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Echocardiography in Sarcoidosis. Kurmann Reto,Mankad Sunil V,Mankad Rekha Current cardiology reports PURPOSE OF REVIEW:Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality. The diagnosis of CS is challenging and typically one that is only entertained after many other conditions have been ruled out. A high index of suspicion is necessary in order to correctly determine appropriate testing for the disease. Transthoracic echocardiography is the most readily available imaging modality available to help establish a diagnosis in a potential patient. However, no one echocardiographic feature is pathognomonic. RECENT FINDINGS:On echocardiography, unusual wall motion abnormalities, which do not fit a classic coronary distribution, along with diastolic dysfunction may alert one to the presence of cardiac sarcoid, particularly in the right clinical context. Myocardial strain imaging on echocardiography may increase the sensitivity of identifying cardiac sarcoidosis. Alternative imaging with cardiac magnetic resonance imaging or positron emission tomography have become more frequently utilized to establish a diagnosis of CS. Cardiac sarcoidosis remains a difficult condition to diagnose. However early diagnosis is critical to decrease the associated high mortality. Endomyocardial biopsy is highly specific but lacks sensitivity due to the patchy nature of the granulomatous deposition. Thus, imaging plays a role in diagnosis as well as for follow-up. Echocardiography remains an hallmark during the workup for CS. Decreased sensitivity of echocardiography has facilitated the use of other techniques to establish the presence of CS. 10.1007/s11886-018-1065-9
Diagnostic accuracy of cardiac magnetic resonance imaging for cardiac sarcoidosis in complete heart block patients implanted with magnetic resonance-conditional pacemaker. Orii Makoto,Tanimoto Takashi,Ota Shingo,Takagi Hidenobu,Tanaka Ryoichi,Fujiwara Jumpei,Akasaka Takashi,Yoshioka Kunihiro Journal of cardiology BACKGROUND:Cardiac magnetic resonance (CMR) imaging has become the principal noninvasive imaging modality for the diagnosis of cardiac sarcoidosis (CS) patients. This study aimed to determine the diagnostic performance of CMR imaging for CS in new-onset complete heart block (CHB) patients implanted with magnetic resonance-conditional pacemaker (MRCP). METHODS:Fifty CHB patients implanted with MRCP were enrolled in this study. Clinical CS was diagnosed if there was a histological diagnosis of extra-cardiac sarcoidosis in patients with CHB based on the consensus statement; clinical CS was the reference standard. The diagnostic performance of CMR sequences, including cine magnetic resonance imaging (MRI), increased T2-weighted signal (T2WS), and late gadolinium enhancement (LGE), for clinical CS was investigated. We also compared the diagnostic performance of CMR sequences between the entire left ventricle (LV) and the basal septum, which involves the electrical pathway of atrioventricular conduction. RESULTS:In total, 8 of the 50 patients with CHB were confirmed to have extra-cardiac sarcoidosis and were diagnosed with clinical CS. The accuracy, sensitivity, and specificity of LGE in the basal septum and entire LV were 94%, 100%, and 93% and 80% (p = 0.023), 100% (p = 1.00), and 76% (p = 0.023), respectively. The accuracy, sensitivity, and specificity of increased T2WS and cine MRI in the basal septum were 94%, 75%, and 98% and 90%, 38%, and 100%, respectively. There was no statistical difference between the entire LV and the basal septum for the diagnostic performance of increased T2WS and cine MRI. CONCLUSIONS:CMR can be a diagnostic tool for evaluating clinical CS in patients with CHB implanted with MRCP. LGE in the basal septum might provide the overall best diagnostic performance for clinical CS with CHB. 10.1016/j.jjcc.2020.02.014
Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis. Wand Alison L,Chrispin Jonathan,Saad Elie,Mukherjee Monica,Hays Allison G,Gilotra Nisha A Frontiers in cardiovascular medicine Cardiac sarcoidosis (CS) is an increasingly recognized cause of heart failure and arrhythmia. Historically challenging to identify, particularly in the absence of extracardiac sarcoidosis, diagnosis of CS has improved with advancements in cardiac imaging. Recognition as well as management may require interpretation of multiple imaging modalities. Echocardiography may serve as an initial screening study for cardiac involvement in patients with systemic sarcoidosis. Cardiac magnetic resonance imaging (CMR) provides information on diagnosis as well as risk stratification, particularly for ventricular arrhythmia in the setting of late gadolinium enhancement. More recently, F-fluorodeoxyglucose position emission tomography (FDG-PET) has assumed a valuable role in the diagnosis and longitudinal management of patients with CS, allowing for the assessment of response to treatment. Hybrid FDG-PET/CT may also be used in the evaluation of extracardiac inflammation, permitting the identification of biopsy sites for diagnostic confirmation. Herein we examine the approach to diagnosis and management of CS using multimodality imaging via a case-based review. 10.3389/fcvm.2021.785279
