Positron-Emission Tomography

ABCIC

Editorial

Nuclear Cardiology: From Consolidation to Integration

Introduction

Over the past decade, nuclear cardiology has undergone a profound transformation.^– What was once primarily a diagnostic tool focused on ischemia detection has evolved into a comprehensive platform for physiological understanding, risk stratification, and precision cardiovascular care.^,- In this context, the field has shifted from simply identifying disease to elucidating its underlying mechanisms, echoing Marie Curie’s insight that “nothing in life is to be feared, it is only to be understood.”

The year 2025 did not stand out for isolated disruptive discoveries, but rather for something equally important: clinical consolidation.^,, During this period, previously emerging concepts matured into actionable clinical paradigms, allowing the field to move from promise to practice.^,

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ABCIC

Review Article

Cardiac Sarcoidosis: The Role of Multimodal Imaging

Lara Cristiane Terra Ferreira Carreira et al. Lívia Carreira Adriana Soares Xavier de Brito

ABSTRACT

Cardiac sarcoidosis (CS) is a potentially severe manifestation of systemic sarcoidosis, associated with advanced atrioventricular block, ventricular arrhythmias, heart failure, and sudden death. Diagnosis remains challenging due to phenotypic variability and the limitations of conventional diagnostic methods. Advances in imaging techniques, especially the combination of positron emission tomography/computed tomography (PET/CT) using ¹⁸F-FDG and cardiac magnetic resonance imaging (CMR), have revolutionized the diagnostic approach and therapeutic monitoring of CS. This article reviews current concepts of CS and its diagnosis, with a focus on the role of PET/CT, the importance of appropriate patient preparation, and integration with CMR.

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ABCIC

Editorial

Metformin in Combination with Immune Checkpoint Inhibitors: Myocardial FDG Uptake Can Predict Prognosis?

Claudio Tinoco Mesquita et al. Ana Beatriz Couto Marina Schmid Nunes Fernanda Azevedo Silva

In Brazil, the estimate for 2023-2025 indicates that there will be 704,000 new cancer cases in the country, 221,000 of which will be non-melanoma skin cancers, cited as the most common type. After this type of cancer, breast cancer has the highest incidence, with 74,000 cases, followed by prostate cancer, with 72,000 cases, colorectum cancer, with 46,000 cases, and lung cancer, with 32,000 new cases. The cancer epidemiological profile in Brazil is like countries with a high income; however, it differs when analyzed by region, indicating significant regional inequalities. While in the country’s more developed regions (South and Southeast), the age-adjusted incidence rates range between 180 and 190 cases per 100,000 inhabitants, in less developed regions (North and Northeast), these rates vary from 157 to 164 cases per 100,000 inhabitants. The highest cancer mortality in Brazil is due to lung cancer (13.7% of cancer deaths), followed by colorectum cancer (10.4% of cancer deaths), and then breast cancer (8% of cancer deaths).

Immune checkpoints, like PD-1, PD-L1, and CTLA-4, regulate the immune system and help to equilibrate immune activation and suppression. They act by avoiding a strong immune response that could attack normal cells. Tumor cells can use these mechanisms to elude the immune system, decreasing its response. The mechanisms used for immune system evasion in lung cancer are linked to PD-1 inhibition, which reduces the activity of tumor immunity cells. Additionally, there is a decrease in T-lymphocyte proliferation and cytokine production (IL-2 and IFN-γ), allowing neoplastic cells to proliferate.

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IJCS

Editorial

Myocardial Ischemia and the Emerging Role of Coronary Flow Reserve Quantification

Ana Carolina do Amaral Henrique de Souza

Recent years have seen remarkable advances in nuclear cardiology. The introduction of cardiac positron emission tomography (PET) and the development of cadmium-zinc-telluride (CZT) imaging systems have significantly improved diagnostic accuracy, clinical decision-making, and ultimately outcomes for patients with coronary artery disease (CAD). In this issue, Giubbini and Milan review key concepts related to myocardial ischemia and explore the emerging importance of quantifying coronary flow reserve (CFR) in patients with known or suspected CAD.

PET imaging has become a preeminent modality in the evaluation of ischemic heart disease, providing high diagnostic and prognostic value. PET imaging offers several advantages over other imaging modalities, including low radiation exposure, accurate assessment of left ventricular function and perfusion, and the ability to quantitatively measure myocardial blood flow (MBF) and CFR. CFR is defined as the ratio of exercise MBF to resting MBF and reflects not only obstructive CAD but also diffuse atherosclerosis and microvascular dysfunction (CMD) throughout the coronary system. The ability to measure absolute flow and flow reserve is particularly beneficial in cases of multivessel disease or CMD, complementing traditional perfusion imaging, as both conditions can occur even when perfusion appears normal.

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ABCIC

Case Report

8F-FDG PET/CT in Diagnosis, Therapeutic Evaluation and Definition of Management in Cardiac Sarcoidosis: Learn From This Case Report

Simone Cristina Soares Brandão et al. Matheus de Araújo Lucena Christiane Wiefels Pedro Rodrigues da Silva … Claudio Tinoco Mesquita Maria Fernanda Rezende Fabio Mastrocola

Introduction

Sarcoidosis is a non-caseating granulomatous inflammatory disease of unknown etiology. The presentation can range from an asymptomatic condition with nonspecific findings on chest radiography to organ failure. Any part of the body can be affected, but the most common sites are the mediastinal lymph nodes and the lungs, followed by the skin and ocular structures such as the uvea. Other systems, such as the nervous, endocrine, gastrointestinal, urinary, musculoskeletal, and cardiovascular systems, can also be affected.

