title: Churg-Strauss syndrome cardiac involvement evaluated by cardiac magnetic resonance imaging and positron-emission tomography: a prospective study on 20 patients.
abstract: OBJECTIVE
  Churg-Strauss syndrome (CSS) cardiac involvement is associated with a poor prognosis. Recently cardiac MRI (CMRI) has emerged as a promising technique to detect early CSS cardiac involvement. However, CMRI-detected myocardial delayed enhancement (MDE) could correspond to fibrosis or inflammation. Fluoro-2-deoxyglucose PET (FDG-PET) was previously used in other systemic diseases to distinguish between them. To determine whether the CMRI-MDE detected in CSS patients reflected fibrosis or myocardial inflammation, patients in CSS remission underwent FDG-PET.
  
  
  METHODS
  Twenty consecutive CSS patients in remission (BVAS = 0) were recruited. Fourteen patients [eight men, six women; mean (S.D.) age 49 (9) years; mean disease duration 3.5 (2.9) years] with CMRI-detected MDE, and six patients [four men, two women; mean (S.D.) age 44 (15) years; mean disease duration 3.5 (5.3) years] with normal CMRI underwent FDG-PET. Segments with MDE on CMRI were analysed on FDG-PET images, with myocardial FDG hypofixation defining fibrosis and hyperfixation corresponding inflammation.
  
  
  RESULTS
  Among the 14 patients with MDE on CMRI, FDG-PET showed 10 had hypofixation, 2 had hyperfixation and 2 had normal scans. CSS duration at the time of CMRI was shorter for patients with myocardial inflammation than in those with fibrosis. The six patients with normal CMRI had normal FDG-PET images.
  
  
  CONCLUSIONS
  For CSS patients in remission, CMRI detected subclinical active myocardial lesions and could be recommended to assess cardiac involvement. However, because CMRI-detected MDE can reflect fibrosis or inflammation, FDG-PET might help to distinguish between the two.
authors: Department of Cardiology, Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. julien.marmursztejn@cch.aphp.fr
authors: Julien
authors: J
authors: Marmursztejn
authors: Loic
authors: L
authors: Guillevin
authors: Regine
authors: R
authors: Trebossen
authors: Pascal
authors: P
authors: Cohen
authors: Philippe
authors: P
authors: Guilpain
authors: Christian
authors: C
authors: Pagnoux
authors: Luc
authors: L
authors: Mouthon
authors: Paul
authors: P
authors: Legmann
authors: Olivier
authors: O
authors: Vignaux
authors: Denis
authors: D
authors: Duboc
mesh_terms: D000328:Adult; D015267:Churg-Strauss Syndrome / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005355:Fibrosis; D019788:Fluorodeoxyglucose F18; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis; D009206:Myocardium / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012074:Remission Induction
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18