Evaluation and Management of Cardiac Sarcoidosis with Advanced Imaging. Heart failure clinics A high clinical suspicion in the setting of appropriate history, physical exam, laboratory, and imaging parameters is often required to set the groundwork for diagnosis and management. Echocardiography may show septal thinning, evidence of systolic and diastolic dysfunction, along with impaired global longitudinal strain. Cardiac MRI reveals late gadolinium enhancement along with evidence of myocardial edema and inflammation on T2 weighted imaging and parametric mapping. 18F-FDG PET detects the presence of active inflammation and the presence of scar. Involvement of the right ventricle on MRI or PET confers a high risk for adverse cardiac events and mortality. 10.1016/j.hfc.2023.06.002
Cardiovascular hybrid imaging using PET/MRI. Nensa Felix,Schlosser Thomas RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin The following overview provides a summary of the state of the art and research as well as potential clinical applications of cardiovascular PET/MR imaging. PET/MRI systems have been clinically available for a few years, and their use in cardiac imaging has been successfully demonstrated. At this period in time, some of the technical difficulties that arose at the beginning have been solved; in particular with respect to MRI-based attenuation correction, caution should be exercised with PET quantification. In addition, many promising technical options are still in the developmental stage, such as MRI-based motion correction of PET data resulting from simultaneous MR acquisition, and are not yet available for cardiovascular imaging. On the other hand, PET/MRI has been used to demonstrate significant pathologies such as acute and chronic myocardial infarction, myocarditis or cardiac sarcoidosis; future applications in clinical routine or within studies appear to be possible. In coming years additional studies will have to be performed to prove diagnostic gain at a reasonable cost-benefit ratio before valid conclusions are possible regarding the clinical utility and future of cardiovascular PET/MR imaging. 10.1055/s-0034-1385009
Clinical application of cardiac CMR. Al-Mallah Mouaz,Kwong Raymond Y Reviews in cardiovascular medicine Cardiovascular magnetic resonance (CMR) imaging is an important clinical tool that aids in the diagnosis and management of patients with cardiomyopathy. With its ability to assess morphologic and physiologic myocardial characteristics in the same imaging session, CMR can effectively rule out less common causes of cardiomyopathy, including cardiac hemochromatosis, amyloidosis, and arrhythmogenic right ventricular tachycardia. The combination of cine function, myocardial perfusion at rest and under stress, and late gadolinium enhancement provides a strong assessment that can establish the cause of the cardiomyopathy as well as guide therapy in cases of ischemic cardiomyopathy. CMR can also identify microvascular obstruction in acute myocardial infarction. This technique can be especially helpful in the diagnosis of conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis, and myocarditis. It can also be used to evaluate patients with chest pain and pericardial diseases. 10.3909/ricm0462
Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Krumm Patrick,Mangold Stefanie,Gatidis Sergios,Nikolaou Konstantin,Nensa Felix,Bamberg Fabian,la Fougère Christian Japanese journal of radiology Combined PET/MRI is a novel imaging method integrating the advances of functional and morphological MR imaging with PET applications that include assessment of myocardial viability, perfusion, metabolism of inflammatory tissue and tumors, as well as amyloid deposition imaging. As such, PET/MRI is a promising tool to detect and characterize ischemic and non-ischemic cardiomyopathies. To date, the greatest benefit may be expected for diagnostic evaluation of systemic diseases and cardiac masses that remain unclear in cardiac MRI, as well as for clinical and scientific studies in the setting of ischemic cardiomyopathies. Diagnosis and therapeutic monitoring of cardiac sarcoidosis has the potential of a possible 'killer-application' for combined cardiac PET/MRI. In this article, we review the current evidence and discuss current and potential future applications of cardiac PET/MRI. 10.1007/s11604-018-0727-2
Potential application of Ga-FAPI PET/CT for diagnosing cardiac sarcoidosis. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Detecting cardiac sarcoidosis; a potentially life-threatening condition is challenging and requires a multimodality imaging approach using echocardiography, PET/CT and CMR. Although 18F-FDG is the recommended PET tracer for evaluating cardiac sarcoidosis, it is limited by physiological cardiac FDG uptake and requires stringent patient preparation/ dietary modifications before imaging. We hereby present a case of cardiac sarcoidosis demonstrating myocardial FAPI uptake on cardiac PET, highlighting the potential role of 68Ga-FAPI PET in the evaluation of cardiac sarcoidosis. 10.1016/j.nuclcard.2024.101835
