Variability in myocardial metabolism on serial tumor (18)F-FDG PET/CT scans

(18)F Fluorodeoxyglucose (FDG) positron emission tomography (PET) scans are performed routinely for oncologic patients. Myocardial uptake can vary among patients and between serial studies in the same patient. Our study aims to evaluate myocardial metabolism on staging FDG PET scans and to analyze factors influencing patterns of cardiac uptake, and their relevance. We analyzed retrospectively 100 PET-CT scans from 20 fasting lymphoma patients. Distribution of myocardial uptake was determined by visual assessment and the maximum standardized uptake value (SUVm) was calculated. Multiple variables were analyzed including: fasting length, cardiovascular risk factors, SUVm, and location of uptake. We found no correlation between fasting hours and cardiac uptake (p-value: 0.4786). There was a trend that showed less uptake in patients scanned in the afternoon versus the morning, although this was not statistically significant. The location of maximum uptake was unexpectedly variable in several patients and could not be ascertained to a specific cause. Interestingly, we found no correlation between cardiac risk factors and the amount of myocardial uptake. Myocardial FDG uptake is spatially and temporally heterogeneous. Differences in myocardial wall pattern and peak uptake exist and may not be explained by the length of fasting, gender, age or cardiac risk factors. This variability may occur in daily cardiac evaluations and affect interpretations of sarcoidosis and viability studies and should be further explored. A larger cohort study is necessary to confirm that our findings do not confer a higher cardiac risk profile to the cancer patient.