Hybrid Cardiac Magnetic Resonance/Fluorodeoxyglucose Positron Emission Tomography to Differentiate Active From Chronic Cardiac Sarcoidosis,JACC: Cardiovascular Imaging

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Hybrid Cardiac Magnetic Resonance/Fluorodeoxyglucose Positron Emission Tomography to Differentiate Active From Chronic Cardiac Sarcoidosis
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-10-13 , DOI: 10.1016/j.jcmg.2021.08.018
Simon Greulich ₁ , Sergios Gatidis ₂ , Christoph Gräni ₃ , Ron Blankstein ₄ , Andreas Glatthaar ₁ , Katharina Mezger ₁ , Karin A L Müller ₁ , Tatsiana Castor ₁ , Heiko Mahrholdt ₅ , Maik Häntschel ₆ , Jürgen Hetzel ₆ , Helmut Dittmann ₇ , Konstantin Nikolaou ₂ , Meinrad Gawaz ₁ , Christian la Fougère ₇ , Patrick Krumm ₂

Affiliation

Objectives

The purpose of this study was to investigate the diagnostic value of simultaneous hybrid cardiac magnetic resonance (CMR) and ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) for detection and differentiation of active (aCS) from chronic (cCS) cardiac sarcoidosis.

Background

Late gadolinium enhancement (LGE) CMR and FDG-PET are both established imaging techniques for the detection of CS. However, there are limited data regarding the value of a comprehensive simultaneous hybrid CMR/FDG-PET imaging approach that includes CMR mapping techniques.

Methods

Forty-three patients with biopsy-proven extracardiac sarcoidosis (median age: 48 years, interquartile range: 37-57 years, 65% male) were prospectively enrolled for evaluation of suspected CS. After dietary preparation for suppression of myocardial glucose metabolism, patients were evaluated on a 3-T hybrid PET/MR scanner. The CMR protocol included T1 and T2 mapping, myocardial function, and LGE imaging. We assumed aCS if PET and CMR (ie, LGE or T1/T2 mapping) were both positive (PET+/CMR+), cCS if PET was negative but CMR was positive (PET−/CMR+), and no CS if patients were CMR negative regardless of PET findings.

Results

Among the 43 patients, myocardial glucose uptake was suppressed successfully in 36 (84%). Hybrid CMR/FDG-PET revealed aCS in 13 patients (36%), cCS in 5 (14%), and no CS in 18 (50%). LGE was present in 14 patients (39%); T1 mapping was abnormal in 10 (27%) and T2 mapping abnormal in 2 (6%). CS was diagnosed based on abnormal T1 mapping in 4 out of 18 CS patients (22%) who were LGE negative. PET FDG uptake was present in 17 (47%) patients.

Conclusions

Comprehensive simultaneous hybrid CMR/FDG-PET imaging is useful for the detection of CS and provides additional value for identifying active disease. Our results may have implications for enhanced diagnosis as well as improved identification of patients with aCS in whom anti-inflammatory therapy may be most beneficial.

中文翻译：

混合心脏磁共振/氟脱氧葡萄糖正电子发射断层扫描以区分活动性心脏结节病和慢性心脏结节病

目标

本研究的目的是探讨同时混合心脏磁共振 (CMR) 和¹⁸ F-氟脱氧葡萄糖正电子发射断层扫描 (FDG-PET) 在检测和区分活动性 (aCS) 和慢性 (cCS) 心脏结节病中的诊断价值。

背景

晚期钆增强 (LGE) CMR 和 FDG-PET 都是用于检测 CS 的成熟成像技术。然而，关于包括 CMR 映射技术的综合同步混合 CMR/FDG-PET 成像方法的价值的数据有限。

方法

43 名经活检证实为心外结节病的患者（中位年龄：48 岁，四分位距：37-57 岁，65% 男性）被前瞻性纳入评估疑似 CS。在为抑制心肌葡萄糖代谢进行饮食准备后，患者在 3-T 混合 PET/MR 扫描仪上进行了评估。CMR 方案包括 T1 和 T2 映射、心肌功能和 LGE 成像。如果 PET 和 CMR（即 LGE 或 T1/T2 标测）均为阳性（PET+/CMR+），我们假设为 aCS，如果 PET 为阴性但 CMR 为阳性（PET-/CMR+），我们假设为 cCS，如果患者为 CMR 阴性，则为无 CS无论 PET 检查结果如何。

结果

在 43 名患者中，36 名（84%）成功抑制了心肌葡萄糖摄取。混合 CMR/FDG-PET 显示 13 名患者 (36%) 为 aCS，5 名患者 (14%) 为 cCS，18 名患者 (50%) 未发现 CS。14 名患者（39%）存在 LGE；10 例 (27%) T1 映射异常，2 例 (6%) T2 映射异常。18 名 LGE 阴性的 CS 患者中有 4 名（22%）根据异常 T1 映射诊断 CS。17 名 (47%) 患者存在 PET FDG 摄取。