Author + information
- Received November 28, 2016
- Revision received January 31, 2017
- Accepted February 7, 2017
- Published online January 1, 2018.
- Marc R. Dweck, MD, PhDa,b,
- Ronan Abgral, MD, PhDa,c,
- Maria Giovanna Trivieri, MD, PhDa,
- Philip M. Robson, PhDa,
- Nicolas Karakatsanis, PhDa,
- Venkatesh Mani, PhDa,
- Anna Palmisano, MDa,
- Marc A. Miller, MDd,
- Anuradha Lala, MDd,
- Helena L. Chang, MSe,
- Javier Sanz, MDd,
- Johanna Contreras, MDd,
- Jagat Narula, MD, PhDd,
- Valentin Fuster, MD, PhDd,
- Maria Padilla, MDf,
- Zahi A. Fayad, PhDa,∗ ( and )
- Jason C. Kovacic, MD, PhDd,∗∗ ()
- aTranslational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bBritish Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- cDepartment of Nuclear Medicine, European University of Brittany, CHRU Brest, Brest, France
- dCardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- eInternational Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- fDivision of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Zahi A. Fayad, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1234, New York, New York 10029-6576. (for technical/imaging matters related to this paper).
- ↵∗∗Dr. Jason C. Kovacic, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029. (for clinical matters related to this manuscript).
Objectives The purpose of this study was to explore the diagnostic usefulness of hybrid cardiac magnetic resonance (CMR) and positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) for active cardiac sarcoidosis.
Background Active cardiac sarcoidosis (aCS) is underdiagnosed and has a high mortality.
Methods Patients with clinical suspicion of aCS underwent hybrid CMR/PET with late gadolinium enhancement (LGE) and FDG to assess the pattern of injury and disease activity, respectively. Patients were categorized visually as magnetic resonance (MR)+PET+ (characteristic LGE aligning exactly with increased FDG uptake), MR+PET− (characteristic LGE but no increased FDG), MR−PET− (neither characteristic LGE nor increased FDG), and MR−PET+ (increased FDG uptake in absence of characteristic LGE) and further characterized as aCS+ (MR+PET+) or aCS− (MR+PET−, MR−PET−, MR−PET+). FDG uptake was quantified using maximum target-to-normal-myocardium ratio and the net uptake rate (Ki) from dynamic Patlak analysis. Receiver-operating characteristic methods were used to identify imaging biomarkers for aCS. FDG PET was assessed using computed tomography/PET in 19 control subjects with healthy myocardium.
Results A total of 25 patients (12 males; 54.9 ± 9.8 years of age) were recruited prospectively; 8 were MR+PET+, suggestive of aCS; 1 was MR+PET−, consistent with inactive cardiac sarcoidosis; and 8 were MR−PET−, with no imaging evidence of cardiac sarcoidosis. Eight patients were MR−PET+ (6 with global myocardial FDG uptake, 2 with focal-on-diffuse uptake); they demonstrated distinct Ki values and hyperintense maximum standardized uptake value compared with MR+PET+ patients. Similar hyperintense patterns of global (n = 9) and focal-on-diffuse (n = 2) FDG uptake were also observed in control patients, suggesting physiological myocardial uptake. Maximum target-to-normal-myocardium ratio values were higher in the aCS+ group (p < 0.001), demonstrating an area under the curve of 0.98 on receiver-operating characteristic analysis for the detection of aCS, with an optimal maximum target-to-normal myocardium ratio threshold of 1.2 (Youden index: 0.94).
Conclusions CMR/PET imaging holds major promise for the diagnosis of aCS, providing incremental information about both the pattern of injury and disease activity in a single scan. (In Vivo Molecular Imaging [MRI] of Atherothrombotic Lesions; NCT01418313)
This work was supported by a National Institutes of Health grant (NIH/NHLBI R01HL071021) (to Dr. Fayad) and by the British Heart Foundation FS/14/78/31020 (to Dr. Dweck). Dr. Dweck is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Dweck and Abgral contributed equally to this work and are co-first authors.
Nathaniel Reichek, MD, served as the Guest Editor for this article.
- Received November 28, 2016.
- Revision received January 31, 2017.
- Accepted February 7, 2017.
- 2018 American College of Cardiology Foundation