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
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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.
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).
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).
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.
KeywordsCardiac sarcoidosis Cardiac magnetic resonance Conduction system disease Atrioventricular block 18F-Fluorodeoxyglucose positron emission tomography
We express our gratitude to the Cardiac Sarcoidosis Cohort Study (CHASM-CS), National Cardiac PET Center teams, and Canadian Care Network of Ontario, including Linda Garrard, RN, Karen MacDonald, RN, and Ann Guo, BEng, as well as May Aung, CNMT, Kym Gardner, CNMT, Monique Pacquette, RN, Patricia Grant, RN, and Kori Kingsbury, MSN.
Compliance with ethical standards
R.S.B. is a career Investigator supported by the Heart and Stroke Foundation of Ontario (HFSO), the University of Ottawa Heart Institute (UOHI) Vered Chair in Cardiology and a Tier 1 University of Ottawa Chair in Cardiovascular Research. D.B. is a mid-career Investigator supported by the HSFO. H.O. was supported by a Molecular Function and Imaging HSFO Program Grant (no. PRG6242), the University of Ottawa Department of Medicine, a Hokkaido Heart Association Grant for Research, and an Astellas Foundation grant for Research on Metabolic Disorders. H.O. and B.M. were supported by the University of Ottawa Heart Institute’s Whit and Heather Tucker Endowed Cardiovascular Research Fellowship.
The work was supported in part by a research trial grant from the Ministry of Health and Long Term Care Research (grant no. 06374) for the Cardiac Sarcoidosis Cohort Study (CHASM-CS). The project is in collaboration with the Canadian Cardiovascular Network of Ontario Working Group for Cardiac PET in collaboration with the PET Steering Committee of Ontario. This work was also partially supported by IMAGE-HF (Imaging Modalities to Assist with Guiding Therapy and the Evaluation of Patients with Heart Failure; Canadian Institute of Health Research team grant no. CIF 99470).
Conflicts of Interest
R.S.B. and R.d.K. are consultants with Jubilant DRAXImage (JDI) and have received grant funding from a government/industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, JDI). R.d.K. receives revenues from a rubidium-82 generator technology licensed to Jubilant DRAXImage, and from sales of FlowQuant. R.S.B. is a consultant for Lantheus Medical Imaging and JDI.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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