Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-02-2016 | Original Article

Comparison of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis

Authors: Hiroshi Ohira, David H. Birnie, Elena Pena, Jordan Bernick, Brian Mc Ardle, Eugene Leung, George A. Wells, Keiichiro Yoshinaga, Ichizo Tsujino, Takahiro Sato, Osamu Manabe, Noriko Oyama-Manabe, Masaharu Nishimura, Nagara Tamaki, Alexander Dick, Carole Dennie, Ran Klein, Jennifer Renaud, Robert A. deKemp, Terrence D. Ruddy, Benjamin J. W. Chow, Ross Davies, Renee Hessian, Peter Liu, Rob S. B. Beanlands, Pablo B. Nery

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2016

Abstract

Purpose

Cardiac sarcoidosis (CS) is a cause of conduction system disease (CSD). ¹⁸F-Fluorodeoxyglucose-positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) are used for detection of CS. The relative diagnostic value of these has not been well studied. The aim was to compare these imaging modalities in this population.

Methods

We recruited steroid-naive patients with newly diagnosed CSD due to CS. All CS patients underwent both imaging studies within 12 weeks of each other. Patients were classified into two groups: group A with chronic mild CSD (right bundle branch block and/or axis deviation), and group B with new-onset atrioventricular block (AVB, Mobitz type II or third-degree AVB).

Results

Thirty patients were included. Positive findings on both imaging studies were seen in 72 % of patients (13/18) in group A and in 58 % of patients (7/12) in group B. The remainder (28 %) of the patients in group A were positive only on CMR. Of the patients in group B, 8 % were positive only on CMR and 33 % were positive only on FDG PET. Patients in group A were more likely to be positive only on CMR, and patients in group B were more likely to be positive only on FDG PET (p = 0.02). Patients in group B positive only on FDG PET underwent CMR earlier relative to their symptomatology than patients positive only on CMR (median 7.0, IQR 1.5 – 34.3, vs. 72.0, IQR 25.0 – 79.5 days; p = 0.03).

Conclusion

The number of positive FDG PET and CMR studies was different in patients with CSD depending on their clinical presentation. This study demonstrated that CMR can adequately detect cardiac involvement associated with chronic mild CSD. In patients presenting with new-onset AVB and a negative CMR study, FDG PET may be useful for detecting cardiac involvement due to CS.

Available only for authorised users

Matsui Y, Iwai K, Tachibana T, Fruie T, Shigematsu N, Izumi T, et al. Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci. 1976;278:455–69.PubMedCrossRef

Silverman KJ, Hutchins GM, Bulkley BH. Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation. 1978;58(6):1204–11.PubMedCrossRef

Nery PB, Beanlands RS, Nair GM, Green M, Yang J, McArdle BA, et al. Atrioventricular block as the initial manifestation of cardiac sarcoidosis in middle-aged adults. J Cardiovasc Electrophysiol. 2014;25(8):875–81. doi:10.1111/jce.12401.PubMedCrossRef

Nery PB, Mc Ardle BA, Redpath CJ, Leung E, Lemery R, Dekemp R, et al. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. Pacing Clin Electrophysiol. 2014;37(3):364–74. doi:10.1111/pace.12277.PubMedCrossRef

Iwai K, Sekiguti M, Hosoda Y, DeRemee RA, Tazelaar HD, Sharma OP, et al. Racial difference in cardiac sarcoidosis incidence observed at autopsy. Sarcoidosis. 1994;11(1):26–31.PubMed

Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J. 2005;26(15):1538–43. doi:10.1093/eurheartj/ehi180.PubMedCrossRef

Youssef G, Leung E, Mylonas I, Nery P, Williams K, Wisenberg G, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 2012;53(2):241–8. doi:10.2967/jnumed.111.090662.PubMedCrossRef

Smedema JP, Snoep G, van Kroonenburgh MP, van Geuns RJ, Dassen WR, Gorgels AP, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45(10):1683–90. doi:10.1016/j.jacc.2005.01.047.PubMedCrossRef

Ohira H, Tsujino I, Ishimaru S, Oyama N, Takei T, Tsukamoto E, et al. Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis. Eur J Nucl Med Mol Imaging. 2008;35(5):933–41. doi:10.1007/s00259-007-0650-8.PubMedCrossRef

10.

Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol. 2014;63(4):329–36. doi:10.1016/j.jacc.2013.09.022.PubMedPubMedCentralCrossRef

11.

Mc Ardle BA, Birnie DH, Klein R, de Kemp RA, Leung E, Renaud J, et al. Is there an association between clinical presentation and the location and extent of myocardial involvement of cardiac sarcoidosis as assessed by 18F-fluorodoexyglucose positron emission tomography? Circ Cardiovasc Imaging. 2013;6(5):617–26. doi:10.1161/CIRCIMAGING.112.000289.PubMedCrossRef

12.

Soejima K, Yada H. The work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities. J Cardiovasc Electrophysiol. 2009;20(5):578–83. doi:10.1111/j.1540-8167.2008.01417.x.PubMedCrossRef

13.

Manabe O, Ohira H, Yoshinaga K, Sato T, Klaipetch A, Oyama-Manabe N, et al. Elevated (18)F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis. Eur J Nucl Med Mol Imaging. 2013;40(10):1558–66. doi:10.1007/s00259-013-2460-5.PubMedCrossRef

14.

Gropler RJ, Siegel BA, Lee KJ, Moerlein SM, Perry DJ, Bergmann SR, et al. Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans. J Nucl Med. 1990;31(11):1749–56.PubMed

15.

Bartlett ML, Bacharach SL, Voipio-Pulkki LM, Dilsizian V. Artifactual inhomogeneities in myocardial PET and SPECT scans in normal subjects. J Nucl Med. 1995;36(2):188–95.PubMed

16.

