scholarly journals Cardiac Sarcoidosis: Clinical Manifestations, Imaging Characteristics, and Therapeutic Approach

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15713 ◽  
Author(s):  
Brian A. Houston ◽  
Monica Mukherjee
Keyword(s):  
Cardiac Sarcoidosis ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Mononuclear Phagocytes ◽  
Nuclear Spectroscopy ◽  
Imaging Modalities ◽  
System Disease ◽  
Imaging Characteristics ◽  
Positron Emission ◽  
Difficult Challenge

Sarcoidosis is a multi-system disease pathologically characterized by the accumulation of T-lymphocytes and mononuclear phagocytes into the sine qua non pathologic structure of the noncaseating granuloma. Cardiac involvement remains a key source of morbidity and mortality in sarcoidosis. Definitive diagnosis of cardiac sarcoidosis, particularly early enough in the disease course to provide maximal therapeutic impact, has proven a particularly difficult challenge. However, major advancements in imaging techniques have been made in the last decade. Advancements in imaging modalities including echocardiography, nuclear spectroscopy, positron emission tomography, and magnetic resonance imaging all have improved our ability to diagnose cardiac sarcoidosis, and in many cases to provide a more accurate prognosis and thus targeted therapy. Likewise, therapy for cardiac sarcoidosis is beginning to advance past a “steroids-only” approach, as novel immunosuppressant agents provide effective steroid-sparing options. The following focused review will provide a brief discussion of the epidemiology and clinical presentation of cardiac sarcoidosis followed by a discussion of up-to-date imaging modalities employed in its assessment and therapeutic approaches.

scholarly journals The usefulness of repeated CMR and FDG PET/CT in the diagnosis of patients with initial possible cardiac sarcoidosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
H. Mathijssen ◽  
T. W. H. Tjoeng ◽  
R. G. M. Keijsers ◽  
A. L. M. Bakker ◽  
F. Akdim ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Imaging Techniques ◽  
Immunosuppressive Treatment ◽  
Imaging Modalities ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Lge Cmr

Abstract Background Cardiac sarcoidosis (CS) diagnosis is usually based on advanced imaging techniques and multidisciplinary evaluation. Diagnosis is classified as definite, probable, possible or unlikely. If diagnostic confidence remains uncertain, cardiac imaging can be repeated. The objective is to evaluate the usefulness of repeated cardiac magnetic resonance imaging (CMR) and fluorodeoxyglucose positron emission tomography (FDG PET/CT) for CS diagnosis in patients with an initial “possible” CS diagnosis. Methods We performed a retrospective cohort study in 35 patients diagnosed with possible CS by our multidisciplinary team (MDT), who received repeated CMR and FDG PET/CT within 12 months after diagnosis. Imaging modalities were scored on abnormalities suggestive for CS and classified as CMR+/PET+, CMR+/PET−, CMR−/PET+ and CMR−/PET−. Primary endpoint was final MDT diagnosis of CS. Results After re-evaluation, nine patients (25.7%) were reclassified as probable CS and 16 patients (45.7%) as unlikely CS. Two patients started immunosuppressive treatment after re-evaluation. At baseline, eleven patients (31.4%) showed late gadolinium enhancement (LGE) on CMR (CMR+) and 26 (74.3%) patients showed myocardial FDG-uptake (PET+). At re-evaluation, nine patients (25.7%) showed LGE (CMR+), while 16 patients (45.7%) showed myocardial FDG-uptake (PET+). When considering both imaging modalities together, 82.6% of patients with CMR−/PET+ at baseline were reclassified as possible or unlikely CS, while 36.4% of patients with CMR+ at baseline were reclassified as probable CS. Three patients with initial CMR−/PET+ showed LGE at re-evaluation. Conclusion Repeated CMR and FDG PET/CT may be useful in establishing or rejecting CS diagnosis, when initial diagnosis is uncertain. However, clinical relevance has to be further determined.

