Keywords
1. Atrial Angiosarcoma
2. PET Imaging
3. Fluorodeoxyglucose F18
4. Cardiac Sarcoma
5. Metastases Detection
The world of oncological imaging is reaching new heights with molecular imaging techniques such as positron emission tomography (PET) becoming cornerstones in the diagnosis and management of various cancers. In a case report published by BMJ Case Reports on May 6, 2019, researchers detail the use of PET tracers in the diagnostic process of a patient with metastatic atrial angiosarcoma, highlighting a significant advancement in the field of nuclear medicine and oncology.
Atrial angiosarcoma is an exceedingly rare form of cancer, with an incidence of only 0.001% to 0.028% in autopsy reports, with approximately 200 cases documented in the scientific literature to date. Such low prevalence underscores the importance of accurate diagnostic techniques, due to the aggressive nature of primary cardiac angiosarcomas, which often carry a dismal prognosis. This is largely due to the challenges in detecting and delineating the true extent of malignant lesions, which is crucial for therapeutic planning and prognostic assessment.
The case report, authored by Kalevi Kairemo and Vivek Subbiah from the University of Texas MD Anderson Cancer Center, involves a middle-aged male presenting with dyspnea and atrial fibrillation. Imaging studies, including echocardiography, revealed a mass in the right atrium, suggestive of a cardiac tumor. In order to establish the diagnosis and evaluate for potential metastasis, the patient underwent a PET scan using a specific radiopharmaceutical, 2-deoxy-2-[18F]fluoro-D-glucose (FDG), commonly known as FDG PET/CT.
The tracer, FDG, is a radioactive glucose analog that is taken up by cells with high metabolic rates, such as cancer cells. This uptake is due to the increased demand for glucose, a phenomenon known as the Warburg effect. By utilizing this principle, FDG PET imaging can highlight areas of intense metabolic activity, corresponding to active malignancy. In the mentioned case, the FDG PET/CT scan provided clear visualization of the primary cardiac tumor and crucially identified distant metastatic lesions that were not initially evident through other imaging modalities.
The incorporation of PET tracers into the diagnostic process is a testament to the importance of molecular imaging’s role in the contemporary management of cancer. Nuclear medicine provides not only structural but also functional information, allowing clinicians to see beyond morphology. This is especially important in cases where conventional imaging falls short.
Using PET tracers for the detection and evaluation of cardiac angiosarcomas has been explored in various studies. For instance, Freudenberg et al. reported the successful diagnosis of a cardiac angiosarcoma using FDG PET, emphasizing its potential in identifying malignant cardiac masses. Similarly, Tan et al. highlighted the use of FDG PET/CT imaging in the diagnosis and follow-up of primary cardiac angiosarcoma, facilitating the assessment of treatment efficacy over time.
Moreover, the potential of PET imaging extends beyond FDG. For example, in oncological therapeutics, 3′-deoxy-3′-[18F]fluorothymidine, or 18F-FLT, has been studied by Kairemo et al. as a possible marker for evaluating early response to targeted therapies. Given the aggressive nature of atrial angiosarcomas, early detection of therapeutic response is vital, contributing greatly to personalized oncology strategies.
The case report, registered under DOI: 10.1136/bcr-2016-218979, is an important addition to the existing body of literature on advanced cardiac imaging. It serves as a resource for healthcare professionals seeking to enhance their understanding of the clinical applications of PET imaging in rare conditions like cardiac angiosarcomas.
For readers interested in further delving into this topic, the following references provide additional insights:
1. Dhull, V. S., Sharma, P., Mukherjee, A., et al. (2015). 18F-FDG PET-CT for evaluation of cardiac angiosarcoma: a case report and review of the literature. (DOI: 10.4274/mirt.02486)
2. Jain, A., Simon, S., Elangovan, I. (2015). (18)F-fluoro-deoxyglucose positron emission tomography-computed tomography in initial assessment và diagnosis of right atrial angiosarcoma with widespread visceral metastases: a rare case report và review of the literature. (DOI: 10.4103/0972-3919.147541)
3. Freudenberg, L. S., Rosenbaum, S. J., Schulte-Herbrüggen, J., et al. (2002). Diagnosis of a cardiac angiosarcoma by fluorine-18 fluordeoxyglucose positron emission tomography. (DOI: 10.1007/s00330-002-1478-z)
4. Hamidi, M., Moody, J. S., Weigel, T. L., et al. (2010). Primary cardiac sarcoma. (DOI: 10.1016/j.athoracsur.2010.03.065)
5. Tan, H., Jiang, L., Gao, Y., et al. (2013). 18F-FDG PET/CT imaging in primary cardiac angiosarcoma: diagnosis và follow-up. (DOI: 10.1097/RLU.0000000000000254)
Alongside the educational value, this case report and its associated references underscore the emergent role of PET tracers in comprehensive cancer care, from diagnosis through to management, and potentially, remission monitoring.
In conclusion, the case of molecular imaging of metastatic atrial angiosarcoma with PET tracer 3′-deoxy-3′[18F]fluorothymidine represents a significant breakthrough in the precise and early detection of this rare and aggressive cancer. The BMJ report is not just a singular clinical narrative but a depiction of the broader strides being made in personalized oncology powered by advanced imaging technologies.