Nuclear Cardiology BulletCardiomyopathy of uncertain etiology: Complementary role of multimodality imaging with cardiac MRI and 18FDG PET
Section snippets
Discussion
A minority of patients with systemic sarcoidosis have clinical symptoms of cardiac infiltration (5%) although up to half of autopsies performed on patients with systemic sarcoidosis show cardiac involvement.1 Early diagnosis of cardiac infiltration is critical as a significant proportion of deaths in patients with systemic sarcoidosis can be attributed to arrhythmias secondary to cardiac infiltration and attendant scar formation.1,2 Current diagnostic criteria are based on guidelines from
Role of cardiac MRI
The contribution of CMR for tissue characterization in the assessment of cardiomyopathy and specifically in the evaluation of patients with suspected or known sarcoidosis is now well recognized. Patel et al in a study of 58 patients showed that CMR detected cardiac involvement in twice as many patients than ECG or echocardiography.5 CMR may detect disease earlier than the conventional diagnostic approaches,6 and has the possible advantage of directing biopsy to focal areas of infiltration.
Role of 18FDG PET
Traditional nuclear medicine techniques used to evaluate for cardiac involvement in with sarcoidosis include 201Thallium or 99mTc-labeled tracers and SPECT. However, a regional perfusion defect is not specific and can be seen in ischemic cardiomyopathy. Although included in the diagnostic criteria for cardiac involvement with sarcoidosis,867Ga scintigraphy has low sensitivity and specificity for the detection of cardiac sarcoidosis.
Fasting 18FDG PET has been shown to be a useful technique in
Complementary roles of 18FDG PET and CMRI
Using current diagnostic criteria the diagnosis of sarcoidosis would have been missed. In the management of this patient, CMR and 18FDG PET demonstrated their inherent individual and complementary strengths: the anatomic diagnosis permitted by CMR and the ability of 18FDG PET to demonstrate inflammatory activity in the myocardium and serve as a marker to monitor therapeutic response.9
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Cited by (9)
The logic and challenges of imaging sarcoidosis with whole body FDG PET
2019, Journal of Nuclear CardiologyUse of multimodality imaging to diagnose cardiac sarcoidosis as well as identify recurrence following heart transplantation
2013, Journal of Nuclear CardiologyIndications for permanent cardiac pacing
2020, Cardiac Pacing and ICDsEvaluation of Known or Suspected Cardiac Sarcoidosis
2016, Circulation: Cardiovascular ImagingIndications for Permanent and Temporary Cardiac Pacing
2014, Cardiac Pacing and ICDs: 6th Edition