Dataset Information

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via ¹⁸F-FDG PET: a case report.

ABSTRACT:

Background

Although methotrexate has been widely used as a second-line therapy for cardiac sarcoidosis (CS), it is not clear if it has a direct anti-inflammatory effect.

Case summary

A 65-year-old man presented to our hospital with symptomatic ventricular tachycardia (VT). After cardioversion, electrocardiography showed a first-degree atrioventricular block with a right bundle branch block, and transthoracic echocardiography revealed left ventricular dilatation. After extensive investigations, including fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET), the patient was diagnosed with CS according to the Japanese Circulation Society guidelines. After the implantation of a transvenous implantable cardioverter defibrillator, corticosteroid therapy was introduced at a starting dose of 30 mg/day. After corticosteroid therapy was tapered to a maintenance dose of 10 mg/day, he had an uneventful clinical course without symptoms for the 1st year after hospital discharge. However, symptomatic VT recurred and ¹⁸F-FDG PET showed abnormal patterns of cardiac FDG uptake. Although he was treated with corticosteroid therapy once more, which was gradually up-titrated to a dose of 20 mg/day over a 1-month period, myocardial uptake of ¹⁸F-FDG PET remained unchanged. As the patient was considered steroid refractory, second-line treatment with 6 mg/week of methotrexate was introduced, whereas maintaining the dose of corticosteroid therapy at 20 mg/day. After 1 month, ¹⁸F-FDG PET showed remarkable reduction in FDG uptake, and the patient had a good clinical course without further episodes of arrhythmia or other symptoms during an 8-month follow-up.

Discussion

Methotrexate may have a direct anti-inflammatory effect in patients with CS refractory to regular corticosteroid therapy.

SUBMITTER: Dotare T

PROVIDER: S-EPMC9195226 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via <sup>18</sup>F-FDG PET: a case report.

Dotare Taishi T Maeda Daichi D Matsue Yuya Y Minamino Tohru T

European heart journal. Case reports 20220531 6

<h4>Background</h4>Although methotrexate has been widely used as a second-line therapy for cardiac sarcoidosis (CS), it is not clear if it has a direct anti-inflammatory effect.<h4>Case summary</h4>A 65-year-old man presented to our hospital with symptomatic ventricular tachycardia (VT). After cardioversion, electrocardiography showed a first-degree atrioventricular block with a right bundle branch block, and transthoracic echocardiography revealed left ventricular dilatation. After extensive in ...[more]

PMID: 35712221

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Project description:Background18F-Fluorodeoxyglucose (FDG) PET/CT is emerging as a tool in the diagnosis and evaluation of pulmonary sarcoidosis, however, there is limited consensus regarding its diagnostic performance and prognostic value.MethodA meta-analysis was conducted with PubMed, Science Direct, MEDLINE, Scopus, and CENTRAL databases searched up to and including September 2023. 1355 studies were screened, with seventeen (n = 708 patients) suitable based on their assessment of the diagnostic performance or prognostic value of FDG-PET/CT. Study quality was assessed using the QUADAS-2 tool. Forest plots of pooled sensitivity and specificity were generated to assess diagnostic performance. Pooled changes in SUVmax were correlated with changes in pulmonary function tests (PFT).ResultsFDG-PET/CT in diagnosing suspected pulmonary sarcoidosis (six studies, n = 400) had a pooled sensitivity of 0.971 (95%CI 0.909-1.000, p = < 0.001) and specificity of 0.873 (95%CI 0.845-0.920)(one study, n = 169). Eleven studies for prognostic analysis (n = 308) indicated a pooled reduction in pulmonary SUVmax of 4.538 (95%CI 5.653-3.453, p = < 0.001) post-treatment. PFTs displayed improvement post-treatment with a percentage increase in predicted forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO) of 7.346% (95%CI 2.257-12.436, p = 0.005) and 3.464% (95%CI -0.205-7.132, p = 0.064), respectively. Reduction in SUVmax correlated significantly with FVC (r = 0.644, p < 0.001) and DLCO (r = 0.582, p < 0.001) improvement.ConclusionIn cases of suspected pulmonary sarcoidosis, FDG-PET/CT demonstrated good diagnostic performance and correlated with functional health scores. FDG-PET/CT may help to guide immunosuppression in cases of complex sarcoidosis or where treatment rationalisation is needed.Clinical relevance statementFDG-PET/CT has demonstrated a high diagnostic performance in the evaluation of suspected pulmonary sarcoidosis with radiologically assessed disease activity correlating strongly with clinically derived pulmonary function tests.Key pointsIn diagnosing pulmonary sarcoidosis, FDG-PET/CT had a sensitivity and specificity of 0.971 and 0.873, respectively. Disease activity, as determined by SUVmax, reduced following treatment in all the included studies. Reduction in SUVmax correlated with an improvement in functional vital capacity, Diffusion Capacity of the Lungs for Carbon Monoxide, and subjective health scoring systems.