Radiological and nuclear medicine imaging of sarcoidosis. Larici Anna R,Glaudemans Andor W,Del Ciello Annemilia,Slart Riemer H,Calandriello Lucio,Gheysens Olivier The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... Sarcoidosis is a multisystem chronic inflammatory disease of unknown etiology characterized by widespread growth of non-caseating granulomas. The diagnosis of sarcoidosis is based on clinical and imaging presentation, histologic confirmation and the absence of alternative diseases. Radiology and Nuclear Medicine play an essential role in the diagnostic work-up of patients with sarcoidosis to assess disease extent and activity. In addition, imaging modalities have shown their potential in managing these patients in terms of treatment response and prognostic assessment. Sarcoidosis has a predilection for chest involvement, showing typical and atypical manifestations in the lungs, airways and hilar/mediastinal lymph nodes. Chest radiography (X-ray) still plays an important role in suggesting diagnosis for cases with typical presentation of sarcoidosis, while computed tomography (CT) has higher accuracy in detecting early stage disease and in narrowing differential diagnosis, particularly in atypical manifestations. For extrathoracic involvement, both CT and MR (magnetic resonance) have comparable performance even though MR is the modality of choice for assessing neurosarcoidosis and cardiac sarcoidosis. In the last decades positron emission tomography/CT (PET/CT) has demonstrated an increasing and relevant value in assessing disease extent and activity, treatment planning and therapy response, with a crucial role in the management of cardiac sarcoidosis. In this article, an overview of the possible imaging manifestations of thoracic and extrathoracic sarcoidosis and current concepts on staging, response assessment and prognosis is provided. Finally, the potential applications of non-FDG radiotracers is briefly discussed. 10.23736/S1824-4785.17.03046-1
Imaging of Sarcoidosis. Silva Mario,Nunes Hilario,Valeyre Dominique,Sverzellati Nicola Clinical reviews in allergy & immunology The diagnostic imaging contributes significantly to the diagnosis and management of sarcoidosis. Imaging techniques are widely employed in the assessment of thoracic and extra-thoracic involvement from sarcoidosis. For the diagnosis of sarcoidosis, chest radiograph has been the cornerstone of sarcoidosis since 1961, when Scadding proposed a standardized staging system. Currently, computed tomography (CT) represents the reference standard for the assessment of both mediastinal lymph nodes and pulmonary findings. In particular, high-resolution computed tomography (HRCT) is more accurate compared to chest radiography for the detection of subtle parenchymal involvement, and provides comprehensive overview of anatomical detail and abnormalities of lung structures. Notably, HRCT allows for accurate differentiation between reversible and irreversible lung disease, which is cornerstone of prognostication. Radionuclide imaging (gallium-67 and (18)F-fluorodeoxyglucose) provides information about activity of the disease and is also useful for diagnostic workup of patients with unexplained persistent disabling symptoms. Magnetic resonance is sensitive for the detection of sarcoidosis granulomata within myocardium, thus providing detailed roadmap for biopsy. For the management of sarcoidosis, CT is of paramount importance in the detection and differential of most common complications, such as vascular disease and suspicious nodular lesions. Conversely, the role of CT in the follow-up of asymptomatic subjects is still under debate. This review focuses on the role of diagnostic imaging in the diagnosis and follow-up of sarcoidosis. 10.1007/s12016-015-8478-7
Diagnosis of cardiac sarcoidosis: a primer for non-imagers. Heart failure reviews Sarcoidosis is a multisystem granulomatous disorder that can potentially involve any organ. Cardiac involvement in sarcoidosis has been reported in up to 25% of patients based on autopsy and imaging studies. The gold standard for diagnosing cardiac sarcoidosis is endomyocardial biopsy demonstrating non-caseating granulomas; however, this technique lacks sensitivity due to the patchy nature of myocardial involvement. This, along with the non-specific clinical presentation, renders the diagnosis of cardiac sarcoidosis extremely challenging. Difficulties in obtaining histopathologic diagnosis and the advances in imaging modalities have led to a paradigm shift toward non-invasive imaging in the diagnosis of cardiac sarcoidosis. Advances in cardiac imaging modalities have also allowed unprecedented insights into the prevalence and natural history of cardiac sarcoidosis. This review discusses the role of non-invasive imaging for diagnosis, risk stratification, and monitoring the response to therapies in cardiac sarcoidosis. Echocardiography remains the first-line modality due to widespread availability and affordability. Cardiac magnetic resonance imaging (CMR) can be used to study cardiac structure, function, and most importantly tissue characterization to detect inflammation and fibrosis. Fluoro-deoxy glucose positron emission tomography (FDG PET) is the gold standard for non-invasive detection of cardiac inflammation, and it offers the unique ability to assess response to therapeutic interventions. Hybrid imaging is a promising technique that allows us to combine the unique strengths of CMR and FDG PET. Understanding the advantages and disadvantages of each of these imaging modalities is crucial in order to tailor the diagnostic algorithm and utilize the most appropriate modality for each patient. 10.1007/s10741-021-10126-5
Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert review of cardiovascular therapy INTRODUCTION:The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED:The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION:The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant. 10.1080/14779072.2023.2266367