Tilkemeier PL, Cooke CD, Ficaro EP, Glover DK, Hansen CL, McCallister Jr BD. American Society of Nuclear Cardiology information statement: Standardized reporting matrix for radionuclide myocardial perfusion imaging. J Nucl Cardiol. 2006;13(6):e157–71. doi:10.1016/j.nuclcard.2006.08.014.PubMedCrossRef

17.

Cunningham M. More than just the kappa coefficient: a program to fully characterize inter-rater reliability between two raters. Presented at the SAS Global Forum 2009, Washington DC. Paper 242-2009

18.

Paik JY, Lee KH, Choe YS, Choi Y, Kim BT. Augmented 18F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein kinase C. J Nucl Med. 2004;45(1):124–8.PubMed

19.

Matsuki M, Matsuo M. MR findings of myocardial sarcoidosis. Clin Radiol. 2000;55(4):323–5. doi:10.1053/crad.1999.0081.PubMedCrossRef

20.

Shimada T, Shimada K, Sakane T, Ochiai K, Tsukihashi H, Fukui M, et al. Diagnosis of cardiac sarcoidosis and evaluation of the effects of steroid therapy by gadolinium-DTPA-enhanced magnetic resonance imaging. Am J Med. 2001;110(7):520–7.PubMedCrossRef

21.

Schatka I, Bengel FM. Advanced imaging of cardiac sarcoidosis. J Nucl Med. 2014;55(1):99–106. doi:10.2967/jnumed.112.115121.PubMedCrossRef

22.

Vignaux O, Dhote R, Duboc D, Blanche P, Dusser D, Weber S, et al. Clinical significance of myocardial magnetic resonance abnormalities in patients with sarcoidosis: a 1-year follow-up study. Chest. 2002;122(6):1895–901.PubMedCrossRef

23.

Crouser ED, Ono C, Tran T, He X, Raman SV. Improved detection of cardiac sarcoidosis using magnetic resonance with myocardial T2 mapping. Am J Respir Crit Care Med. 2014;189(1):109–12. doi:10.1164/rccm.201309-1668LE.PubMedPubMedCentral

24.

Hiraga H, Hiroe M, Iwai K. Guidelines for diagnosis of cardiac sarcoidosis: study report on diffuse pulmonary diseases (in Japanese). Tokyo: The Japanese Ministry of Health and Welfare; 1993. p. 23–4.

25.

Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M, et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest. 2008;133(6):1426–35. doi:10.1378/chest.07-2784.PubMedCrossRef

26.

Soussan M, Brillet PY, Nunes H, Pop G, Ouvrier MJ, Naggara N, et al. Clinical value of a high-fat and low-carbohydrate diet before FDG-PET/CT for evaluation of patients with suspected cardiac sarcoidosis. J Nucl Cardiol. 2013;20(1):120–7. doi:10.1007/s12350-012-9653-3.PubMedCrossRef

27.

Lee NJ, Lee B, Litt H. Cardiac MRI vs. myocardial 18F-FDG PET/CT in patients with clinical concern for cardiac sarcoid. J Cardiovasc Magn Reson. 2015;17 Suppl 1:O30. doi:10.1186/1532-429X-17-S1-O30 PubMedCentralCrossRef

28.

Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, et al. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm. 2007;4(10):1292–9. doi:10.1016/j.hrthm.2007.06.006.PubMedCrossRef

29.

Roberts WC, McAllister Jr HA, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group I) and review of 78 previously described necropsy patients (group II). Am J Med. 1977;63(1):86–108.PubMedCrossRef

30.

Vohringer M, Mahrholdt H, Yilmaz A, Sechtem U. Significance of late gadolinium enhancement in cardiovascular magnetic resonance imaging (CMR). Herz. 2007;32(2):129–37. doi:10.1007/s00059-007-2972-5.PubMedCrossRef

31.

Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, et al. HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis. Heart Rhythm Off J Heart Rhythm Soc. 2014;11(7):1305–24. doi:10.1016/j.hrthm.2014.03.043.CrossRef

32.

White JA, Rajchl M, Butler J, Thompson RT, Prato FS, Wisenberg G. Active cardiac sarcoidosis: first clinical experience of simultaneous positron emission tomography-magnetic resonance imaging for the diagnosis of cardiac disease. Circulation. 2013;127(22):e639–41. doi:10.1161/CIRCULATIONAHA.112.001217.PubMedCrossRef

Title: Comparison of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis
Authors: Hiroshi Ohira
David H. Birnie
Elena Pena
Jordan Bernick
Brian Mc Ardle
Eugene Leung
George A. Wells
Keiichiro Yoshinaga
Ichizo Tsujino
Takahiro Sato
Osamu Manabe
Noriko Oyama-Manabe
Masaharu Nishimura
Nagara Tamaki
Alexander Dick
Carole Dennie
Ran Klein
Jennifer Renaud
Robert A. deKemp
Terrence D. Ruddy
Benjamin J. W. Chow
Ross Davies
Renee Hessian
Peter Liu
Rob S. B. Beanlands
Pablo B. Nery
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3181-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2016

Thoracic fat volume is independently associated with coronary vasomotion

The impact of acquisition time of planar cardiac 123I-MIBG imaging on the late heart to mediastinum ratio

Multiparametric imaging of patient and tumour heterogeneity in non-small-cell lung cancer: quantification of tumour hypoxia, metabolism and perfusion

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Sympathetic nerve damage and restoration after ischemia-reperfusion injury as assessed by 11C-hydroxyephedrine

High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined 18F-FDG PET/MR imaging