Project description:Knowledge of the within-subject variability of 18F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test-retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUVmax, the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%-12.8%) than PET/MRI (6.6%-8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUVpeak, the wCVs appeared similar for PET/CT (9.9%-11.5%) and PET/MRI (9.2%-11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADCmedian of 3.5% appeared lower than the wCVs for SUVmax (6.6%-8.7%) and SULpeak (9.2%-11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18F-FDG PET/MRI is both acceptably high and similar to previously published values for 18F-FDG PET/CT and MRI, supporting the use of 18F-FDG PET/MRI for quantitative oncologic treatment response assessments.

Project description:PurposeTumor voxel dose-response matrix (DRM) can be quantified using feedback from serial FDG-PET/CT imaging acquired during radiotherapy. This study investigated the dynamic characteristics and the predictive capability of DRM.MethodsFDG-PET/CT images were acquired before and weekly during standard chemoradiotherapy with the treatment dose 2 Gy × 35 from 31 head and neck cancer patients. For each patient, deformable image registration was performed between the pretreatment/baseline PET/CT image and each weekly PET/CT image. Tumor voxel DRM was derived using linear regression on the logarithm of the weekly standard uptake value (SUV) ratios for each tumor voxel, such as SUV measured at a dose level normalized to the baseline SUV0. The dynamic characteristics were evaluated by comparing the DRMi estimated using a single feedback image acquired at the ith treatment week (i = 1, 2, 3, or 4) to the DRM estimated using the last feedback image for each patient. The predictive capability of the DRM estimated using 1 or 2 feedback images was evaluated using the receiver operating characteristic test with respect to the treatment outcome of tumor local-regional control or failure.ResultsThe mean ± SD of tumor voxel SUV measured at the pretreatment and the 1st, 2nd, 3rd, 4th, and last treatment weeks was 6.76 ± 3.69, 5.72 ± 3.43, 3.85 ± 2.22, 3.27 ± 2.25, 2.5 ± 1.79, and 2.23 ± 1.27, respectively. The deviations between the DRMi estimated using the single feedback image obtained at the ith week and the last feedback image were 0.86 ± 4.87, -0.06 ± 0.3, -0.09 ± 0.17, and -0.09 ± 0.12 for DRM1, DRM2, DRM3, and DRM4, respectively. The predictive capability of DRM3 and DRM4 was significant (p < 0.001). The area under the curve (AUC) was increased with the increase in treatment dose level. The DRMs constructed using the single feedback image achieved an AUC of 0.86~1. The AUC was slightly improved to 0.94~1 for the DRMs estimated using 2 feedback images.ConclusionTumor voxel metabolic activity measured using FDG-PET/CT fluctuated noticeably during the first 2 treatment weeks and obtained a stabilized reduction rate thereafter. Tumor voxel DRM constructed using a single FDG-PET/CT feedback image after the 2nd treatment week (>20 Gy) has a good predictive capability. The predictive capability improved continuously using a later feedback image and marginally improved when two feedback images were applied.

Project description:Knowledge of the intrinsic variability of radiomic features is essential to the proper interpretation of changes in these features over time. The primary aim of this study was to assess the test-retest repeatability of radiomic features extracted from 18F-FDG PET images of cervical tumors. The impact of different image preprocessing methods was also explored. Methods: Patients with cervical cancer underwent baseline and repeat 18F-FDG PET/CT imaging within 7 d. PET images were reconstructed using 2 methods: ordered-subset expectation maximization (PETOSEM) or ordered-subset expectation maximization with point-spread function (PETPSF). Tumors were segmented to produce whole-tumor volumes of interest (VOIWT) and 40% isocontours (VOI40). Voxels were either left at the default size or resampled to 3-mm isotropic voxels. SUV was discretized to a fixed number of bins (32, 64, or 128). Radiomic features were extracted from both VOIs, and repeatability was then assessed using the Lin concordance correlation coefficient (CCC). Results: Eleven patients were enrolled and completed the test-retest PET/CT imaging protocol. Shape, neighborhood gray-level difference matrix, and gray-level cooccurrence matrix features were repeatable, with a mean CCC value of 0.81. Radiomic features extracted from PETOSEM images showed significantly better repeatability than features extracted from PETPSF images (P < 0.001). Radiomic features extracted from VOI40 were more repeatable than features extracted from VOIWT (P < 0.001). For most features (78.4%), a change in bin number or voxel size resulted in less than a 10% change in feature value. All gray-level emphasis and gray-level run emphasis features showed poor repeatability (CCC values < 0.52) when extracted from VOIWT but were highly repeatable (mean CCC values > 0.96) when extracted from VOI40 Conclusion: Shape, gray-level cooccurrence matrix, and neighborhood gray-level difference matrix radiomic features were consistently repeatable, whereas gray-level run length matrix and gray-level zone length matrix features were highly variable. Radiomic features extracted from VOI40 were more repeatable than features extracted from VOIWT Changes in voxel size or SUV discretization parameters typically resulted in relatively small differences in feature value, though several features were highly sensitive to these changes.

Dataset Information

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via ¹⁸F-FDG PET: a case report.

Background

Case summary

Discussion

Publications

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via <sup>18</sup>F-FDG PET: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via 18F-FDG PET: a case report.

Background

Case summary

Discussion

Publications

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via <sup>18</sup>F-FDG PET: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Effectiveness of methotrexate as a second-line treatment for cardiac sarcoidosis assessed via ¹⁸F-FDG PET: a case report.