https://www.heartrhythmjournal.com/article/S1547-5271(14)00335-X/pdf

HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis

Cardiac Positron Emission Tomography Enhances Prognostic Assessments of Patients With Suspected Cardiac Sarcoidosis

ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures.

Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. The 1993 guidelines of the Ministry of Health, Labour, and Welfare (MHLW) of Japan have been used as the diagnostic gold standard and for comparison with imaging modalities. 18F-FDG PET is not currently included in the guidelines. However, studies have shown promising data using 18F-FDG PET. We conducted a systematic review of studies that evaluated the accuracy of 18F-FDG PET for the diagnosis of cardiac sarcoidosis compared with MHLW guidelines. Data from a prospective Ontario provincial registry are also reported and included in the metaanalysis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies that satisfied predetermined criteria. Quality evaluation using the Quality Assessment for Diagnostic Accuracy Studies was performed by 2 independent masked observers. Data were extracted and analyzed to measure study-specific and pooled accuracy for 18F-FDG PET compared with the MHLW as the reference. Results: A total of 519 titles was identified; 7 studies, including the Ontario registry, were selected for inclusion. Metaanalysis of these 7 studies was conducted, with a total of 164 patients, most of whom had been diagnosed with systemic sarcoidosis. The prevalence of cardiac sarcoidosis was 50% in the whole population. Pooled estimates for 18F-FDG PET yielded 89% sensitivity (95% confidence interval [CI], 79%–96%), 78% specificity (95% CI, 68%–86%), a 4.1 positive likelihood ratio (95% CI, 1.7–10), and a 0.19 negative likelihood ratio (95% CI, 0.1–0.4). The overall diagnostic odds ratio was 25.6 (95% CI, 7.3–89.5), and the area under the summary receiver operator characteristic curve was 93% ± 3.5. The Ontario study yielded sensitivity and specificity of 79% and 70%, respectively. Conclusion: The high diagnostic accuracy determined for 18F-FDG PET in this metaanalysis suggests potential value for diagnosis of cardiac sarcoidosis compared with the MHLW guidelines. These results may affect patient care by providing supportive evidence for more effective use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis. Large-scale multicenter studies are required to further evaluate this role.

https://jnm.snmjournals.org/content/jnumed/53/2/241.full.pdf

The Use of 18F-FDG PET in the Diagnosis of Cardiac Sarcoidosis: A Systematic Review and Metaanalysis Including the Ontario Experience

Cardiac Involvement in Patients with Sarcoidosis: Diagnostic and Prognostic Value of Outpatient Testing

Aims To evaluate the value of 18 F-fluoro-2-deoxyglucose positron emission tomography ( 18 F-FDG PET) in detecting cardiac sarcoidosis. Methods and results Thirty-two patients with sarcoidosis and thirty controls were recruited. All subjects underwent cardiac 18 F-FDG PET after a 6 h fasting period, and subjects with sarcoidosis underwent blood testing, ECG, echocardiography, and 67 Ga and 99m Tc-sestamibi (MIBI) scintigraphy. We classified 18 F-FDG PET images into four patterns ('none', 'diffuse', 'focal', and 'focal on diffuse') and found that all the control subjects exhibited either none (n = 16) or diffuse (n = 14) pattern. In contrast, fifteen subjects with sarcoidosis exhibited none, seven exhibited diffuse, eight exhibited focal, and two exhibited focal on diffuse patterns, with the prevalence of the focal and focal on diffuse patterns being significantly higher in the sarcoidosis group when compared with the control group (P < 0.001). None of the 32 subjects with sarcoidosis exhibited abnormal findings on 67 Ga scintigraphy, and 4 exhibited abnormal findings on 99m Tc-MIBI scintigraphy. Conclusion Focal uptake of the heart on 18 F-FDG PET images is a characteristic feature of patients with sarcoidosis. Furthermore, 18 F-FDG PET has the potential to detect cardiac sarcoidosis that cannot be diagnosed by 67 Ga or 99m Tc-MIBI scintigraphy.

/pdf/focal-uptake-on-18f-fluoro-2-deoxyglucose-positron-emission-2z8gwcuwjj.pdf

Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis

A 45-year-old man, who had been diagnosed with primary pulmonary hypertension (PPH) 8 years before, was referred to our hospital because of short breath and lower-limb edema. Findings of chest X-ray, electrocardiogram, and cardiac ultrasound showed right atrial and ventricular dilatation/hypertrophy that were compatible with advanced PPH. Chest enhanced computed tomography (CT), however, unexpectedly showed that contrast in the main pulmonary artery was diluted by blood flow from the descending aorta. On electrocardiography-synchronized CT, the arterial duct connecting the main pulmonary artery and descending aorta was clearly delineated. As a result, the long-standing diagnosis of PPH was corrected to secondary pulmonary arterial hypertension caused by patent ductus arteriosus, thanks to the “reverse” enhancement on CT.

Enhanced computed tomography unveiling the underlying cause of pulmonary hypertension

F-FDG PET images intofour patterns (‘none’, ‘diffuse’, ‘focal’, and ‘focal on diffuse’) and found that allthe control subjects exhibited either none (n ¼ 16) or diffuse (n ¼ 14) pattern. In con-trast, ﬁfteen subjects with sarcoidosis exhibited none, seven exhibited diffuse, eightexhibited focal, and two exhibited focal on diffuse patterns, with the prevalence ofthe focal and focal on diffuse patterns being signiﬁcantly higher in the sarcoidosisgroup when compared with the control group (P , 0.001). None of the 32 subjectswith sarcoidosis exhibited abnormal ﬁndings on

emission tomography images indicates cardiac involvement of sarcoidosis

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Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis

Enhanced computed tomography unveiling the underlying cause of pulmonary hypertension

emission tomography images indicates cardiac involvement of sarcoidosis