Published Online:

PET/CT can be useful for diagnosing inflammatory processes that affect the cardiovascular system, identifying the extent of disease, and monitoring the response to therapy.

Inflammatory disorders of the cardiovascular system can affect the myocardium, pericardium, or vessel walls. Patients with myocardial and pericardial disease may present with chest pain, palpitations, and shortness of breath, symptoms resembling myocardial ischemia or infarction. The manifestations of vasculitis may include fever, weight loss, and fatigue, mimicking infectious or malignant processes. Because of the difficulty of differentiating these disease processes, patients frequently undergo multiple diagnostic examinations before obtaining a final diagnosis of myocarditis, pericarditis, or vasculitis. Computed tomography (CT) and magnetic resonance imaging play important roles in the assessment of structural abnormalities of the cardiovascular system, and combined positron emission tomography (PET) and CT may depict inflammatory processes before structural changes occur. Familiarity with the PET/CT appearances of inflammatory processes in the myocardium, pericardium, and vessels is important for accurate and prompt diagnosis.

© RSNA, 2011


  • 1 Lloyd-Jones D, Adams RJ, Brown TM, et al.. Heart disease and stroke statistics: 2010 update—a report from the American Heart Association [executive summary]. Circulation 2010;121(7):948–954. Crossref, MedlineGoogle Scholar
  • 2 Ben-Haim S, Gacinovic S, Israel O. Cardiovascular infection and inflammation. Semin Nucl Med 2009; 39(2):103–114. Crossref, MedlineGoogle Scholar
  • 3 Hillner BE, Siegel BA, Shields AF, et al.. Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: initial results from the National Oncologic PET Registry. J Clin Oncol 2008;26(13):2155–2161. Crossref, MedlineGoogle Scholar
  • 4 Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. RadioGraphics 2005;25(5):1357–1368. LinkGoogle Scholar
  • 5 Basu S, Chryssikos T, Moghadam-Kia S, Zhuang H, Torigian DA, Alavi A. Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med 2009;39(1): 36–51. Crossref, MedlineGoogle Scholar
  • 6 Balink H, Collins J, Bruyn G, Gemmel F. F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med 2009;34(12):862–868. Crossref, MedlineGoogle Scholar
  • 7 Gropler RJ, Siegel BA, Lee KJ, et al.. Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans. J Nucl Med 1990;31(11):1749–1756. MedlineGoogle Scholar
  • 8 Fukuchi K, Ohta H, Matsumura K, et al.. Benign variations and incidental abnormalities of myocardial FDG uptake in the fasting state as encountered during routine oncology positron emission tomography studies. Br J Radiol 2007;80(949):3–11. Crossref, MedlineGoogle Scholar
  • 9 Cheng VY, Slomka PJ, Ahlen M, Thomson LE, Waxman AD, Berman DS. Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: a randomized controlled trial. J Nucl Cardiol 2010;17(2): 286–291. Crossref, MedlineGoogle Scholar
  • 10 Hunninghake GW, Costabel U, Ando M, et al.. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis 1999;16(2):149–173. MedlineGoogle Scholar
  • 11 Matsui Y, Iwai K, Tachibana T, et al.. Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci 1976;278:455–469. Crossref, MedlineGoogle Scholar
  • 12 Longcope WT, Freiman DG. A study of sarcoidosis: based on a combined investigation of 160 cases including 30 autopsies from The Johns Hopkins Hospital and Massachusetts General Hospital. Medicine (Baltimore) 1952;31(1):1–132. Crossref, MedlineGoogle Scholar
  • 13 Mehta D, Lubitz SA, Frankel Z, et al.. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest 2008;133(6):1426–1435. Crossref, MedlineGoogle Scholar
  • 14 Sköld CM, Larsen FF, Rasmussen E, Pehrsson SK, Eklund AG. Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography. J Intern Med 2002;252(5):465–471. Crossref, MedlineGoogle Scholar
  • 15 Patel MR, Cawley PJ, Heitner JF, et al.. Detection of myocardial damage in patients with sarcoidosis. Circulation 2009;120(20):1969–1977. Crossref, MedlineGoogle Scholar
  • 16 Okumura W, Iwasaki T, Toyama T, et al.. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med 2004;45(12):1989–1998. MedlineGoogle Scholar
  • 17 Koyama T, Ueda H, Togashi K, Umeoka S, Kataoka M, Nagai S. Radiologic manifestations of sarcoidosis in various organs. RadioGraphics 2004;24(1): 87–104. LinkGoogle Scholar
  • 18 Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation 2006;113(6):876–890. Crossref, MedlineGoogle Scholar
  • 19 Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis: experimental and clinical correlates. Circulation 1997;95(1):163–168. Crossref, MedlineGoogle Scholar
  • 20 Goitein O, Matetzky S, Beinart R, et al.. Acute myocarditis: noninvasive evaluation with cardiac MRI and transthoracic echocardiography. AJR Am J Roentgenol 2009;192(1):254–258. Crossref, MedlineGoogle Scholar
  • 21 Laissy JP, Hyafil F, Feldman LJ, et al.. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology 2005;237(1):75–82. LinkGoogle Scholar
