Additional Value of Cardiac Assessment With Oncologic ¹⁸F-FDG PET/CT in Pre-Treatment Tumor Patients

To study the occurrence, site, reasons, metabolism, and texture features of unusual heart absorption in cancer patients undergoing their first Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) full-body scan.

A total of 2159 patients who underwent their first ¹⁸F-FDG PET/CT full-body scan and received hospital care between July 2017 and December 2022 were included. Of these, 1611 were diagnosed with tumors, and 548 were non-tumor cases, based on clinical, pathological, and PET/CT evaluations. Abnormal uptake was categorized as a "known cause" when supported by clinical evidence of the associated origin and as an "unknown cause" when evidence was insufficient. We compared metabolic parameters and texture features between groups and constructed receiver operating characteristic (ROC) curves.

Among the patients studied, 118 with tumors exhibited abnormal cardiac uptake patterns, while 14 non-tumor patients showed similar abnormalities. The occurrence of abnormal cardiac uptake without a known cause among cases of abnormal cardiac uptake was higher in tumor patients than in non-tumor patients (62.71% vs. 35.71%; p > 0.05). Within the tumor group, the high-tumor-burden subset had a significantly higher proportion of unexplained abnormal cardiac uptake than the low-tumor-burden subset (72.9% vs. 52.5%; p < 0.05). ROC curve analysis revealed that a combined assessment of selected metabolic parameters and texture features yielded an area under the curve (AUC) of 0.809 (0.732, 0.886), sensitivity of 77.3%, and specificity of 71.6%.

Unusual cardiac uptake observed in tumor patients during ¹⁸F-FDG PET/CT scans could be linked to existing heart conditions and the extent of the tumor. Metabolic parameters and texture characteristics provide valuable insights into the underlying causes.