Skip to main content

Advertisement

SpringerLink
Log in

Reproducibility of cardiac magnetic resonance imaging in patients referred for the assessment of cardiac sarcoidosis; implications for clinical practice

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Cardiac sarcoidosis (CS) is an increasingly recognized condition, but cardiac magnetic resonance (CMR) image interpretation in these patients may be challenging as findings are often non-specific. The main objective of this study was to investigate the inter-reader agreement for the overall interpretation of CMR for the diagnosis of CS in an experienced reference center and investigate factors that may lead to discrepancies between readers. Consecutive patients undergoing CMR imaging to investigate for CS were included. CMR images were independently reviewed by two readers, blinded to all clinical, imaging and demographic information. The readers classified each scan as “consistent with cardiac sarcoidosis”, “not consistent with cardiac sarcoidosis” or “indeterminate”. Inter-reader agreement was assessed using κ-statistics. When there was disagreement on the overall interpretation, a third reader reviewed the images. Also, two readers independently commented on the presence of edema, presence of LGE (both ventricles) and quantified the extent of left ventricular LGE. 87 patients (43 women, mean age 54.3 ± 12.2 years) were included in the study. There was agreement regarding the overall interpretation in 72 of 87 (83%) CMR scans. The κ value was 0.64, indicating moderate agreement. There was similar moderate agreement in the interpretation of LGE parameters. In an experienced referral center, we found moderate agreement between readers in the interpretation of CMR in patients with suspected CS. Physicians should be aware of this inter-observer variability in interpretation of CMR studies in patients with suspected CS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Silverman KJ, Hutchins GM, Bulkley BH (1978) Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation 58:1204–1211

    Article  CAS  Google Scholar 

  2. Iwai K, Tachibana T, Takemura T, Matsui Y, Kitaichi M, Kawabata Y (1993) Pathological studies on sarcoidosis autopsy. I. Epidemiological features of 320 cases in Japan. Acta Pathol Jpn 43:372–376

    PubMed  CAS  Google Scholar 

  3. Nery PB, Beanlands RS, Nair GM, Green M, Yang J, McArdle BA et al (2014) Atrioventricular block as the initial manifestation of cardiac sarcoidosis in middle-aged adults. J Cardiovasc Electrophysiol 25:875–881

    Article  Google Scholar 

  4. Nery PB, Mc Ardle BA, Redpath CJ, Leung E, Lemery R, Dekemp R et al (2014) Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. Pacing Clin Electrophysiol PACE 37:364–374

    Article  Google Scholar 

  5. Nordenswan H-K, Lehtonen J, Ekström K, Kandolin R, Simonen P, Mäyränpää M et al (2018) Outcome of cardiac sarcoidosis presenting with high-grade atrioventricular block. Circ Arrhythm Electrophysiol 11:e006145

    Article  Google Scholar 

  6. Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS et al (2014) HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm Off J Heart Rhythm Soc 11:1305–1323

    Article  Google Scholar 

  7. Ohira H, Ardle BM, deKemp RA, Nery P, Juneau D, Renaud JM et al (2017) Inter- and intraobserver agreement of (18)F-FDG PET/CT image interpretation in patients referred for assessment of cardiac sarcoidosis. J Nucl Med Off Publ Soc Nucl Med 58:1324–1329

    CAS  Google Scholar 

  8. Terasaki F, Yoshinaga K (2017) New guidelines for diagnosis of cardiac sarcoidosis in Japan. Ann Nucl Cardiol 3:42–45

    Article  Google Scholar 

  9. Weng Z, Yao J, Chan RH, He J, Yang X, Zhou Y et al (2016) Prognostic value of LGE-CMR in HCM: a meta-analysis. JACC Cardiovasc Imaging 9:1392–1402

    Article  Google Scholar 

  10. Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G et al (2006) Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 114:1581–1590

    Article  Google Scholar 

  11. Almehmadi F, Joncas SX, Nevis I, Zahrani M, Bokhari M, Stirrat J et al (2014) Prevalence of myocardial fibrosis patterns in patients with systolic dysfunction: prognostic significance for the prediction of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. Circ Cardiovasc Imaging 7:593–600

    Article  Google Scholar 

  12. Patel MR, Cawley PJ, Heitner JF, Klem I, Parker MA, Jaroudi WA et al (2009) Detection of myocardial damage in patients with sarcoidosis. Circulation 120:1969–1977

    Article  Google Scholar 

  13. Birnie DH, Nery PB, Ha AC, Beanlands RSB (2016) Cardiac sarcoidosis. J Am Coll Cardiol 68:411–421

    Article  Google Scholar 

  14. Hulten E, Agarwal V, Cahill M, Cole G, Vita T, Parrish S et al (2016) Presence of late gadolinium enhancement by cardiac magnetic resonance among patients with suspected cardiac sarcoidosis is associated with adverse cardiovascular prognosis: a systematic review and meta-analysis. Circ Cardiovasc Imaging 9:e005001

    PubMed  PubMed Central  Google Scholar 

  15. Birnie D, Ha A, Kron J (2018) Which patients with cardiac sarcoidosis should receive implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol 11:e006685