scholarly journals Advances in Diagnostic Imaging for Cardiac Sarcoidosis

2021 ◽  
Vol 10 (24) ◽  
pp. 5808
Author(s):  
Osamu Manabe ◽  
Noriko Oyama-Manabe ◽  
Tadao Aikawa ◽  
Satonori Tsuneta ◽  
Nagara Tamaki
Keyword(s):  
Cardiac Sarcoidosis ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Granulomatous Inflammation ◽  
Unknown Etiology ◽  
Lower Sensitivity ◽  
Positron Emission ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
Enhanced Computed Tomography

Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS.

Abstract 17103: A Novel Approach to an Old and Unrecognized Disease- Intricacies of Cardiac Sarcoidosis

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Nael Aldweib ◽  
Michael Popeck ◽  
Rohan Trivedi ◽  
Mark Doyle ◽  
Amresh Raina ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Conduction System ◽  
Multivariable Model ◽  
Imaging Diagnosis ◽  
System Disease ◽  
Imaging Characteristics ◽  
Imaging Results ◽  
Conduction System Disease ◽  
Group 1

Introduction: Appropriate referral of patients to advanced imaging for suspected cardiac sarcoidosis (CS), and prognosis of patients based on imaging results is not well understood. We sought to define clinical predictors associated with an imaging diagnosis of CS and compare outcomes in the CS group, based on imaging characteristics Methods: Study population comprised 164 consecutive patients, referred for FDG-PET or MRI imaging based on clinical suspicion for CS. Imaging diagnosis of CS was based on prior MRI results or current FDG-PET results, classified as scar+ inflammation (group1), scar-only (group2) and inflammation-only (group3). Follow-up was 2.3±1.3 years Results: Among 164 patients, 61% were male (mean age 59±10 years, 82% white) and 86 (52%) were diagnosed as CS (68 by PET and 18 by MRI). Clinical presentation of VT (32/86-37% vs 7/78-10%) and conduction system disease i.e. AV block and sinus node dysfunction (14/86-16% vs 6/78-6%) was more likely in CS (p<0.05). Prior diagnosis of extracardiac sarcoid was less frequent in CS (49% vs 69% p=0.03). LVEF was similar in both groups (45±18 in CS vs 51±19 in controls). In a multivariable model including the above variables, presentation with VT (OR5.64; CI-1.98-16.10) and conduction system disease (OR 2.13; CI-1.03-9.94) remained significant predictors of imaging diagnosis of CS. The distribution of FDG-PET results was: Group 1 (29%), Group 2 (32%) and Group 3 (38%). Group 1 had the highest incidence of VT at presentation (55% vs 41% vs 19%). Mean LVEF was 44±14, 23±14 and 52±12 across 3 groups respectively (p<0.003). Steroids and immunosuppressants were more commonly used in Groups 1 and 3 vs 2 (75%, 69% vs 18% p<0.0001). In a multivariable model that included LVEF and presentation with VT/conduction system disease, use of immunosuppressants (OR 2.57; CI 1.05-6.25) and LVEF (OR 0.97; CI 0.94-0.99) significantly predicted the outcome of death or recurrent VT (chi-sq 9.57; p=0.008) Conclusions: In a population being referred for imaging diagnosis of CS, presentation with VT or conduction system disease is more likely to identify those with disease. Among those with imaging diagnosis of CS by FDG-PET, presence of inflammation and therefore use of immunosuppressants and low LVEF were predictive of death or VT.

scholarly journals In Which Patients with Sarcoidosis Is FDG PET/CT Indicated?

