AI-enabled CT-guided end-to-end quantification of total cardiac activity in 18FDG cardiac PET/CT for detection of cardiac sarcoidosis.

Abstract

Background: [18F]-fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) plays a central role in diagnosing and managing cardiac sarcoidosis. We propose a fully automated pipeline for quantification of [18F]FDG PET activity using deep learning (DL) segmentation of cardiac chambers on computed tomography (CT) attenuation maps and evaluate quantitative approaches based on this framework.

Methods: We included consecutive patients undergoing [18F]FDG PET/CT for suspected cardiac sarcoidosis. DL segmented left atrium, left ventricle (LV), right atrium, right ventricle, aorta, LV myocardium, and lungs from CT attenuation scans. CT-defined anatomical regions were applied to [18F]FDG PET images automatically to target to background ratio (TBR), volume of inflammation (VOI) and cardiometabolic activity (CMA) using full sized and shrunk segmentations.

Results: A total of 69 patients were included, with mean age of 56.1 ± 13.4 and cardiac sarcoidosis present in 29 (42%). CMA had highest prediction performance (area under the receiver operating characteristic curve [AUC] 0.919, 95% confidence interval [CI] 0.858 - 0.980) followed by VOI (AUC 0.903, 95% CI 0.834 - 0.971), TBR (AUC 0.891, 95% CI 0.819 - 0.964), and maximum standardized uptake value (AUC 0.812, 95% CI 0.701 - 0.923). Abnormal CMA (≥1) had a sensitivity of 100% and specificity 65% for cardiac sarcoidosis. Lung quantification was able to identify patients with pulmonary abnormalities.

Conclusion: We demonstrate that fully automated volumetric quantification of [18F]FDG PET for cardiac sarcoidosis based on CT attenuation map-derived volumetry is feasible, rapid, and has high prediction performance. This approach provides objective measurements of cardiac inflammation with consistent definition of myocardium and background region.

Condensed abstract: We developed a fully automated pipeline for [18F]-fluorodeoxyglucose ([18F]FDG) PET quantification in patients with suspected cardiac sarcoidosis. A previously validated deep learning model segmented cardiac chambers from computed tomography, followed by quantification of target to background ratio, volume of inflammation and cardiometabolic activity (CMA). A total of 69 patients were included, with cardiac sarcoidosis present in 29 (42%). CMA had highest area under the receiver operating characteristic curve (0.919, 95% confidence interval 0.858 - 0.980). Fully automated volumetric quantification of [18F]FDG PET is feasible and has high prediction performance for cardiac sarcoidosis.