Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis.
OBJECTIVE
This study analyzed the accuracy of gadolinium-enhanced cardiovascular magnetic resonance (CMR) for the diagnosis of cardiac sarcoidosis (CS).


BACKGROUND
The diagnosis of CS was made according to the guidelines of the Japanese Ministry of Health and Welfare (1993); CMR has not been incorporated into the guidelines, and the diagnostic accuracy of CMR for the diagnosis of CS has not yet been evaluated.


METHODS
We performed an analysis of 12-lead electrocardiograms (ECGs), 24-h ambulatory ECGs, echocardiograms, thallium scintigrams, and gadolinium-enhanced CMR studies in 58 biopsy-proven pulmonary sarcoidosis patients assessed for CS. The diagnostic accuracy of CMR for CS was determined using modified Japanese guidelines as the gold standard.


RESULTS
The diagnosis of CS was made in 12 of 58 patients (21%); CMR revealed late gadolinium enhancement (LGE), mostly involving basal and lateral segments (73%), in 19 patients. In 8 of the 19 patients, scintigraphy was normal, while patchy LGE was present. The sensitivity and specificity of CMR were 100% (95% confidence interval, 78% to 100%) and 78% (95% confidence interval, 64% to 89%), and the positive and negative predictive values were 55% and 100%, respectively, with an overall accuracy of 83%.


CONCLUSIONS
In patients with sarcoidosis, CMR is a useful diagnostic tool to determine cardiac involvement. New diagnostic guidelines should include CMR.
Smedema
Jan-Peter
JP
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands. j.smedema@cardio.azm.nl
Snoep
Gabriel
G
van Kroonenburgh
Marinus P G
MP
van Geuns
Robert-Jan
RJ
Dassen
Willem R M
WR
Gorgels
Anton P M
AP
Crijns
Harry J G M
HJ
D000328:Adult; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis*; D003287:Contrast Media / Q000008:administration & dosage; D015716:Electrocardiography, Ambulatory; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D017410:Practice Guidelines as Topic; D012507:Sarcoidosis / Q000175:diagnosis*; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA