Background The diagnostic yield of cardiac sarcoidosis (CS) by endomyocardial biopsy is limited. Fluorodeoxyglucose (FDG) positron emission tomography (PET) and cardiac magnetic resonance imaging (MRI) may facilitate noninvasive diagnosis, but the accuracy of this approach is not well defined. We aimed to correlate findings from FDG PET and cardiac MRI with histological findings from explanted hearts of patients who underwent cardiac transplantation. Methods We analyzed the explanted heart histology for all patients who underwent cardiac transplant at our center from April 2008 to July 2018 and had pretransplant FDG PET (n=18) or cardiac MRI (n=31). The likelihood of CS based on FDG PET or cardiac MRI was categorized in a blinded fashion using a previously published method. RESULTS: Using a CS probable cutoff for FDG PET resulted in a sensitivity of 100.0% (95% CI, 54.1%-100.0%) and a specificity of 33.3% (95% CI, 9.9%-65.1%). Three of the 9 CS probable by FDG PET cases were found to be arrhythmogenic cardiomyopathy. The test characteristics of cardiac MRI are more challenging to comment on using our data as there was only one confirmed case of CS on post-transplant histological assessment. Of the 8 CS highly probable or probable cases by cardiac MRI, 3 were found to be dilated cardiomyopathy, and 2 were found to be end-stage hypertrophic cardiomyopathy. Conclusions FDG PET and cardiac MRI can help facilitate the diagnosis of CS in patients with advanced heart failure with a high degree of sensitivity but lower specificity.

中文翻译：

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心脏结节病高级影像学的诊断准确性。

背景技术心肌内膜活检对心脏结节病（CS）的诊断率有限。氟代葡萄糖（FDG）正电子发射断层扫描（PET）和心脏磁共振成像（MRI）可能有助于无创诊断，但这种方法的准确性尚不确定。我们旨在将FDG PET和心脏MRI的发现与接受心脏移植的患者的离体心脏的组织学发现相关联。方法我们分析了2008年4月至2018年7月在我们中心接受心脏移植并已进行了移植前FDG PET（n = 18）或心脏MRI（n = 31）的所有患者的移植心脏组织学。基于FDG PET或心脏MRI的CS的可能性已使用先前公布的方法以盲法进行了分类。结果：对于FDG PET，使用CS可能的截止值会导致灵敏度为100.0％（95％CI，54.1％-100.0％）和特异性为33.3％（95％CI，9.9％-65.1％）。发现FDG PET病例9例CS中有3例为心律失常性心肌病。心脏MRI的测试特征对于使用我们的数据进行评论更具挑战性，因为在移植后的组织学评估中只有一例确诊为CS的病例。通过心脏MRI检查的8例CS高可能性或高可能性病例中，发现3例是扩张型心肌病，另外2例是末期肥厚型心肌病。结论FDG PET和心脏MRI有助于敏感性高但特异性低的晚期心力衰竭患者的CS诊断。发现FDG PET病例9例CS中有3例为心律失常性心肌病。心脏MRI的测试特征对于使用我们的数据进行评论更具挑战性，因为在移植后的组织学评估中只有一例确诊为CS的病例。通过心脏MRI检查的8例CS高可能性或高可能性病例中，发现3例是扩张型心肌病，另外2例是末期肥厚型心肌病。结论FDG PET和心脏MRI有助于敏感性高但特异性低的晚期心力衰竭患者的CS诊断。发现FDG PET病例9例CS中有3例为心律失常性心肌病。心脏MRI的测试特征对于使用我们的数据进行评论更具挑战性，因为在移植后的组织学评估中只有一例确诊为CS的病例。通过心脏MRI检查的8例CS高可能性或高可能性病例中，发现3例是扩张型心肌病，另外2例是末期肥厚型心肌病。结论FDG PET和心脏MRI有助于敏感性高但特异性低的晚期心力衰竭患者的CS诊断。通过心脏MRI检查的8例CS高可能性或高可能性病例中，发现3例是扩张型心肌病，另外2例是末期肥厚型心肌病。结论FDG PET和心脏MRI有助于敏感性高但特异性低的晚期心力衰竭患者的CS诊断。通过心脏MRI检查的8例CS高可能性或高可能性病例中，发现3例是扩张型心肌病，另外2例是末期肥厚型心肌病。结论FDG PET和心脏MRI有助于敏感性高但特异性低的晚期心力衰竭患者的CS诊断。