Assessment Of Cardiac Sarcoidosis Research Articles

Assessment of Cardiac Sarcoidosis with PET/CT.

18F-FDG PET with CT is an important advanced imaging modality used to assess patients with suspected or known cardiac sarcoidosis (CS). 18F-FDG PET is indicated for CS work-up in patients with extra-CS and abnormal screening results for cardiac involvement, patients under 60 y old presenting with unexplained high-grade atrioventricular heart block, and patients with suspected CS and idiopathic ventricular arrhythmias. In patients with established CS, serial 18F-FDG PET can be used to assess response to immunosuppressive therapy and long-term surveillance for reactivation of myocardial inflammation in patients with low-grade or quiescent disease. Patient preparation before 18F-FDG PET scanning is key in ensuring adequate suppression of physiologic myocardial 18F-FDG uptake, to maximize the power of the test to detect pathology. Inadequate dietary preparation can cause diffuse or focal-on-diffuse 18F-FDG uptake in the absence of active inflammation. It is important to assess resting myocardial perfusion, typically with 82Rb cardiac PET. Several different patterns of abnormalities have been reported in patients with CS, including normal myocardial perfusion with focal or patchy 18F-FDG uptake suggesting myocardial inflammation without scarring; the presence of a myocardial perfusion defect with abnormal 18F-FDG uptake suggesting myocardial scarring with inflammation; and the presence of a myocardial perfusion defect without 18F-FDG uptake indicating myocardial scarring without inflammation. Prognostically, the presence of myocardial perfusion defects and abnormal 18F-FDG uptake has been shown to be an independent predictor of death or ventricular arrythmias. A high myocardial SUVmax in the left and right ventricles has been shown to be an independent predictor of adverse clinical outcomes. Although the diagnostic performance of 18F-FDG PET has been studied, the reference standard for CS tended to rely on clinical criteria, which may be less sensitive than 18F-FDG PET at detecting CS. Therefore, the diagnosis of CS should rely on a multidisciplinary team approach involving multimodality advanced imaging, including echocardiography, cardiovascular MR, and 18F-FDG PET.

Cardiovascular CT, MRI, and PET/CT in 2021: Review of Key Articles.

This review focuses on three key noninvasive cardiac imaging modalities-cardiac CT angiography (CTA), MRI, and PET/CT-and summarizes key publications in 2021 relevant to radiologists in clinical practice. Although this review focuses primarily on articles published in Radiology, important studies from other major journals are included to highlight "must-know" articles in the field of cardiovascular imaging. Cardiac CTA has been established as the first-line test for patients with stable chest pain and no known coronary artery disease, and its value remains central to the assessment of surgical or transcatheter aortic valve replacement. Artificial intelligence continues to evolve in a number of applications in cardiovascular disease. In cardiac MRI studies, 2021 has seen an emphasis on nonischemic cardiomyopathies, valvular heart disease, and COVID-19 disease cardiac manifestations and the authors highlight the key articles on these topics. A section featuring the increasing role of cardiac PET/CT in the assessment of cardiac sarcoidosis and prosthetic valves is also provided.

Nuclear Medicine Image Interpretation Progress in the Assessment of Cardiac Sarcoidosis: July <b>2019</b> ASNC/JSNC Joint Session

Sarcoidosis is a significant disease affecting the heart. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-validated method for identifying significant focal inflammatory sarcoid lesions. The recent progress in image interpretation in nuclear medicine improves the diagnosis and the risk stratification in patients with cardiac sarcoidosis. Especially, metabolic activity, texture analysis, phase analysis, right ventricle assessment, and digital PET/CT are promising methods to assess cardiac sarcoidosis. This review focuses on the latest data analyses and image interpretation used in nuclear medicine to assess cardiac sarcoidosis.

The role of positron emission tomography in the assessment of cardiac sarcoidosis.

The myocardium and the cardiovascular system are often involved in patients with sarcoidosis. As therapy should be started as early as possible to avoid complications such as left ventricular dysfunction, a prompt and reliable diagnosis by means of non-invasive tests would be highly warranted. Among other techniques, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as a high sensitive tool to detect sites of inflammation before morphological changes are visible to conventional imaging techniques. We therefore aim at summarizing the most relevant findings in the literature on the use of 18F-fluorodeoxyglucose PET in the diagnostic workup of cardiac sarcoidosis and to underline future perspectives.

P307Efficacy and adverse effects of strict pretest preparation for 18F-FDG PET/CT for assessment of cardiac sarcoidosis

P307Efficacy and adverse effects of strict pretest preparation for 18F-FDG PET/CT for assessment of cardiac sarcoidosis

Complementary Value of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Assessment of Cardiac Sarcoidosis.

