Investig Magn Reson Imaging.  2019 Jun;23(2):100-113. 10.13104/imri.2019.23.2.100.

Recent Update of Advanced Imaging for Diagnosis of Cardiac Sarcoidosis: Based on the Findings of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography

Affiliations
  • 1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
  • 3Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Korea. drejchun@hanmail.net

Abstract

Sarcoidosis is a multisystem disease characterized by noncaseating granulomas. Cardiac involvement is known to have poor prognosis because it can manifest as a serious condition such as the conduction abnormality, heart failure, ventricular arrhythmia, or sudden cardiac death. Although early diagnosis and early treatment is critical to improve patient prognosis, the diagnosis of CS is challenging in most cases. Diagnosis usually relies on endomyocardial biopsy (EMB), but its diagnostic yield is low due to the incidence of patchy myocardial involvement. Guidelines for the diagnosis of CS recommend a combination of clinical, electrocardiographic, and imaging findings from various modalities, if EMB cannot confirm the diagnosis. Especially, the role of advanced imaging such as cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET), has shown to be important not only for the diagnosis, but also for monitoring treatment response and prognostication. CMR can evaluate cardiac function and fibrotic scar with good specificity. Late gadolinium enhancement (LGE) in CMR shows a distinctive enhancement pattern for each disease, which may be useful for differential diagnosis of CS from other similar diseases. Effectively, T1 or T2 mapping techniques can be also used for early recognition of CS. In the meantime, PET can detect and quantify metabolic activity and can be used to monitor treatment response. Recently, the use of a hybrid CMR-PET has introduced to allow identify patients with active CS with excellent co-localization and better diagnostic accuracy than CMR or PET alone. However, CS may show various findings with a wide spectrum, therefore, radiologists should consider the possible differential diagnosis of CS including myocarditis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Radiologists should recognize the differences in various diseases that show the characteristics of mimicking CS, and try to get an accurate diagnosis of CS.

Keyword

Cardiac sarcoidosis; Magnetic resonance imaging; Positron-emission tomography

MeSH Terms

Amyloidosis
Arrhythmias, Cardiac
Arrhythmogenic Right Ventricular Dysplasia
Biopsy
Cardiomyopathy, Dilated
Cardiomyopathy, Hypertrophic
Cicatrix
Death, Sudden, Cardiac
Diagnosis*
Diagnosis, Differential
Early Diagnosis
Electrocardiography
Electrons*
Gadolinium
Granuloma
Heart Defects, Congenital
Humans
Incidence
Magnetic Resonance Imaging*
Myocarditis
Positron-Emission Tomography*
Prognosis
Sarcoidosis*
Sensitivity and Specificity
Gadolinium
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