Utility of FDG PET and Cardiac MRI in Diagnosis and Monitoring of                     Immunosuppressive Treatment in Cardiac Sarcoidosis

Coulden, Richard; Sonnex, Emer; Abele, Jonathan; Crean, Andrew M.

doi:10.1148/ryct.2020190140

Cited by 26 publications

(24 citation statements)

References 37 publications

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“… 47 , 49 Visual reduction in the intensity and extent of myocardial inflammation on follow-up 18 FDG-PET imaging and indices, such as Standard Uptake Value, show utility in monitoring response to therapy. 60 , 61 , 62 The exact timing to repeat PET imaging is unknown; however, 4 to 6 months post initiation of treatment has been suggested. 38 Moreover, the Heart Rhythm Society (HRS) indicates use of CMR to determine eligibility for implantable cardioverter defibrillator (ICD) placement with indications being reduced LV ejection fraction (35%) after immunosuppressive therapy (Class I) or if LGE is present in patients with LV ejection fraction 35% to 49% after immunosuppression (Class IIb).…”

Section: Advanced Cardiac Imaging For Csmentioning

confidence: 99%

Epidemiology, Pathogenesis, and Diagnosis of Cardiac Sarcoidosis

Mathai

Patel

Jorde

et al. 2022

Methodist DeBakey Cardiovascular Journal

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Cardiac sarcoidosis (CS) is a widely underdiagnosed yet clinically significant form of granulomatous myocarditis associated with significant morbidity and mortality. Clinical presentation ranges from silent cardiac involvement detected on imaging to cardiomyopathy or sudden cardiac death. Diagnosis of CS remains challenging due to the lack of sensitivity and specificity of any single diagnostic method, underscoring the importance of elevated clinical suspicion and the use of multimodality imaging to guide diagnosis and treatment. In this review, we discuss the epidemiology, pathogenesis, clinical features, and diagnosis of this clinically evading and enigmatic disease.

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Section: Advanced Cardiac Imaging For Csmentioning

confidence: 99%

Epidemiology, Pathogenesis, and Diagnosis of Cardiac Sarcoidosis

Mathai

Patel

Jorde

et al. 2022

Methodist DeBakey Cardiovascular Journal

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“…With regard to cardiac sarcoidosis, both FDG PET and cardiac magnetic resonance imaging (CMRI) have a role, and are often complementary in this setting. With FDG PET imaging in an adequately prepared patient, abnormal activity in the myocardium reflects active inflammation, and can be useful in monitoring disease response, whereas on CMRI late gadolinium enhancement represents myocardial fibrosis or scarring 20 . There are few cases reporting the use of FDG PET scanning when subcutaneous involvement is present.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous sarcoidosis (Darier–Roussy sarcoidosis) with extensive disease on positron emission tomography: A case report and review of the literature

Youn

Francis

Preston

et al. 2022

Respirology Case Reports

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Cutaneous manifestations of sarcoidosis are common, but subcutaneous nodules are rare, originally described in 1904 by Darier and Roussy and thought to represent isolated skin disease. We present a 61‐year‐old male who presented with 3 months of subcutaneous nodules on the forearms and knees. Biopsy confirmed sarcoidosis. An [F‐18] fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed confluent uptake in the skin of forearms and knees, along with thighs and buttocks, mediastinal, hilar and upper abdominal lymph nodes, and multiple bones. He was well and treated with hydroxychloroquine 400 mg/day. The nodules resolved and a repeat FDG PET/CT at 5 months showed a significant decrease in the uptake at all involved sites. Although a PET scan can demonstrate extensive disease in a patient presenting with subcutaneous nodules, the literature suggests prognosis is good and treatment should start simply with the least toxic approach, such as with hydroxychloroquine therapy.