Although cardiac magnetic resonance (CMR) and positron emission tomography (PET) detect different pathological attributes of cardiac sarcoidosis (CS), the complementary value of these tests has not been evaluated. Our objective was to determine the value of combining CMR and PET in assessing the likelihood of CS and guiding patient management. In this retrospective study, we included 107 consecutive patients referred for evaluation of CS by both CMR and PET. Two experienced readers blinded to all clinical data reviewed CMR and PET images and categorized the likelihood of CS as no (<10%), possible (10%-50%), probable (50%-90%), or highly probable(>90%) based on predefined criteria. Patient management after imaging was assessed for all patients and across categories of increasing CS likelihood. A final clinical diagnosis for each patient was assigned based on a subsequent review of all available imaging, clinical, and pathological data. Among 107 patients (age, 55±11 years; left ventricular ejection fraction, 43±16%), 91 (85%) had late gadolinium enhancement, whereas 82 (76%) had abnormal F18-fluorodeoxyglucose uptake on PET, suggesting active inflammation. Among the 91 patients with positive late gadolinium enhancement, 60 (66%) had abnormal F18-fluorodeoxyglucose uptake. When PET data were added to CMR, 48 (45%) patients were reclassified as having a higher or lower likelihood of CS, most of them (80%) being correctly reclassified when compared with the final diagnosis. Changes in immunosuppressive therapies were significantly more likely among patients with highly probable CS. Among patients with suspected CS, combining CMR and PET provides complementary value for estimating the likelihood of CS and guiding patient management.

Optimal Patient Preparation for Detection and Assessment of Cardiac Sarcoidosis by FDG-PET

Optimal Patient Preparation for Detection and Assessment of Cardiac Sarcoidosis by FDG-PET

Late gadolinium enhancement identified with cardiac magnetic resonance imaging in sarcoidosis patients is associated with long-term ventricular arrhythmia and sudden cardiac death

Aims Cardiac involvement with sarcoidosis is a major cause of morbidity and mortality in affected individuals. Cardiac magnetic resonance (CMR) imaging promises a new and more accurate assessment of cardiac sarcoidosis by identifying typical patterns of myocardial fibrosis. We assessed the utility of CMR in the prediction of adverse outcomes. Methods and results One hundred and six CMR patients with biopsy-proven extracardiac and/or presumed cardiac sarcoidosis were enrolled. Late gadolinium enhancement (LGE) on CMR typical of sarcoidosis was used to determine the presence of cardiac involvement. Clinical endpoints and medical records were assessed and those with implantable cardioverter–defibrillators (ICDs) underwent device interrogation. Survival rates of patients with cardiac sarcoidosis were compared with those with only extracardiac disease. CMR identified 32 (30%) individuals as having cardiac sarcoidosis; the remaining 74 (70%) had only extracardiac disease. At a mean follow-up time of 36.8 ± 20.5 months, patients with cardiac sarcoidosis had a higher rate of the composite cardiac endpoint—comprising sudden cardiac death (SCD) and ventricular tachyarrhythmia—compared with those with only extracardiac disease ( P < 0.001). There was a higher rate of SCD or ICD-aborted SCD in patients with cardiac sarcoidosis vs. those without ( P = 0.005). In patients with cardiac sarcoidosis, the rate of SCD was lower in those with an ICD compared with those without ( P < 0.02). Conclusions Patients with evidence of cardiac sarcoidosis on CMR have higher rates of adverse cardiovascular events than those with only extracardiac disease. In patients with sarcoidosis detected on CMR, the presence of an ICD is associated with a lower rate of SCD.

Assessment of cardiac sarcoidosis with advanced imaging modalities.

Sarcoidosis is a chronic systemic disease of unknown etiology that is characterized by the presence of noncaseating epithelioid granulomas, usually in multiple organs. Several studies have shown that sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in genetically susceptible individuals. Cardiac involvement may occur and lead to an adverse outcome: the heart mechanics will be affected and that causes ventricular failure, and the cardiac electrical system will be disrupted and lead to third degree atrioventricular block, malignant ventricular tachycardia, and sudden cardiac death. Thus, early diagnosis and treatment of this potentially devastating disease is critically important. However, sensitive and accurate imaging modalities have not been established. Recent studies have demonstrated the promising potential of cardiac magnetic resonance imaging (MRI) and 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) in the diagnosis and assessment of cardiac sarcoidosis (CS). In this review, we discuss the epidemiology, etiology, histological findings, and clinical features of sarcoidosis. We also introduce advanced imaging including 18F-FDG PET and cardiac MRI as more reliable diagnostic modalities for CS.

Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis

Despite accumulating reports on the clinical value of (18)F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) and magnetic resonance imaging (MRI) in the assessment of cardiac sarcoidosis, no studies have systematically compared the images of these modalities. Twenty-one consecutive patients with suspected cardiac sarcoidosis underwent cardiac examinations that included 18F-FDG PET and MRI. The association of 18F-FDG PET and MRI findings with blood sampling data such as serum angiotensin converting enzyme levels was also evaluated. Eight of 21 patients were diagnosed as having cardiac sarcoidosis according to the Japanese Ministry of Health and Welfare Guidelines for Diagnosing Cardiac Sarcoidosis. Sensitivity and specificity for diagnosing cardiac sarcoidosis were 87.5 and 38.5%, respectively, for 18F-FDG PET, and 75 and 76.9%, respectively, for MRI. When the 18F-FDG PET and MRI images were compared, 16 of 21 patients showed positive findings in one (n = 8) or both (n = 8) of the two modalities. In eight patients with positive findings on both images, the distribution of the findings differed among all eight cases. The presence of positive findings on 18F-FDG PET was associated with elevated serum angiotensin-converting enzyme levels; this association was not demonstrated on MRI. Both 18F-FDG PET and MRI provided high sensitivity for diagnosing cardiac sarcoidosis in patients with suspected cardiac involvement, but the specificity of (18)F-FDG PET was not as high as previously reported. The different distributions of the findings in the two modalities suggest the potential of 18F-FDG PET and MRI in detecting different pathological processes in the heart.