Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy
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ORIGINAL ARTICLE
Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy Mari Katagiri1 · Tadaki Nakahara1 · Mitsushige Murata2 · Yuji Ogata1 · Yohji Matsusaka1 · Yu Iwabuchi1 · Yoshitake Yamada1 · Keiichi Fukuda2 · Masahiro Jinzaki1
Received: 25 November 2016 / Accepted: 23 March 2017 / Published online: 31 March 2017 © The Japanese Society of Nuclear Medicine 2017
Abstract Purpose Apical wall thickening with an “ace-of-spades” configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET. Methods Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT. Results Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14–15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In * Tadaki Nakahara [email protected] 1
Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
2
Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p 35 mm) and LV strain pattern (ST depression and T-wave inversion in the lateral leads). AHCM was diagnosed when giant negative T wave deeper than 10 mm in V4–V5 was associated with the voltage criteria [3]. After overnight fasting, dipyridamole stress SPECT was performed 15 min after injection of thallium-201 (Tl) chloride (111 MBq) at peak stress, followed by low-dose CT scanning for attenuation correction using SPECT/CT scanner (Discovery NM/CT 670pro, GE Healthcare, Waukesha, Wisconsin). Rest SPECT imaging was performed about 4 h after the tracer injection. SPECT imaging protocol was as follows: projections, 60; rotation, 2 × 180° (360° acquisition); matrix, 128 × 128; and acquisition time, 10–15 min depending on patient’s weight. Reconstructed SPECT images were obtai
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