Open Access
Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F-FDG cardiac PET study
Author(s) -
Kalie Kebed,
Spencer V Carter,
Erin E. Flatley,
R. Parker Ward,
Joshua D. Moss,
Daniel Appelbaum,
Amita Singh,
Roberto M. Lang,
Roderick Tung,
Amit R. Patel
Publication year - 2020
Publication title -
the international journal of cardiovascular imaging
Language(s) - English
Resource type - Journals
eISSN - 1875-8312
pISSN - 1569-5794
DOI - 10.1007/s10554-020-02090-2
Subject(s) - medicine , sarcoidosis , ventricular tachycardia , cardiac sarcoidosis , positron emission tomography , cardiology , magnetic resonance imaging , cardiac magnetic resonance imaging , cardiac imaging , cardiac pet , cardiac magnetic resonance , fluorodeoxyglucose , radiology , nuclear medicine
Cardiac sarcoidosis (CS) is known to be associated with ventricular tachycardia (VT); however, most investigations to date have focused on patients with known extra-cardiac sarcoidosis. The presence of CS is typically evaluated using 18F-fluorodeoxyglucose (18F-FDG) uptake on cardiac positron emission tomography (PET) or late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). In this study, we sought to determine the prevalence of primary CS and the relationship between myocardial 18F-FDG uptake and LGE in patients with VT without known sarcoidosis. We retrospectively identified 67 patients without known sarcoidosis or active ischemic heart disease (i.e. significant ischemic disease that had not been previously revascularized) referred for both CMR and PET for evaluation of VT. Standard cine- and LGE- CMR and cardiac PET protocols were used. Myocardial LGE was defined as signal intensity > 5 SDs above the mean signal intensity of normal myocardium. Cardiac PET images were considered positive if there was focal myocardial 18F-FDG uptake having greater activity than the left ventricular blood pool. 45 patients (67%) had LGE, while only 4 (6%) had myocardial FDG uptake. Nine percent of patients with LGE had FDG-uptake while none without LGE did, and 10% of the cohort had indeterminate FDG uptake presumably from poor dietary preparation. Of those with both FDG uptake and LGE, 3/4 ultimately received a clinical diagnosis of CS. 4.5% of patients without previously known sarcoidosis or active ischemic heart disease presenting with VT have newly diagnosed CS. Detection of CS can be increased using a CMR first approach followed by cardiac PET for patients with non-ischemic LGE.