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Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study

  • Cardiac
  • Published:
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Abstract

Objectives

To evaluate the diagnostic value of delayed contrast-enhanced computed tomography (DE-CT) for cardiac sarcoidosis (CS) in patients with or without implantable devices, including a quantitative comparison with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).

Methods

Twenty-four patients (mean age, 64 ± 9 years; 17 women) with known or suspected CS underwent retrospective electrocardiogram-gated DE-CT at 80 kV with knowledge-based iterative model reconstruction. Fourteen patients without implantable devices also underwent LGE-CMR, while ten with pacemakers or implantable cardioverter-defibrillators did not. The presence of hyperenhanced myocardium was assessed visually and quantitatively using a 5-standard deviation threshold above the mean of remote myocardium.

Results

Inter-observer agreement for visual detection of hyperenhanced segments on DE-CT was excellent in patients with implantable devices and in those without (κ = 0.91 and κ = 0.94, respectively). Comparisons of the percent area of hyperenhanced myocardium between DE-CT and LGE-CMR on both per-patient and per-segment analyses showed good correlations (r = 0.96 and r = 0.83, respectively; p < 0.001). The sensitivity and specificity of DE-CT for the diagnosis of CS were 94% and 33%.

Conclusions

The extent of hyperenhanced lesion with DE-CT showed good agreement with LGE-CMR results. DE-CT showed high sensitivity for detecting CS and may be useful particularly in patients with contraindications to CMR.

Key Points

• Delayed contrast-enhanced CT (DE-CT) can be applied to patients with implantable devices.

• DE-CT can detect cardiac sarcoidosis (CS) lesions similarly to cardiac MRI.

• DE-CT shows high sensitivity for detecting CS.

• DE-CT may be useful particularly in patients with contraindications to cardiac MRI.

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Abbreviations

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

CNR:

Contrast-to-noise ratio

CS:

Cardiac sarcoidosis

DE-CT:

Delayed contrast-enhanced computed tomography

JSSOG:

Japanese Society of Sarcoidosis and other Granulomatous Disorder

LGE:

Late gadolinium enhancement

SD:

Standard deviation

SNR:

Signal-to-noise ratio

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Authors and Affiliations

  1. Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Tadao Aikawa, Masanao Naya & Masahiko Obara

  2. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan

    Noriko Oyama-Manabe & Kohsuke Kudo

  3. First Department of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Hiroshi Ohira, Ayako Sugimoto & Ichizo Tsujino

  4. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Osamu Manabe & Nagara Tamaki

  5. Department of Cardiovascular Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Hiroyuki Tsutsui

Authors
  1. Tadao Aikawa
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  2. Noriko Oyama-Manabe
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  3. Masanao Naya
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  4. Hiroshi Ohira
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  6. Ichizo Tsujino
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  7. Masahiko Obara
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  8. Osamu Manabe
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  9. Kohsuke Kudo
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  11. Nagara Tamaki
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Corresponding author

Correspondence to Noriko Oyama-Manabe.

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Guarantor

The scientific guarantor of this publication is Nagara Tamaki, Hokkaido University Graduate School of Medicine.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Yoichi M. Ito, PhD, kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• experimental

• performed at one institution

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Aikawa, T., Oyama-Manabe, N., Naya, M. et al. Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study. Eur Radiol 27, 4054–4063 (2017). https://doi.org/10.1007/s00330-017-4824-x

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  • DOI: https://doi.org/10.1007/s00330-017-4824-x

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