¹⁸F-FDG PET before treatment may be a useful biomarker to predict CS recurrence.