Cardiac sarcoidosis is a disease that is still under-researched in cardiology. It is related to cardiomyopathy conditions that can be confused with hypertrophic, infiltrative, or even ischemic cardiomyopathy, and it courses with ventricular arrhythmias and conduction disorders with possible progression to heart failure and/or sudden death. It is worth emphasizing that cardiac sarcoidosis is responsible for up to 35% of cases of complete atrioventricular block (CAVB) in patients under 60 years of age. These patients benefit from the implantation of a pacemaker and implantable cardioverter defibrillator (ICD). Immunosuppressive therapy is indicated to control the inflammatory process.

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ABCIC

Case Report

Primary Cardiac Angiosarcoma Evaluated on PET/CT

Pedro Henrique Rodrigues da Silva et al. Carlos Eduardo Lucena Montenegro Maria Eduarda Duarte de Mello Flamini Mariana Vila Nova de Oliveira Pontual Simone Cristina Soares Brandão

Introduction

Cardiac angiosarcoma is a rare malignant endothelial tumor that is aggressive and has an adverse prognosis.^, It features a high mortality rate because of the tendency for local recurrence and high incidence of systemic metastases. Therefore, its early diagnosis is very important, as is the determination of its local and distant extension, to ensure its proper therapeutic management. The objective of this case report was to show the value of positron emission tomography associated with computed tomography with 18-fluorodeoxyglucose (¹⁸F-FDG PET/CT) in the diagnosis and staging of cardiac angiosarcoma.

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ABC

Editorial

Precision Medicine: Can 18F-FDG PET Detect Cardiotoxicity Phenotypes?

Claudio Tinoco Mesquita et al. Maria Fernanda Rezende

The publication of the article by Dourado et al. in the Arquivos Brasileiros de Cardiologia should be carefully considered by cardiologists engaged in Precision Medicine. In this study, the authors investigated the intensity of 2-deoxy-2[18F] fluoro-D-glucose (18F-FDG) myocardial uptake in 70 patients with lymphoma by positron emission tomography associated with computed tomography (PET/CT) scans before, during and after chemotherapy. They observed a progressive increase in glucose metabolism in the left ventricle from baseline PET/CT to interim PET/CT, and from interim PET/CT to post-therapy PET/CT. More than half of patients showed an increase of ≥ 30% in cardiac 18F-FDG uptake measured by left ventricular SUV max. The authors inferred that PET/CT is a reliable method to assess the intensity of 18F-FDG uptake in patients with lymphoma during and after chemotherapy. More importantly, the authors could identify a group of patients in which the metabolic effects of chemotherapy on the left ventricle were the greatest. These findings can contribute to a strategy for the early identification of patients who are more sensitive to cardiotoxicity of chemotherapeutic agents and for the definition of individualized preventive measures of irreversible myocardial damage.

Precision Medicine is commonly defined as an approach for disease treatment and prevention that takes into account individual variability and disease manifestation for each person. For this purpose, it is fundamental to clarify specific mechanisms of disease and key points for the implementation of effective interventions. This process is known as deep phenotyping, where endotypes, i.e., phenotypes underlying the common phenotype are identified, allowing a more effective guidance of therapeutic approaches.

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ABCIC

Image

Cardiac Imaging for Overlap Connective Tissue Disease Myocarditis

Roberto Muniz Ferreira et al. Hildo da Silva Neto Ana Paula dos Reis Veloso Siciliano Julio Cesar da Silva Borges Blanca Elena Rios Gomes Bica

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ABCIC

Review Article

PET-CT 18F-FDG applications in cardiac tumors

Simone Cristina Soares Brandão et al. Luca Terracini Dompieri

ABSTRACT

Cardiac neoplasms are divided into primary and secondary. Secondary neoplasms are 20 to 40 times more common than the primary ones. Although rare, primary cardiac neoplasms may be benign or malignant. Benign neoplasms are responsible for 75% of the cases. The main objectives of cardiovascular imaging are to define tumor morphology and etiology, identify potential complications and assist in the establishment of treatment. For the diagnosis of cardiac neoplasms, positron emission tomography combined with computed tomography (PET-CT) with fluorodeoxyglucose-F18 (¹⁸F-FDG) is a technique that is still little used, especially in primary cardiac tumors. However, it can help differentiate between malignant and benign tumors, thus preventing cardiac biopsies and unnecessary invasive treatments. For this review, we searched the PubMed database, considering the publications on this topic in the past 10 years. PET-CT ¹⁸F-FDG is a useful test to differentiate benign from malignant heart masses according to the higher degree of glycolytic metabolism found in malignant neoplasms. Moreover, in malignant tumors, PET-CT ¹⁸F-FDG plays a central role in disease staging and may help assess treatment response.

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ABC

Editorial

Infections of Cardiac Implantable Electronic Devices – A Growing, Worrying Reality

Eduardo Arrais Rocha et al. João Lins de Araújo Neto Ricardo Pereira Silva

Infection rates of Cardiac Implantable Electronic Devices (CIEDs) have been increasing, determining the need for a wide debate on the subject. Several reasons can justify the issue, such as: a greater number of devices implanted over the latest years, overaging of the population, new techniques and equipment, with more complex and prolonged procedures.

Maciel and Silva address this topic in a clear, objective manner, bringing an important contribution from the national literature, in a significant case selection, confirming those worrying findings and discussing their impacts, considering the high rates of morbidity and mortality and high costs involved, particularly in the cases of endocarditis and sepsis.

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