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“…In cardiac sarcoidosis, segments that are positive for LGE on MRI but negative for focal FDG uptake on PET likely reflect myocardial scarring/fibrosis in the setting of chronic disease without active inflammation. Compared to LGE, focal FDG uptake on PET is a more specific marker of active disease reflecting metabolically active immune cells and typically resolves or regresses following anti-inflammatory treatment (Coulden et al 2020 ). FDG-PET is particularly well suited for investigation of cardiac sarcoidosis due to the presence of macrophage-dense regions in areas of active sarcoidosis (Li et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…When available, combined PET/MRI with T1/T2 mapping could improve diagnostic performance and risk stratification of patients with suspected cardiac sarcoidosis compared to either modality alone. FDG uptake on PET is particularly useful to rule in active disease when positive and may also be an important noninvasive biomarker for monitoring response to anti-inflammatory therapy (Coulden et al 2020 ). Cardiac MRI findings are more sensitive and are therefore helpful in ruling out cardiac sarcoidosis when negative.…”

Section: Discussionmentioning

confidence: 99%

Combined simultaneous FDG-PET/MRI with T1 and T2 mapping as an imaging biomarker for the diagnosis and prognosis of suspected cardiac sarcoidosis

Cheung

Ahmad

Aitken

et al. 2021

European J Hybrid Imaging

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Purpose To evaluate the diagnostic and prognostic significance of combined cardiac 18F-fluorodeoxyglucose (FDG) PET/MRI with T1/T2 mapping in the evaluation of suspected cardiac sarcoidosis. Methods Patients with suspected cardiac sarcoidosis were prospectively enrolled for cardiac 18F-FDG PET/MRI, including late gadolinium enhancement (LGE) and T1/T2 mapping with calculation of extracellular volume (ECV). The final diagnosis of cardiac sarcoidosis was established using modified JMHW guidelines. Major adverse cardiac events (MACE) were assessed as a composite of cardiovascular death, ventricular tachyarrhythmia, bradyarrhythmia, cardiac transplantation or heart failure. Statistical analysis included Cox proportional hazard models. Results Forty-two patients (53 ± 13 years, 67% male) were evaluated, 13 (31%) with a final diagnosis of cardiac sarcoidosis. Among patients with cardiac sarcoidosis, 100% of patients had at least one abnormality on PET/MRI: FDG uptake in 69%, LGE in 100%, elevated T1 and ECV in 100%, and elevated T2 in 46%. FDG uptake co-localized with LGE in 69% of patients with cardiac sarcoidosis compared to 24% of those without, p = 0.014. Diagnostic specificity for cardiac sarcoidosis was highest for FDG uptake (69%), elevated T2 (79%), and FDG uptake co-localizing with LGE (76%). Diagnostic sensitivity was highest for LGE, elevated T1 and ECV (100%). After median follow-up duration of 634 days, 13 patients experienced MACE. All patients who experienced MACE had LGE, elevated T1 and elevated ECV. FDG uptake (HR 14.7, p = 0.002), elevated T2 (HR 9.0, p = 0.002) and native T1 (HR 1.1 per 10 ms increase, p = 0.044) were significant predictors of MACE even after adjusting for left ventricular ejection fraction and immune suppression treatment. The presence of FDG uptake co-localizing with LGE had the highest diagnostic performance overall (AUC 0.73) and was the best predictor of MACE based on model goodness of fit (HR 14.9, p = 0.001). Conclusions Combined cardiac FDG-PET/MRI with T1/T2 mapping provides complementary diagnostic information and predicts MACE in patients with suspected cardiac sarcoidosis.

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Utility of FDG PET and Cardiac MRI in Diagnosis and Monitoring of Immunosuppressive Treatment in Cardiac Sarcoidosis

Cited by 26 publications

References 37 publications

Epidemiology, Pathogenesis, and Diagnosis of Cardiac Sarcoidosis

Epidemiology, Pathogenesis, and Diagnosis of Cardiac Sarcoidosis

Subcutaneous sarcoidosis (Darier–Roussy sarcoidosis) with extensive disease on positron emission tomography: A case report and review of the literature

Combined simultaneous FDG-PET/MRI with T1 and T2 mapping as an imaging biomarker for the diagnosis and prognosis of suspected cardiac sarcoidosis

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