Myocardial ¹⁸F-FDG Uptake Pattern for Cardiovascular Risk Stratification in Patients Undergoing Oncologic PET/CT

Positron emission tomography/computed tomography with ¹⁸F-fluorodeoxy-glucose (¹⁸F-FDG-PET/CT) has become the standard staging modality in various tumor entities. Cancer patients frequently receive cardio-toxic therapies. However, routine cardiovascular assessment in oncologic patients is not performed in current clinical practice. Accordingly, this study sought to assess whether myocardial ¹⁸F-FDG uptake patterns of patients undergoing oncologic PET/CT can be used for cardiovascular risk stratification.

Myocardial ¹⁸F-FDG uptake pattern was assessed in 302 patients undergoing both oncologic whole-body ¹⁸F-FDG-PET/CT and myocardial perfusion imaging by single-photon emission computed tomography (SPECT-MPI) within a six-month period. Primary outcomes were myocardial ¹⁸F-FDG uptake pattern, impaired myocardial perfusion, ongoing ischemia, myocardial scar, and left ventricular ejection fraction.

Among all patients, 109 (36.1%) displayed no myocardial ¹⁸F-FDG uptake, 77 (25.5%) showed diffuse myocardial ¹⁸F-FDG uptake, 24 (7.9%) showed focal ¹⁸F-FDG uptake, and 92 (30.5%) had a focal on diffuse myocardial ¹⁸F-FDG uptake pattern. In contrast to the other uptake patterns, focal myocardial ¹⁸F-FDG uptake was predominantly observed in patients with myocardial abnormalities (i.e., abnormal perfusion, impaired LVEF, myocardial ischemia, or scar). Accordingly, a multivariate logistic regression identified focal myocardial ¹⁸F-FDG uptake as a strong predictor of abnormal myocardial function/perfusion (odds ratio (OR) 5.32, 95% confidence interval (CI) 1.73-16.34, p = 0.003). Similarly, focal myocardial ¹⁸F-FDG uptake was an independent predictor of ongoing ischemia and myocardial scar (OR 4.17, 95% CI 1.53-11.4, p = 0.005 and OR 3.78, 95% CI 1.47-9.69, p = 0.006, respectively).

Focal myocardial ¹⁸F-FDG uptake seen on oncologic PET/CT indicates a significantly increased risk for multiple myocardial abnormalities. Obtaining and taking this information into account will help to stratify patients according to risk and will reduce unnecessary cardiovascular complications in cancer patients.