Updates on the Role of Imaging in Cardiac Sarcoidosis

Yatsynovich, Yan; Valencia, Damian; Petrov, Mikhail; Linares, Juan; Rahman, Mufti Munsurar; Dittoe, Nathaniel

doi:10.1007/s11936-018-0670-7

Cited by 8 publications

(3 citation statements)

References 108 publications

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“…In the case of clinical signs suggestive of other organ involvement, specific further assessments should be evaluated (table 2). In patients with suspected cardiac sarcoidosis the combination of cardiac MRI and 18 F-FDG-PET/CT are considered as the diagnostic tools of choice [118].…”

Section: Diagnosismentioning

confidence: 99%

Sarcoidosis – a multisystem disease

Franzen¹,

Brutsche²,

Nilsson³

et al. 2022

Swiss Med Wkly

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Sarcoidosis is a systemic inflammatory disease, characterised by granuloma formation upon an unknown trigger in genetically predisposed individuals. The inflammation is characterised by an activation of both the innate immune system, with macrophages differentiating into epitheloid cells and dendritic cells, and the adaptive immune system, particularly T helper (Th) 1 and Th17 cells. Since all organs can be affected to varying extents, clinical presentation is often diverse. Most commonly, the lungs, lymph nodes, skin and eyes are involved, whereas cardiac, renal and neurological manifestations are less common but associated with higher morbidity. Depending on the clinical symptoms, a detailed evaluation including thorough clinical examination, imaging and laboratory tests should explore all possible organ involvements. In some patients, fatigue manifests as a para-sarcoidosis symptom impacting quality of life, even if sarcoidosis is in remission. Some acute syndromic presentations, such as Löfgren’s syndrome, have a good prognosis and are commonly self-limiting. If possible, a topical treatment, for example for cutaneous sarcoidosis or bronchial involvement, should be applied. Treatment of severe cases with persisting disease activity necessitates long-term immunosuppressive drugs, with glucocorticoids as the first-line option. Steroid-sparing and second-line drugs include methotrexate, azathioprine, mycophenolate mofetil and immunomodulators such hydroxychloroquine, with the latter being first-line therapy in cutaneous sarcoidosis. Tumour necrosis factor-alpha inhibitors (particularly adalimumab and infliximab) are used as third-line agents but are administered earlier in cases of persistent disease activity, severe organ-involvement or intolerance to conventional drugs. Treatment decisions should be based on a multidisciplinary approach, depending on organ involvement and treatment tolerability. Para-sarcoidosis manifestations, particularly fatigue, should also be carefully addressed, where the patient could also be enrolled in multidimensional rehabilitation programmes. With various organ involvement and different phenotypes, larger studies including real-world data from registries are necessary to evaluate different sarcoidosis endotypes and preferential treatment pathways.

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Section: Diagnosismentioning

confidence: 99%

Sarcoidosis – a multisystem disease

Franzen¹,

Brutsche²,

Nilsson³

et al. 2022

Swiss Med Wkly

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“…The cardiac imaging modalities of choice are Cardiac magnetic resonance tomography (CMR) and cardiac fluoro-deoxy-glucose positron emission tomography (PET-CT), FDG-PET being the gold standard test to detect inflammation. They provide complimentary information [ 5 ].…”

Section: Clinical Diagnosis Of Granulomatous Cardiomyopathymentioning

confidence: 99%

Diagnosis and management of Granulomatous Myocarditis

Kumar

Narasimhan

2022

Indian Pacing and Electrophysiology Journal

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“…The introduction and the desirable widespread of hybrid systems combining PET and MRI (PET/MRI) may be a real opportunity for CS imaging thus improving the imaging performance in this topic. 19 Further studies evaluating the capability of 18 F-FDG-PET in diagnosis and prognosis of cardiac disease as well as evaluation of new imaging approach-using radiopharmaceuticals as 68 Gallium-DOTANOC, 18 F-Flurpiridaz, and 13 Nitrogen-Ammonia that are currently undergoing testing and have shown promising results in initial small studies 20 -are warranted to establish a unified approach, thus improving the assessment of CS.…”

mentioning

confidence: 99%