2020 ◽  
Vol 9 (3) ◽  
pp. 890 ◽  
Author(s):  
Ruth G.M. Keijsers ◽  
Jan C. Grutters
Keyword(s):  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Clinical Manifestations ◽  
Emission Tomography ◽  
Diagnostic Process ◽  
Inflammatory Lesions ◽  
Positron Emission ◽  
Pet Ct ◽  
Conventional Tests ◽  
Fdg Pet Ct

Sarcoidosis is a granulomatous disease of which the etiology remains unknown. The diverse clinical manifestations may challenge clinicians, particularly when conventional markers are inconclusive. From various studies, it has become clear that fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT aids in sarcoidosis care. In this article, an update on FDG PET/CT in sarcoidosis is provided. The use of FDG PET/CT in the diagnostic process of sarcoidosis is explained, especially in determining treatable inflammatory lesions in symptomatic patients with indecisive conventional tests. Furthermore, FDG PET/CT for evaluating the potential benefit of additional inflammatory treatment is described and its use in cardiac sarcoidosis is highlighted.

Adrenocortical neoplasms in adulthood and childhood: distinct presentation. Review of the clinical, pathological and imaging characteristics

2017 ◽  
Vol 30 (3) ◽  
Author(s):  
Andréa Farias de Melo-Leite ◽  
Paula Condé Lamparelli Elias ◽  
Sara Reis Teixeira ◽  
Silvio Tucci ◽  
Gyl Eanes Barros ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Imaging Techniques ◽  
Abdominal Mass ◽  
Age Groups ◽  
Genetic Alterations ◽  
Benign Tumors ◽  
Conn Syndrome ◽  
Imaging Characteristics ◽  
Positron Emission ◽  
Adults And Children

AbstractAdrenocortical tumors (ACT) in adulthood and childhood vary in clinical, histopathological, molecular, prognostic, and imaging aspects. ACT are relatively common in adults, as adenomas are often found incidentally on imaging. ACT are rare in children, though they have a significantly higher prevalence in the south and southeast regions of Brazil. In clinical manifestation, adults with ACT present more frequently with glucocorticoid overproduction (Cushing syndrome), mineralocorticoid syndromes (Conn syndrome), or the excess of androgens in women. Subclinical tumors are frequently diagnosed late, associated with compression symptoms of abdominal mass. In children, the usual presentation is the virilizing syndrome or virilizing association and hypercortisolism. Histopathological grading and ACT classification in malignant and benign lesions are different for adults and children. In adults, the described criteria are the Hough, Weiss, modified Weiss, and Van Slooten. These scores are not valid for children; there are other criteria, such as proposed by Wieneke and colleagues. In molecular terms, there is also a difference related to genetic alterations found in these two populations. This review discusses the imaging findings of ACT, aiming to characterize the present differences between ACT found in adults and children. We listed several differences between magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography–computed (PET-CT) and also performed a literature review, which focuses on studied age groups of published articles in the last 10 years regarding cortical neoplasm and imaging techniques. Published studies on ACT imaging in children are rare. It is important to stress that the majority of publications related to the differentiation of malignant and benign tumors are based almost exclusively on studies in adults. A minority of articles, however, studied adults and children together, which may not be appropriate.

scholarly journals A literature review on multimodality molecular imaging nanoprobes for cancer detection

2019 ◽  
Vol 25 (2) ◽  
pp. 57-68 ◽  
Author(s):  
Daryoush Shahbazi-Gahrouei ◽  
Pegah Moradi Khaniabadi ◽  
Saghar Shahbazi-Gahrouei ◽  
Amir Khorasani ◽  
Farshid Mahmoudi
Keyword(s):  
Molecular Imaging ◽  
Cancer Detection ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Emission Tomography ◽  
Imaging Modalities ◽  
Single Photon Emission ◽  
Positron Emission ◽  
Magnetic Resonance Imaging Mri

Abstract Molecular imaging techniques using nanoparticles have significant potential to be widely used for the detection of various types of cancers. Nowadays, there has been an increased focus on developing novel nanoprobes as molecular imaging contrast enhancement agents in nanobiomedicine. The purpose of this review article is to summarize the use of a variety of nanoprobes and their current achievements in accurate cancer imaging and effective treatment. Nanoprobes are rapidly becoming potential tools for cancer diagnosis by using novel molecular imaging modalities such as Ultrasound (US) imaging, Computerized Tomography (CT), Single Photon Emission Tomography (SPECT) and Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), and Optical Imaging. These imaging modalities may facilitate earlier and more accurate diagnosis and staging the most of cancers.

