Assessment of cardiac tumors by F-18-FDG PET/CT imaging: Histological correlation and clinical outcomes

Background To evaluate the diagnostic value of F-18-FDG PET/CT in distinguishing benign versus malignant cardiac tumors as well as to assess its prognostic value. Methods We analyzed 38 patients with cardiac tumors who underwent F-18-FDG PET/CT and followed for median 8.5 +/- 12.5 months. SUVmax and TBRmax (maximum tumor-to-background ratio) by receiver-operating characteristic (ROC) curve analysis were used to obtain threshold for the diagnosis of malignancy as defined by histology (n = 38). Survival was assessed and correlated with the dignity of the lesions and PET parameters. Results Optimal cut-off values indicating malignancy were as follows: SUVmax = 3.44, with 100% sensitivity and 92.9% specificity, and TBRmax = 1.55, with 95.8% sensitivity and 92.9% specificity. A significant difference of F-18-FDG uptake was observed between primary benign (n = 14, SUVmax = 2.35 +/- 1.31, TBRmax = 1.05 +/- 0.50) compared to primary malignant cardiac tumors (n = 11, SUVmax = 8.90 +/- 4.23, TBRmax = 3.82 +/- 1.44) as well as cardiac metastases and lymphoma (n = 13, SUVmax = 14.37 +/- 8.05, TBRmax = 6.19 +/- 3.38) (all P < .001). Survival rate was significantly lower in patients with malignant as compared to benign cardiac tumors (P < .05). Regression analysis revealed that the lesion dignity determined by the cut-off value of SUVmax was an independent predictor for death in patients with cardiac tumors (P < .05). Conclusion F-18-FDG uptake in cardiac tumors can differentiate between benign and malignant cardiac tumors and predicts survival.