Chest
Volume 107, Issue 2, February 1995, Pages 330-334
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Clinical Investigations: Cardiology
Diagnostic and Prognostic Value of Myocardial Scintigraphy With Thallium-201 and Gallium-67 in Cardiac Sarcoidosis

https://doi.org/10.1378/chest.107.2.330Get rights and content

Study objective

To examine the diagnostic and prognostic value of myocardial scintigraphy using thallium-201 and gallium-67 in cardiac sarcoidosis.

Patients

Twenty-five patients with sarcoidosis.

Methods

All patients underwent myocardial thallium-201 scintigraphy. Six patients with myocardial thallium-201 defects were classified into group A and another 19 without defects were classified into group B. Between group A and B, we compared the results of other noninvasive examinations, including standard 12-lead ECG, 24 h ambulatory ECG, chest radiography, measurements of serum angiotensin-converting enzyme (ACE) and lysozyme levels, and gallium-67 scintigraphy.

Results

Proportions of subjects who had varying degrees of heart block, severe ventricular arrhythmias (more than or equal to third grade of Lown’s classification), and high levels of serum ACE and lysozyme levels were not different between these two groups (p>0.05). Although an enlarged cardiothoracic ratio was more frequent in group A (p<0.05), bilateral hilar lymphadenopathy was more frequent in group B (p<0.01). Four patients of group A and 15 of group B underwent gallium-67 scintigraphy. Although no subjects of group B had myocardial uptake of gallium-67, two of four group A patients showed cardiac uptake. These four group A patients were treated with corticosteroids. The therapy provided clinical and scintigraphic improvement in two patients with myocardial gallium-67 uptake, although it did no improvement in the other two patients without gallium-67 uptake.

Conclusions

When cardiac sarcoidosis was diagnosed according to myocardial thallium-201 defects, other noninvasive examinations were not useful to detect this disease. However, gallium-67 uptake may predict the efficacy of corticosteroids. Thus, the combination of thallium-201 and gallium-67 scintigraphy may be useful not only in diagnosis of cardiac sarcoidosis but also in prediction of effects of corticosteroids.

Section snippets

METHODS

A patient population consisted of 25 patients who underwent thallium-201 scintigraphy in our hospital between 1988 and 1992. Sarcoidosis was diagnosed by pulmonologists in all patients except one whose condition was diagnosed by dermatologists on skin biopsy specimen. All the patients had no history of ischemic heart disease and no evidence of previous myocardial infarction on resting ECG. Myocardial thallium-201 scintigraphy was performed in all patients. After an overnight fast, 111 MBq of

RESULTS

A summary of the clinical findings is presented in Tables 1 and 2. The proportions of the patients with any kind of abnormalities on ECG and ambulatory ECg, and mean levels of serum ACE and lysozyme were not significantly different between two groups (p>0.05). The proportion of the patients with an enlarged CTR on chest radiographs was significantly higher in group A than in group B (p<0.05). Conversely, the proportion of BHL was significantly lower in group A than in group B (p<0.01) (Table 3).

DISCUSSION

In this study, when cardiac involvements of sarcoidosis were diagnosed according to the findings of myocardial thallium-201 scintigraphy, other findings of noninvasive examinations, including BHL, any kind of conduction block, ventricular arrhythmias, and serum ACE and lysozyme levels were not useful for detecting cardiac sarcoidosis. Although the frequency of an enlarged CTR was significantly higher in group A (consisting of patients with myocardial thallium-201 defects), the findings of

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Revision accepted June 8.

Reprint requests: Dr. Okayama, Third Dept. of Internal Medicine, Hamamatsu University, 3600 Handa-Cho, Hamamatsu, 431–31 Japan

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