scholarly journals Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1993
Author(s):  
Kazumasa Oura ◽  
Mao Yamaguchi Oura ◽  
Ryo Itabashi ◽  
Tetsuya Maeda
Keyword(s):  
Takayasu Arteritis ◽  
Imaging Techniques ◽  
Duplex Ultrasound ◽  
Disease Diagnosis ◽  
Vascular Imaging ◽  
Arterial Stenosis ◽  
Imaging Modalities ◽  
Positron Emission ◽  
Cerebrovascular Events ◽  
Ischemic Attack

Takayasu arteritis (TA) is a large vessel vasculitis that causes stenosis, occlusion, and sometimes the aneurysm of the aorta and its major branches. TA often occurs in young women, and because the symptoms are not obvious in the early stages of the disease, diagnosis is difficult and often delayed. In approximately 10% to 20% of patients, TA is reportedly complicated by ischemic stroke or transient ischemic attack. It is important to diagnose TA early and provide appropriate treatment to prevent complications from stroke. Diagnostic imaging techniques to visualize arterial stenosis are widely used in clinical practice. Even if no signs of cerebrovascular events are present at the time of the most recent evaluation of patients with TA, follow-up vascular imaging is important to monitor disease progression and changes in the cerebrovascular risk. However, the optimal imaging technique for monitoring of TA has not been established. Therefore, the purpose of this review is to describe newly available evidence on the usefulness of conventional imaging modalities (digital subtraction angiography, computed tomography angiography, magnetic resonance imaging/angiography, duplex ultrasound, and positron emission tomography) and novel imaging modalities (optical coherence tomography, infrared thermography, contrast-enhanced ultrasonography, and superb microvascular imaging) in the diagnosis and monitoring of TA.

scholarly journals Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge

2020 ◽  
Vol 16 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Francis J. Ha ◽  
Sharad Agarwal ◽  
Katharine Tweed ◽  
Sonny C. Palmer ◽  
Heath S. Adams ◽  
...  
Keyword(s):  
Cardiac Imaging ◽  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Imaging Techniques ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Imaging Modalities ◽  
Cardiac Imaging Techniques ◽  
Diagnostic Dilemma

Cardiac Sarcoidosis (CS) represents a unique diagnostic dilemma. Guidelines have been recently revised to reflect the established role of sophisticated imaging techniques. Trans-thoracic Echocardiography (TTE) is widely adopted for initial screening of CS. Contemporary TTE techniques could enhance detection of subclinical Left Ventricular (LV) dysfunction, particularly LV global longitudinal strain assessment which predicts event-free survival (meta-analysis of 5 studies, hazard ratio 1.28, 95% confidence interval 1.18-1.37, p < 0.0001). However, despite the wide availability of TTE, it has limited sensitivity and specificity for CS diagnosis. Cardiac Magnetic resonance Imaging (CMR) is a crucial diagnostic modality for suspected CS. Presence of late gadolinium enhancement signifies myocardial scar and enables risk stratification. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) coupled with myocardial perfusion imaging can identify active CS and guide immunosuppressant therapy. Gallium scintigraphy may be considered although FDG-PET is often preferred. While CMR and FDG-PET provide complementary information in CS evaluation, current guidelines do not recommend which imaging modalities are essential in suspected CS and if so, which modality should be performed first. The utility of hybrid imaging combining both advanced imaging modalities in a single scan is currently being explored, although not yet widely available. In view of recent, significant advances in cardiac imaging techniques, this review aims to discuss changes in guidelines for CS diagnosis, the role of various cardiac imaging modalities and the future direction in CS.

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