Advancing cardiac tumor diagnosis: evaluating 18F-FDG PET/CT against traditional imaging methods

Abstract

Background: Cardiac tumors are rare but clinically significant lesions requiring prompt and accurate diagnosis. While echocardiography remains the first-line imaging modality, it is limited by its inability to characterize tissue. Cardiovascular magnetic resonance imaging (CMR) and cardiac computed tomography (CT) offer superior anatomical detail but cannot reliably differentiate benign from malignant tumors. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) provides metabolic information that may overcome these limitations. Methods: A systematic scoping review was conducted following a structured literature search covering January 2019 to September 2025. After screening 192 articles and applying predefined inclusion and exclusion criteria, 7 retrospective studies enrolling a total of 381 adult patients with newly diagnosed cardiac masses who underwent 18F-FDG PET/CT were included. Results: Across all included studies, 18F-FDG PET/CT demonstrated high diagnostic accuracy in differentiating benign from malignant cardiac and pericardial masses. Key quantitative metabolic parameters consistently outperformed traditional imaging modalities. Reported sensitivity and specificity ranged from 92-100 and 88-93, respectively. In one study, 18F-FDG PET/CT achieved a 100 decision-making rate and the highest area under the curve (AUC) of 0.94 compared to transthoracic echocardiography, CT, and CMR. SUVmax also emerged as an independent predictor of survival. Conclusion: 18F-FDG PET/CT plays a significant diagnostic and prognostic role in evaluating cardiac tumors, offering metabolic insights that complement conventional anatomical imaging. It should be incorporated as a key adjunct in the multimodality work-up of suspected cardiac masses, particularly when malignancy is suspected or biopsy is not feasible.