Abstract
We report a case in which late gadolinium enhancement (LGE) and 67-Ga scintigraphy were useful for the diagnosis of cardiac sarcoidosis and for the evaluation of the disease activity.The patient was a 60-year-old woman who had been diagnosed as having eye sarcoidosis when she was 48. Two years previously her electrocardiogram had shown abnormalities but the coronary angiography had shown normal coronary arteries; however, an aneurysm was detected in the apical portion by left ventriculography. A II degree AV block was noted on the electrocardiogram and she was referred to us for further detailed evaluation. Since the biopsy findings of skin eruptions on both eyelids indicated an epithelial cell granuloma, she was diagnosed as having cutaneous sarcoidosis. On the 67-Ga scintigram, myocardial accumulation of gallium was recognized, and on cardiovascular magnetic resonance (CMR), LGE was recognized. She was diagnosed as cardiac sarcoidosis and steroid therapy started with 30 mg prednisolone. The myocardial accumulation of gallium on the 67-Ga scintigram disappeared after the 30th day of steroid therapy. On the other hand, no changes in LGE patterns were seen after steroid therapy. In this case, LGE was useful for the diagnosis of cardiac sarcoidosis, and 67-Ga scintigram was useful for the evaluation of the disease activity. This case shows that both imaging techniques are important for the diagnosis of cardiac sarcoidosis and evaluation of the disease.
References
Roberts WC, McAllister HA Jr, Ferrans VJ (1977) Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med 63(1):86–108
Matsui Y, Iwai K, Tachibana T et al (1976) Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci 278:455–469
Hiraga H, Yuwai K, Hiroe M et al (1993) The Japanese Ministry of Health and Welfare. Guideline for the diagnosis of cardiac sarcoidosis: study report on diffuse pulmonary diseases in [Japanese]. Tokyo, Japan, pp 23–24
Shimada T, Shimada K, Sakane T et al (2001) Diagnosis of cardiac sarcoidosis and evaluation of the effects of steroid therapy by gadolinium–DTPA-enhanced magnetic resonace imaging. Am J Med 110:520–527
Vignaux O, Dhote R, Duboc D et al (2002) Clinical ignificance of myocardial magnetic resonace abnormalities in patients with sarcoidosis.CHEST 122:1895–1901
Skold CM, Larsen FF, Phersson SK et al (2002) Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography. J Intern Med 252:465–471
Serra JJ, Monte GU, Mello ES et al (2003) Cardiac sarcoidosis evaluated by delayed-enhanced magnetic resonance imaging. Circulation 107:e188–e189
Nemeth MA, Muthupilla R, Wilson JM, et al (2004) Cardiac sarcoidosis. Detected by delayed-hyperenhancement magnetic resonace imaging. Tex Heart Inst J 31(1):99–102.
Smedema JP, Snoep G, van Kroonenburgh MP et al (2005) Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol 45(10):1683–1690
Simonetti OP, Kim RJ, Fieno DS et al (2001) An improved MR imaging technique for the visualization of myocardial infarction. Radiology 218:215–223
Wu E, Judd RM, Vargas JD et al (2001) Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet 357:21–28
Smedema JP, Snoep G, van Kroonenburgh MP et al (2005) The additional value of gadolinium-enhanced MRI to standard assessment for cardiac involvement in patients with pulmonary sarcoidosis. Chest 128(3):1629–1637
Sharma OP (1997) Cardiac and neurologic dysfunction in sarcoidosis. Clin Chest Med 18(4):813–825
Silverman KJ, Hutchins GM, Bulkley BH (1978) Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation 58(6):1204–1211
Iwai K, Sekiguti M, Hosoda Y et al (1994) Racial difference in cardiac sarcoidosis incidence observed at autopsy. Sarcoidosis 11(1):26–31
Tadamura E, Yamamuro M, Kubo S et al (2005) Effectiveness of delayed enhanced MRI for identification of cardiac sarcoidosis: comparison with radionuclide imaging. AJR Am J Roentgenol 185(1):110–115
Smedema JP, Snoep G, van Kroonenburgh MP et al (2005) Cardiac involvement in patients with pulmonary sarcoidosis assessed at two university medical centers in the Netherlands. Chest 128(1):30–35
Okayama K, Kurata C, Tawarahara K et al (1995) Diagnostic and prognostic value of myocardial scintigraphy with thallium-201 and gallium-67 in cardiac sarcoidosis. Chest 107(2):330–334
O’Connell JB, Henkin RE, Robinson JA et al (1984) Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis. Circulation 70(1):58–62
Newman LS, Rose CS, Maier LA (1997) Sarcoidosis. N Engl J Med 336(17):1224–1234
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Kiuchi, S., Teraoka, K., Koizumi, K. et al. Usefulness of late gadolinium enhancement combined with MRI and 67-Ga scintigraphy in the diagnosis of cardiac sarcoidosis and disease activity evaluation. Int J Cardiovasc Imaging 23, 237–241 (2007). https://doi.org/10.1007/s10554-006-9134-3
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DOI: https://doi.org/10.1007/s10554-006-9134-3