Diagnosis and Detection of Myocardial Injury in Active Cardiac Sarcoidosis　– Significance of Myocardial Fatty Acid Metabolism and Myocardial Perfusion Mismatch –

Abstract

Background: Myocardial injury can be detected more sensitively using 123 I-radioiodinated 15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) than thallium-201 (TL). The present study investigated whether 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) uptake as an index of active inflammation in patients with cardiac sarcoidosis (CS) is associated with BMIPP and TL findings, and whether dual single-photon emission computed tomography (SPECT) can facilitate diagnosis of CS. Methods and Results:We retrospectively enrolled 52 consecutive patients with suspected CS who were assessed on FDG-PET/computed tomography (CT) and BMIPP/TL dual SPECT. The SPECT images were divided into 17 segments and then BMIPP and TL total defect scores (BMDS, TLDS) as well as mismatch scores (BMDS-TLDS: sumMS) were calculated. Maximum standardized uptake value (SUVmax) in the entire myocardium was obtained from FDG-PET/CT. SUVmax was much higher in patients with, than without CS (P<0.0001). BMDS was higher and sumMS much higher in CS (P<0.05 and P<0.0001, respectively). The sensitivity and specificity of sumMS to detect CS were 74% and 80%, respectively. SUVmax was not associated with either BMDS or sumMS in the patients with CS. On multivariate analysis, the combination of sumMS and SUVmax had greater prognostic significance compared with each parameter on its own. equipped with low-energy general-purpose collimators. Data were acquired over 180° in 32 steps of 50 s each in a 64×64 matrix with electrocardiographic gating of 8 frames per cardiac cycle. The TL and BMIPP data were obtained using symmetrical 72±10-and 159±10-keV windows, respectively, to separate the distribution of the isotopes. 18 Conclusions CMRPatients without the relevant contraindication underwent CMR. Cardiac MR images were acquired on either Intera Achieva 1.5T (Phillips) or Ingenia 3.0T (Phillips) with a cardiac-dedicated phased-array coil. Cine images were acquired in multiple short-axis, vertical long-axis and 4-chamber view for assessment of LV function. Ten minutes after the additional administration of 0.1 mmol/kg gadolinium-DTPA, short-axis and 4-chamber images were obtained with spin echo to assess for the presence of late gadolinium-enhancing (LGE) lesions.

Cardiac Sarcoidosis Mimicking Septal Tumor with Intermittent Complete Atrioventricular Block

“…One report identified a maximum SUV of 2.5 on PET as a useful threshold for disease activity. 30) Studies for clarifying the adequate SUV for dose titration or cessation of steroid are necessary in the future. Residual LGE on CMR might illustrate the progression of fibrosis in the affected region, although the prognostic value of LGE for acute-phase sarcoidosis is unclear.…”

Clinical Application of ¹⁸F-fluorodeoxyglucose PET and LGE CMR in Cardiac Sarcoidosis

“…Ann Nucl Cardiol 2017；3（1） ：125-130 -127 - patients with than those without CS (17). They also performed FDG PET/CT with a low-carbohydrate diet and 12-h fast.…”

Magnetic Resonance Imaging and Positron Emission Tomography Approaches to Imaging Vascular and Cardiac Inflammation

“…72,73 123 I-radioiodinated 15-(p-iodophenyl)-3(R, S)-methylpentadecanoic acid and 201 thallium dual-tracer mismatch appears promising for cardiac sarcoidosis diagnosis, particularly when added to FDG-PET/CT. 74 Moreover, 18F-FDG uptake is predictive of adverse outcomes in sarcoidosis, such as cardiac death, conduction block and ventricular arrhythmia. 75,76 Acute Transplant Rejection Noninvasive imaging can be useful for monitoring the cellular infiltration that occurs in case of acute cardiac transplant rejection.…”