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18F-FDG PET/CT in Differentiating Acute Tuberculous From Idiopathic Pericarditis: Preliminary Study

Dong, Aisheng MD*; Dong, Hui MD; Wang, Yang MSc; Cheng, Chao MD*; Zuo, Changjing MD*; Lu, Jianping MD§

doi: 10.1097/RLU.0b013e31827a2537
Original Articles

Purpose: The aim of this study was to evaluate retrospectively the diagnostic capability of 18F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis.

Methods: FDG PET/CT findings were reviewed in 15 patients with acute tuberculous (n = 5) or idiopathic pericarditis (n = 10). The maximal thickness and SUVmax of the pericardium and the number, size, and SUVmax of the mediastinal and supraclavicular lymph nodes with increased FDG uptake were measured.

Results: All patients had small-to-large amount of pericardial effusion. The patients with acute tuberculous pericarditis (n = 5) showed diffuse (n = 3) or multifocal (n = 2) FDG uptake in the pericardia. The patients with acute idiopathic pericarditis (n = 10) showed diffuse (n = 6) or regional (n = 4) FDG uptake in the pericardia. The mean (SD) pericardial thickness and SUVmax of acute tuberculous pericarditis were significantly higher than those of acute idiopathic pericarditis (5.1 [1.0] vs 3.4 [0.9], P < 0.05; 13.5 [3.9] vs 3.0 [0.7], P < 0.05, respectively). A total of 69 mediastinal and supraclavicular lymph nodes with increased FDG uptake were observed in all 15 patients (44 in patients with acute tuberculous pericarditis and 25 in patients with acute idiopathic pericarditis). The mean (SD) SUVmax of mediastinal and supraclavicular lymph nodes of acute tuberculous pericarditis (5.3 [1.8]) was significantly higher than that of acute idiopathic pericarditis (2.8 [0.6], P < 0.05). There was no significant difference in the mean size of the mediastinal and supraclavicular lymph nodes between acute tuberculous and idiopathic pericarditis.

Conclusions: The degrees of FDG uptake in the pericardium and the mediastinal and supraclavicular lymph nodes are useful for differentiating acute tuberculous from idiopathic pericarditis. Familiarity with the FDG uptake patterns of acute tuberculous and idiopathic pericarditis may be helpful for successful (especially timely) diagnosis and treatment.

From the *Department of Nuclear Medicine, Changhai Hospital; †Department of Pathology, Eastern Hepatobiliary Surgery Hospital; Departments of ‡Pathology and §Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.

Received for publication July 6, 2012; revision accepted October 15, 2012.

Drs Aisheng Dong and Hui Dong contributed equally to the article.

Conflicts of interest and sources of funding: Aisheng Dong was sponsored by Young Scholar Grant from National Natural Science Foundation of China (81000601).

Reprints: Changjing Zuo, MD, Department of Nuclear Medicine, Changhai Hospital, 168 Changhai Rd, Yangpu District, Shanghai 200433, China. E-mail: dongaisheng@gmail.com; Jianping Lu, MD, Department of Radiology, Changhai Hospital, 168 Changhai Rd, Yangpu District, Shanghai 200433, China. E-mail: cjr.lujianping@vip.163.com.

© 2013 by Lippincott Williams & Wilkins