Figures
- FIGURE 1
Frequency of positive scans. a) Positive 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) findings consistent with cardiac sarcoidosis (CS) were recorded in 27% of the patients in the normal group and 53% of those in the abnormal group, with the frequency of positive findings being significantly higher in the abnormal group (p=0.012). b) Positive cardiac MRI (CMR) findings consistent with CS were recorded in 42% of the patients in the normal group and 71% of those in the abnormal group, with the frequency of positive findings being significantly higher in the abnormal group (p=0.005). ECG: electrocardiography; TTE: transthoracic echocardiography.
- FIGURE 2
Study flow and prevalence of cardiac sarcoidosis. A flow diagram illustrating the classification of normal and abnormal groups based on the ECG and TTE results. Six of the 33 patients (18%) in the normal group and 43 of the 79 patients (59%) in the abnormal group were diagnosed with CS on the basis of Japanese guidelines, with a significantly higher frequency in the abnormal group (p=0.0004). CS: cardiac sarcoidosis; ECG: electrocardiography; TTE: transthoracic echocardiography.
- FIGURE 3
Representative images (small cardiac lesion) (patient 1 in table 2). a). Maximum intensity projection 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) image shows 18F-FDG uptake in the mediastinal, bilateral hilar and abdominal lymph nodes and heart. b) 18F-FDG PET image shows focal myocardial 18F-FDG uptake in the right ventricular papillary muscle (arrow). c) Late gadolinium-enhanced magnitude inversion recovery image in the short axis shows hyperenhancement in the right ventricular papillary muscle (arrow).
- FIGURE 4
Representative images (multiorgan involvement) (patient 5 in table 2). a) Maximum intensity projection 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) image shows 18F-FDG uptake in the mediastinal, bilateral hilar and abdominal lymph nodes, spleen and heart. b) 18F-FDG PET image shows focal myocardial 18F-FDG uptake in the mid-segments of the anteroseptal and inferior walls (arrows). c) Late gadolinium-enhanced magnitude inversion recovery image in the short axis shows hyperenhancements in the mid-segments of the anteroseptal and inferior walls (arrows).
- FIGURE 5
A case with reduced LV ejection fraction (LVEF) (patient 6 in table 2). a) Maximum intensity projection 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) image shows 18F-FDG uptake in the mediastinal lymph nodes and heart. b) 18F-FDG PET image shows focal myocardial 18F-FDG uptake in the basal segment of the anteroseptal wall (arrow). c) Late gadolinium-enhanced magnitude inversion recovery image in the short axis shows hyperenhancements in the basal segment of the anteroseptal wall (arrow).
Tables
- TABLE 1
Patient characteristics
All Normal Abnormal p-value Subjects n 112 33 79 Age years, mean±sd 55.2±17.2 52.6±16.5 56.3±17.5 0.30 Women 72 (64) 25 (76) 47 (59) 0.10 Biopsy site n (lung/extra-lung) 99/13 30/3 69/10 0.58 Steroid n (yes/no) 11/101 3/30 8/71 0.87 Involved organ(s) Eye 73 (65) 21 (64) 52 (66) 0.82 LN 105 (94) 31 (94) 74 (94) 0.96 Lung 77 (69) 23 (70) 54 (68) 0.89 Skin 22 (20) 5 (15) 17 (22) 0.44 Liver 5 (4) 2 (6) 3 (4) 0.60 Number of involved organ(s) except for heart, mean±sd 2.69±0.95 2.70±0.95 2.68±0.95 0.95 Positive FDG PET consistent with CS 51 (46) 9 (27) 42 (53) 0.012 Positive LGE-CMR consistent with CS 70 (63) 14 (42) 56 (71) 0.005 Diagnosis of CS 49 (44) 6 (18) 43 (54) 0.0004 Data presented as n (%) unless otherwise stated. LN: lymph node; FDG PET: 18F-fluorodeoxyglucose positron emission tomography; CS: cardiac sarcoidosis; LGE-CMR: late gadolinium-enhanced cardiac magnetic resonance imaging.
- TABLE 2
Detailed results for the six patients with cardiac sarcoidosis (CS) in the normal group
No. Sex Age years Involved organ(s) except for heart 18F-FDG PET Cardiac MRI ACE IU L−1 Comments Follow-up timings of PET and MRI Outcome 1 F 51 LN#, skin# FDG uptake in the RV papillary muscle LGE in the RV papillary muscle 21.4 Small cardiac lesion in the RV 6 M, 12 M, 24 M, 42 M Natural remission after 3.5 years;
FDG uptake disappeared and LGE remained at 42 M2 F 22 Eye, LN#, lung# FDG uptake in the mid-segment of the lateral wall of the LV LGE in the mid-segment of the lateral (epicardial and endocardial layers) wall of the LV 28.9 Small cardiac lesion in the lateral wall of the LV 6 M Natural remission after 6 M;
FDG uptake disappeared and LGE remained at 6 M3 M 35 Bone, LN, skin#, stomach# FDG uptake in the basal to mid-segments of the anteroseptal walls of the LV LGE in the basal to mid-segment of the anteroseptal walls (subepicardial layer) of the LV 23.5 Multiorgan involvement (bone, LN, skin, stomach and heart) 1 M, 6 M Syncope with transient 2nd degree AVB and initiate steroid therapy. AVB improved; FDG uptake disappeared and LGE remained at 1 M and 6 M 4 F 71 Eye, LN#, lung FDG uptake in the basal segments of the anterolateral and inferoseptal walls of the LV LGE in the basal segment of the anterolateral (subepicardial layer) and inferoseptal walls (mid-layer) of the LV 14.9 Small cardiac lesions in the anterolateral and inferoseptal walls of the LV 24 M Natural remission after 24 M;
FDG uptake disappeared and LGE remained at 24 M5 F 25 Eye, LN#, lung, spleen FDG uptake in the mid to apical segments of the anteroseptal and inferior walls LGE in the mid-segments of the anteroseptal (subendocardial layer) and inferior walls (subepicardial layer) 18.4 Multiorgan involvement (eye, LN, lung, spleen and heart) 3 M, 4 M Follow-up after 3 M revealed progression of active cardiac and extracardiac involvements; degree and extent of FDG uptake and LGE enhanced at 3 M. Start steroid therapy. FDG uptake reduced and LGE remained at 4 M 6 M 35 LN, lung# FDG uptake in the basal to mid-segments of the anterior wall and mid to apical segments of the septum LGE in the basal to mid-segments of the anterior to anterolateral walls (subepicardial layer) and mid-segment of the septum (RV side) 7.9 Mildly reduced LVEF (49%) 1 M, 3 M, 12 M Start steroid therapy to preserve LVEF;
no FDG uptake and LGE remained at 1 M, 3 M and 12 M;
LVEF recovered to the normal rangeFDG: 18F-fluorodeoxy glucose; PET: positron emission tomography; MRI: magnetic resonance imaging; ACE: angiotensin-converting-enzyme; M: months; LN: lymph nodes; LV: left ventricle; RV: right ventricle; LGE: late gadolinium enhancement; AVB: atrioventricular block; LVEF: left ventricular ejection fraction. #: organ with diagnostic histology consistent with sarcoidosis.