    Article  Google Scholar 

  16. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB et al (2018) 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 15:e73–189

    Article  Google Scholar 

  17. Agoston-Coldea L, Kouaho S, Sacre K, Dossier A, Escoubet B, Chillon S et al (2016) High mass (>18g) of late gadolinium enhancement on CMR imaging is associated with major cardiac events on long-term outcome in patients with biopsy-proven extracardiac sarcoidosis. Int J Cardiol 222:950–956

    Article  Google Scholar 

  18. Ise T, Hasegawa T, Morita Y, Yamada N, Funada A, Takahama H et al (2014) Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis. Heart Br Card Soc 100:1165–1172

    CAS  Google Scholar 

  19. Smedema J-P, van Geuns R-J, Ector J, Heidbuchel H, Ainslie G, Crijns HJGM (2018) Right ventricular involvement and the extent of left ventricular enhancement with magnetic resonance predict adverse outcome in pulmonary sarcoidosis. ESC Heart Fail 5:157–171

    Article  Google Scholar 

  20. Flett AS, Hasleton J, Cook C, Hausenloy D, Quarta G, Ariti C et al (2011) Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. JACC Cardiovasc Imaging 4:150–156

    Article  Google Scholar 

  21. Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85

    Article  Google Scholar 

  22. Bomma C, Rutberg J, Tandri H, Nasir K, Roguin A, Tichnell C et al (2004) Misdiagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Cardiovasc Electrophysiol 15:300–306

    Article  Google Scholar 

  23. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA et al (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 121:1533–1541

    Article  Google Scholar 

  24. Vita T, Okada DR, Veillet-Chowdhury M, Bravo PE, Mullins E, Hulten E et al (2018) Complementary value of cardiac magnetic resonance imaging and positron emission tomography/computed tomography in the assessment of cardiac sarcoidosis CLINICAL PERSPECTIVE. Circ Cardiovasc Imaging 11:e007030

    Article  Google Scholar 

Download references

Acknowledgements

We thank Tammy Knight and Karen MacDonald for patient recruitment and study co-ordination. We thank Keri O’Reilly for data entry.

Funding

At the time of data collection and analysis, DJ was a Cardiac Imaging Fellow and was supported by the UOHI Foundation and the Vered-Beanlands Fellowship in Cardiology Research as well as a grant from the CHUM and CHUM Foundation. RSB is a Career Investigator supported by the Heart and Stroke Foundation of Ontario (HSFO), a Tier 1 Chair in Cardiac Imaging Research at the University of Ottawa and Vered Chair in Cardiology at the University of Ottawa Heart Institute. GD was supported by a CIHR new investigator salary support award while at UOHI. D.B. is a Mid-career Investigator supported by the HSFO, UOHI Leadership Chair in Electrophysiology and the Tier 1 University of Ottawa Chair in Electrophysiology Research. This work has also been partially supported by the Canadian Institute of Health Research (D. Birnie, PI) for The Cardiac Sarcoidosis Cohort Study (CHASM-CS). (Grant No. 342139, NCT01477359).

Author information

Author notes

  1. Girish Dwivedi and David Birnie are co-senior authors.

Authors and Affiliations

  1. Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    Daniel Juneau, Pablo B. Nery, João R. Inácio, Rob S. B. Beanlands, Robert A. deKemp, Stewart Spence, Maria C. Medor, Girish Dwivedi & David Birnie

  2. Department of Radiology and Nuclear Medicine, Centre Hospitalier de L’Université de Montréal, Montréal, QC, Canada

    Daniel Juneau

  3. Department of Radiology, University of Ottawa and Medical Imaging Department, The Ottawa Hospital, Ottawa, ON, Canada

    Elena Pena, João R. Inácio & Zainab M. Alhajari

  4. Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, The University of Western Australia, Perth, Australia

    Girish Dwivedi

Authors
  1. Daniel Juneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pablo B. Nery
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Pena
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. João R. Inácio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rob S. B. Beanlands
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert A. deKemp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zainab M. Alhajari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stewart Spence
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria C. Medor
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Girish Dwivedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. David Birnie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Birnie.

Ethics declarations

Conflict of interest:

RSB is consultant for- and has received grant funding from GE Healthcare, Lantheus Medical Imaging, and Jubilant DraxImage. DJ is a consultant for AbbVie and Advanced Accelerator Applications. GD provides consultancy support to Artrya Inc. RDK is consultant for- and received grant funding from Jubilant DraxImage, receives royalties from Rubidium-82 generator technologies licensed to Jubilant DraxImage, and from sales of FlowQuant software. All other authors have no relevant conflict of interest or disclosure.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 11283 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Juneau, D., Nery, P.B., Pena, E. et al. Reproducibility of cardiac magnetic resonance imaging in patients referred for the assessment of cardiac sarcoidosis; implications for clinical practice. Int J Cardiovasc Imaging 36, 2199–2207 (2020). https://doi.org/10.1007/s10554-020-01923-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01923-4

Keywords

Search

Navigation