  • 22 Takano H, Nakagawa K, Ishio N, et al.. Active myocarditis in a patient with chronic active Epstein-Barr virus infection. Int J Cardiol 2008;130(1):e11–e13. Crossref, MedlineGoogle Scholar
  • 23 Jingu K, Kaneta T, Nemoto K, et al.. The utility of 18F-fluorodeoxyglucose positron emission tomography for early diagnosis of radiation-induced myocardial damage. Int J Radiat Oncol Biol Phys 2006; 66(3):845–851. Crossref, MedlineGoogle Scholar
  • 24 Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst 2010;102(1):14–25. Crossref, MedlineGoogle Scholar
  • 25 Ferrans VJ. Overview of cardiac pathology in relation to anthracycline cardiotoxicity. Cancer Treat Rep 1978;62(6):955–961. MedlineGoogle Scholar
  • 26 Oikawa M, Kagaya Y, Otani H, et al.. Increased [18F]fluorodeoxyglucose accumulation in right ventricular free wall in patients with pulmonary hypertension and the effect of epoprostenol. J Am Coll Cardiol 2005;45(11):1849–1855. Crossref, MedlineGoogle Scholar
  • 27 Israel O, Weiler-Sagie M, Rispler S, et al.. PET/CT quantitation of the effect of patient-related factors on cardiac 18F-FDG uptake. J Nucl Med 2007;48(2):234–239. MedlineGoogle Scholar
  • 28 O'Leary SM, Williams PL, Williams MP, et al.. Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography. Br J Radiol 2010;83(987):194–205. Crossref, MedlineGoogle Scholar
  • 29 Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR imaging of pericardial disease. RadioGraphics 2003;23(Spec No): S167–S180. LinkGoogle Scholar
  • 30 Strobel K, Schuler R, Genoni M. Visualization of pericarditis with fluoro-deoxy-glucose-positron emission tomography/computed tomography. Eur Heart J 2008;29(9):1212. Crossref, MedlineGoogle Scholar
  • 31 Losik SB, Studentsova Y, Margouleff D. Chemotherapy-induced pericarditis on F-18 FDG positron emission tomography scan. Clin Nucl Med 2003;28(11):913–915. Crossref, MedlineGoogle Scholar
  • 32 van den Heuvel DA, van Es HW, Cirkel GA, Bos WJ. Acute chest pain caused by pericardial fat ne-crosis. Thorax 2010;65(2):188. Crossref, MedlineGoogle Scholar
  • 33 Pineda V, Cáceres J, Andreu J, Vilar J, Domingo ML. Epipericardial fat necrosis: radiologic diagnosis and follow-up. AJR Am J Roentgenol 2005;185(5): 1234–1236. Crossref, MedlineGoogle Scholar
  • 34 Fan CM, Fischman AJ, Kwek BH, Abbara S, Aquino SL. Lipomatous hypertrophy of the interatrial septum: increased uptake on FDG PET. AJR Am J Roentgenol 2005;184(1):339–342. Crossref, MedlineGoogle Scholar
  • 35 Brodmann M, Lipp RW, Passath A, et al.. The role of 2-18F-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology 2004;43(2):241–242. Crossref, MedlineGoogle Scholar
  • 36 Chen W, Bural GG, Torigian DA, Rader DJ, Alavi A. Emerging role of FDG-PET/CT in assessing atherosclerosis in large arteries. Eur J Nucl Med Mol Imaging 2009;36(1):144–151. Crossref, MedlineGoogle Scholar
  • 37 Wassélius JA, Larsson SA, Jacobsson H. FDG-accumulating atherosclerotic plaques identified with 18F-FDG-PET/CT in 141 patients. Mol Imaging Biol 2009;11(6):455–459. Crossref, MedlineGoogle Scholar
  • 38 Rogers IS, Nasir K, Figueroa AL, et al.. Feasibility of FDG imaging of the coronary arteries: comparison between acute coronary syndrome and stable angina. JACC Cardiovasc Imaging 2010;3(4): 388–397. Crossref, MedlineGoogle Scholar
  • 39 Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, et al.. Takayasu's arteritis: clinical study of 107 cases. Am Heart J 1977;93(1):94–103. Crossref, MedlineGoogle Scholar
  • 40 Arend WP, Michel BA, Bloch DA, et al.. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33(8):1129–1134. Crossref, MedlineGoogle Scholar
  • 41 Koide K. Takayasu arteritis in Japan. Heart Vessels Suppl 1992;7:48–54. Crossref, MedlineGoogle Scholar
  • 42 Nordborg E. Epidemiology of biopsy-positive giant cell arteritis: an overview. Clin Exp Rheumatol 2000;18(4 Suppl. 20):S15–S17. MedlineGoogle Scholar
  • 43 Hoffman GS. Giant cell arteritis: biopsy may not be diagnostic. Cleve Clin J Med 1998;65(4):218. Crossref, MedlineGoogle Scholar
  • 44 Gotway MB, Araoz PA, Macedo TA, et al.. Imaging findings in Takayasu's arteritis. AJR Am J Roentgenol 2005;184(6):1945–1950. Crossref, MedlineGoogle Scholar
  • 45 Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. Neth J Med 2003;61(10):323–329. MedlineGoogle Scholar
  • 46 Webb M, Chambers A, Al-Nahhas A, et al.. The role of F-18-FDG-PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging 2004;31(5):627–634. Crossref, MedlineGoogle Scholar
  • 47 Kobayashi Y, Ishii K, Oda K, et al.. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med 2005;46(6):917–922. MedlineGoogle Scholar
  • 48 Meller J, Vosshenrich R, Grabbe E, Becker W. Value of F-18-FDG-hybrid camera PET and MRI in early Takayasu aortitis. Eur Radiol 2003;13(2):400–405. Crossref, MedlineGoogle Scholar

Article History

Received: Oct 21 2010
Revision requested: Jan 7 2011
Revision received: Mar 29 2011
Accepted: Apr 29 2011
Published online: Sept 6 2011
Published in print: Sept 2011