Hybrid Cardiac Magnetic Resonance/Fluorodeoxyglucose Positron Emission Tomography to Differentiate Active From Chronic Cardiac Sarcoidosis

Greulich, Simon; Gatidis, Sergios; Gräni, Christoph; Blankstein, Ron; Glatthaar, Andreas; Mezger, Katharina; Müller, K.; Castor, Tatsiana; Mahrholdt, Heiko; Häntschel, Maik; Hetzel, Jürgen; Dittmann, Helmut; Nikolaou, Konstantin; Gawaz, Meinrad; Fougère, Christian la; Krumm, Patrick

doi:10.1016/j.jcmg.2021.08.018

Cited by 43 publications

(23 citation statements)

References 31 publications

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“…As an outlook, acute or persistent myocardial inflammation may be investigated by a simultaneous hybrid 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) CMR as a reference standard for detecting inflammation. The value of PET and whether it may be superior to T2 mapping for detecting myocardial inflammation should be further investigated [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy

Krumm

Brendel

Klingel

et al. 2022

JCM

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(1) Objectives: To discriminate biopsy-proven myocarditis (chronic vs. healed myocarditis) and to differentiate from dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR). (2) Methods: A total of 259 consecutive patients (age 51 ± 15 years; 28% female) who underwent both endomyocardial biopsy (EMB) and CMR in the years 2008–2021 were evaluated. According to right-ventricular EMB results, patients were divided into either chronic (n = 130, 50%) or healed lymphocytic myocarditis (n = 60, 23%) or DCM (n = 69, 27%). The CMR protocol included functional, strain, and late gadolinium enhancement (LGE) imaging, T2w imaging, and T2 mapping. (3) Results: Left-ventricular ejection fraction (LV-EF) was higher, and the indexed end-diastolic volume (EDV) was lower in myocarditis patients (chronic: 42%, median 96 mL/m²; healed: 49%, 86 mL/m²) compared to the DCM patients (31%, 120 mL/m²), p < 0.0001. Strain analysis demonstrated lower contractility in DCM patients vs. myocarditis patients, p < 0.0001. Myocarditis patients demonstrated a higher LGE prevalence (68% chronic; 59% healed) than the DCM patients (45%), p = 0.01. Chronic myocarditis patients showed a higher myocardial edema prevalence and ratio (59%, median 1.3) than healed myocarditis (23%, 1.3) and DCM patients (13%, 1.0), p < 0.0001. T2 mapping revealed elevated values more frequently in chronic (90%) than in healed (21%) myocarditis and DCM (23%), p < 0.0001. T2 mapping yielded an AUC of 0.89 (sensitivity 90%, specificity 76%) in the discrimination of chronic from healed myocarditis and an AUC of 0.92 (sensitivity 86%, specificity 91%) in the discrimination of chronic myocarditis from DCM, both p < 0.0001. (4) Conclusions: Multiparametric CMR imaging, including functional parameters, LGE and T2 mapping, may allow differentiation of chronic from healed myocarditis and DCM and therefore help to optimize patient management in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy

Krumm

Brendel

Klingel

et al. 2022

JCM

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“…LGE was defined of an image intensity level ≥ 2 SD above the mean of remote myocardium; the results were expressed as percentage of myocardial LV mass. LGE was further divided by distribution (linear, focal), and its pattern (epi-and endocardial, midwall) as previously described (8,9,14,15). Ischemic LGE was defined as subendocardial or transmural enhancement; non-ischemic LGE was defined as midwall or subepicardial enhancement.…”

Section: Cardiovascular Magnetic Resonance Analysismentioning

confidence: 99%

TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study

Mengel

Nenova²,

Müller³

et al. 2022

Front. Cardiovasc. Med.

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AimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadolinium Enhancement (LGE)-cardiac magnetic resonance (CMR) with mapping techniques [T1, T2, extracellular volume (ECV)] allow the detection of both focal and diffuse myocardial abnormalities. We investigated the prevalence of culprit lesions by coronary angiography and myocardial tissue abnormalities by a comprehensive CMR protocol in troponin-positive stroke patients.Methods and resultsPatients with troponin-positive acute ischemic stroke and no history of coronary artery disease were prospectively enrolled. Coronary angiography and CMR (LGE, T1 + T2 mapping, ECV) were performed within the first days of the acute stroke. Twenty-five troponin-positive patients (mean age 62 years, 44% females) were included. 2 patients (8%) had culprit lesions on coronary angiography and underwent percutaneous coronary intervention. 13 patients (52%) demonstrated LGE: (i) n = 4 ischemic, (ii) n = 4 non-ischemic, and (iii) n = 5 ischemic AND non-ischemic. In the 12 LGE-negative patients, mapping revealed diffuse myocardial damage in additional 9 (75%) patients, with a high prevalence of increased T2 values.ConclusionsOur data show a low prevalence of culprit lesions in troponin-positive stroke patients. However, > 50% of the patients demonstrated myocardial scars (ischemic + non-ischemic) by LGE-CMR. Mapping revealed additional myocardial abnormalities (mostly inflammatory) in the majority of LGE-negative patients. Therefore, a comprehensive CMR protocol gives important insights in the etiology of troponin which might have implications for the further work-up of troponin-positive stroke patients.

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“…Recently, simultaneous hybrid PET/CMR have shown promising results in patients with suspected CS and may be superior in terms of sensitivity and specificity to performing both tests separately [20,21]. Indeed, the spatial resolution of superimposed PET/CMR permits a better localization of inflammation and pattern of injury and may provide incremental information on disease activity in a single scan [21,22,23 ▪ ,24]. Interestingly, Trivieri et al recently reported a pattern of LGE and FDG uptake that appeared exclusive to patients with biopsy-proven CS suggesting that this finding could potentially be enough to initiate IT under certain circumstances [21].…”

Section: Cardiac Magnetic Resonance and Hybrid Imagingmentioning

confidence: 99%

What cardiologists should know about cardiac sarcoidosis in 2022?

Lemay

Marchand

Sénéchal

2022

Current Opinion in Cardiology

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Purpose of reviewCardiac sarcoidosis (CS) is a potentially fatal condition when unrecognized or not treated adequately. The purpose of this review is to provide new strategies to increase clinical recognition of CS and to present an updated overview of the immunosuppressive treatments using most recent data published in the last 18 months. Recent findingsCS is an increasingly recognized pathology, and its diagnostic is made 20 times more often in the last two decades. Recent studies have shown that imaging alone usually lacks specificity to distinguish CS from other inflammatory cardiomyopathies. However, imaging can be used to increase significantly diagnostic yield of extracardiac and cardiac biopsy. Recent reviews have also demonstrated that nearly 25% of patients will be refractory to standard treatment with prednisone and that combined treatment with a corticosteroid-sparing agent is often necessary for a period that remains undetermined. SummaryCS is a complex pathology that should always require a biopsy attempt to have a histological proven diagnosis before starting immunosuppressive therapy consisting of corticosteroids with or without a corticosteroid-sparing agent.

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Hybrid Cardiac Magnetic Resonance/Fluorodeoxyglucose Positron Emission Tomography to Differentiate Active From Chronic Cardiac Sarcoidosis

Cited by 43 publications

References 31 publications

Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy

Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy

TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study

What cardiologists should know about cardiac sarcoidosis in 2022?

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