Combined PET/CT with thoracic contrast-enhanced CT in assessment of primary cardiac tumors in adult patients

BACKGROUND: (18)F-FDG PET/CT is a key molecular imaging modality to noninvasively assess and differentiate benign and malignant cardiac tumors. However, few benign cardiac tumors can be characterized by increased (18)F-FDG uptake, which makes differential diagnosis difficult. This study sought to retrospectively evaluate whether combined (18)F-FDG PET/CT with thoracic contrast-enhanced CT (CECT) helps in assessing primary cardiac tumors in adult patients, compared with CECT or PET/CT alone. METHODS: Forty-six consecutive patients who were diagnosed as primary cardiac tumors were enrolled. All patients underwent (18)F-FDG PET/CT followed by thoracic CECT before biopsy or surgery. Visual qualitative interpretation and quantitative analysis were performed, and diagnostic performance was evaluated. RESULTS: More than half (16/29) of benign tumors exhibited with mild (18)F-FDG uptake. There were significant differences in (18)F-FDG uptake and the degree of absolute enhancement between benign and malignant tumors (P < 0.001). The combination of two modalities improved the specificity from 79 to 93%, the positive predictive value from 73 to 89%, and the accuracy of diagnosis from 85 to 93%. There were significant differences between PET/CT alone or thoracic CECT alone and combined modalities (P = 0.034 and P = 0.026, respectively). The combination with the optimal SUVmax cutoff value generated 94% sensitivity, 100% specificity, 97% negative predictive values, 100% positive predictive values, and 98% accuracy rates. CONCLUSIONS: Combining (18)F-FDG PET/C with thoracic CECT significantly improved specificity and accuracy compared to CECT or PET/CT alone in detecting tumors. This combination of diagnostic imaging is effective in differentiating malignant from benign masses.