Regional myocardial damage and active inflammation in patients with cardiac sarcoidosis detected by non-invasive multi-modal imaging.
OBJECTIVE
Cardiac sarcoidosis (CS) can be diagnosed using18F-FDG-PET/CT (PET), cardiovascular magnetic resonance (CMR), and123I-BMIPP/201TlCl dual myocardial SPECT. This study aims to clarify the relationships among the three modalities with respect to CS.


RESULTS
We evaluated 16 patients (male n = 11; age 55 ± 13 years) with confirmed CS who underwent PET, CMR, and dual SPECT with gated SPECT before starting steroid therapy. The left ventricular myocardium was divided into 17 segments to obtain SUVmax for PET images, defect scores from 0 to 4 (0 normal; 4 absent), and mismatch scores for dual SPECT (BMDS, TLDS, and MS) images and late gadolinium enhancement (LGE) scores (0 none; 1 partly positive; 2 homogeneous) on CMR images. Summed BMDS, TLDS, and MS were 18.6 ± 12.6, 12.9 ± 10.9, and 5.7 ± 3.1, respectively. The segmental BMDS and TLDS scores became significantly higher as the LGE scores increased. The MS scores were significantly higher in areas of LGE with a score of 1 than 0 (both, p < 0.001), but did not significantly differ between areas with LGE scores of 1 and 2. The SUVmax was significantly higher in LGE areas with a score of 1 than 0 (p < 0.025), but did not significantly differ between those with scores of 1 or 2.


CONCLUSIONS
Regions with a higher SUVmax indicating active myocardial inflammation were mainly located in areas with LGE, where BMIPP and TL mismatches were evident in patients with CS.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Shohei
S
Kataoka
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. momose.mitsuru@twmu.ac.jp.
Mitsuru
M
Momose
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Kenji
K
Fukushima
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Naoki
N
Serizawa
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Atsushi
A
Suzuki
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Chisato
C
Kondo
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Koichiro
K
Abe
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Shuji
S
Sakai
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Nobuhisa
N
Hagiwara
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000276:immunology; D003287:Contrast Media; D005227:Fatty Acids; D005260:Female; D019788:Fluorodeoxyglucose F18; D005682:Gadolinium; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007462:Iodobenzenes; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009205:Myocarditis / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000276:immunology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
D003287:Contrast Media; D005227:Fatty Acids; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; C049338:iodofiltic acid; D019788:Fluorodeoxyglucose F18; D005682:Gadolinium
Cardiac magnetic resonance; Cardiac sarcoidosis; Fatty acid metabolism; Myocardial perfusion; Positron emission tomography