The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis

Lee, Pei-Ing; Cheng, Gang; Alavi, Abass

doi:10.1007/s12350-016-0682-1

Cited by 56 publications

(21 citation statements)

References 29 publications

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“…pejorative factor [11, 21-23, 25, 30, 37-39]. Interestingly, repeat FDG PET scan may help to determine the extent of disease activity and to assess the cardiac response to therapy [40][41][42].…”

Section: Plos Onementioning

confidence: 99%

Cardiac sarcoidosis: A long term follow up study

et al. 2020

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Background Prognostic factors are lacking in cardiac sarcoidosis (CS), and the effects of immunosuppressive treatments are unclear. Objectives To identify prognostic factors and to assess the effects of immunosuppressive drugs on relapse risk in patients presenting with CS. Methods From a cohort of 157 patients with CS with a median follow-up of 7 years, we analysed all cardiac and extra-cardiac data and treatments, and assessed relapse-free and overall survival. Results The 10-year survival rate was 90% (95% CI, 84-96). Baseline factors associated with mortality were the presence of high degree atrioventricular block (

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Section: Plos Onementioning

confidence: 99%

Cardiac sarcoidosis: A long term follow up study

et al. 2020

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“…In fact, a re-review of CMR in the above cases found that the scan in Case 1 was indeterminate rather than a true negative due inadequate nulling of the myocardium in the delayed enhancement series. The resolution of FDG-PET avidity on serial imaging seen with the cases above is reassuring, especially given recent data demonstrating improved PET parameters correlate with improved LVEF and other clinical outcome measures [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 92%

Cardiac magnetic resonance imaging-indeterminate/negative cardiac sarcoidosis revealed by 18F-fluorodeoxyglucose-positron emission tomography: two case reports and a review of the literature

et al. 2017

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BackgroundSarcoidosis is an inflammatory disorder of immune dysregulation characterized by non-caseating granulomas that can affect any organ. Cardiac sarcoidosis is an under-recognized entity that has a heterogeneous presentation and may occur independently or with any severity of systemic disease. Diagnosing cardiac sarcoidosis remains problematic with endomyocardial biopsies associated with a high risk of complications. Several diagnostic algorithms are currently available that rely on histopathology or clinical and radiological measures. The dominant mode of diagnostic imaging to date for cardiac sarcoidosis has been cardiac magnetic resonance imaging with gadolinium enhancement.Case presentationsWe report the cases of two adult patients: case 1, a 50-year-old white man who presented with severe congestive cardiac failure; and case 2, a 37-year-old white woman who presented with complete heart block. Both patients had a background of untreated pulmonary sarcoidosis. Cardiac magnetic resonance imaging did not show evidence of sarcoidosis in either patient and both proceeded to 18F-fluorodeoxyglucose-positron emission tomography scans that were highly suggestive of cardiac sarcoidosis. Both patients were systemically immunosuppressed with orally administered prednisone and methotrexate and had subsequent improvement by clinical and nuclear medicine imaging measures.ConclusionsCurrent consensus guidelines recommend all patients with sarcoidosis undergo screening for occult cardiac disease, with thorough history and examination, electrocardiogram, and transthoracic echocardiogram. If any abnormalities are detected, advanced cardiac imaging should follow. While cardiac magnetic resonance imaging identifies the majority of cardiac sarcoidosis, early disease may not be detected. These cases demonstrate 18F-fluorodeoxyglucose-positron emission tomography is warranted following an indeterminate or normal cardiac magnetic resonance imaging if clinical suspicion remains high. Unidentified and untreated cardiac sarcoidosis risks significant morbidity and mortality, but early detection can facilitate disease-modifying immunosuppression and cardiac-specific interventions.

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“…18 F‐FDG PET is a useful modality to evaluate disease severity and activity in patients with CS . Moreover, previous reports showed serial 18 F‐FDG PET scanning was useful for evaluating therapeutic response and effect, believed to be associated with active inflammation . However, the usefulness of serial 18 F‐FDG PET scans for the diagnosis of isolated CS remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Case of isolated cardiac sarcoidosis diagnosed by newly developed abnormal uptake during serial follow‐up fluorine‐18 fluorodeoxyglucose positron emission tomography

et al. 2019

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Cardiac sarcoidosis (CS) causes lethal arrhythmia and heart failure and has a poor prognosis; therefore, early detection and early stage treatment are important. However, diagnosis of isolated CS may be difficult in some cases owing to the low sensitivity of myocardial biopsy. Herein, we describe the case of a patient with isolated CS, showing change from negative to positive fluorine‐18 fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET) uptake results within 9 months. The patient showed rapid reduction in left ventricular systolic function with sustained ventricular tachycardia. The diagnosis of isolated CS is often under‐recognized in clinical practice because it commonly requires the diagnosis of extracardiac disease in the absence of a positive endomyocardial biopsy. The Japanese Circulation Society recently published guidelines for CS diagnosis stating that isolated CS can be clinically diagnosed with positive 18F‐FDG PET or 67Gallium result. In this case, serial follow‐up 18F‐FDG PET was useful for diagnosing isolated CS.

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The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis

Abstract: Our results indicated that serial FDG PET is feasible to determine the extent of disease activity and to quantitatively assess the response of cardiac sarcoidosis to therapy.

Cited by 56 publications

References 29 publications

Cardiac sarcoidosis: A long term follow up study

Cardiac sarcoidosis: A long term follow up study

Cardiac magnetic resonance imaging-indeterminate/negative cardiac sarcoidosis revealed by 18F-fluorodeoxyglucose-positron emission tomography: two case reports and a review of the literature

Case of isolated cardiac sarcoidosis diagnosed by newly developed abnormal uptake during serial follow‐up fluorine‐18 fluorodeoxyglucose positron emission tomography

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