Background-Although cardiac magnetic resonance (CMR) and positron emission tomography (PET) detect different pathological attributes of cardiac sarcoidosis (CS), the complementary value of these tests has not been evaluated. Our objective was to determine the value of combining CMR and PET in assessing the likelihood of CS and guiding patient management. Methods and Results-In this retrospective study, we included 107 consecutive patients referred for evaluation of CS by both CMR and PET. Two experienced readers blinded to all clinical data reviewed CMR and PET images and categorized the likelihood of CS as no (<10%), possible (10%-50%), probable (50%-90%), or highly probable(>90%) based on predefined criteria. Patient management after imaging was assessed for all patients and across categories of increasing CS likelihood. A final clinical diagnosis for each patient was assigned based on a subsequent review of all available imaging, clinical, and pathological data. Among 107 patients (age, 55±11 years; left ventricular ejection fraction, 43±16%), 91 (85%) had late gadolinium enhancement, whereas 82 (76%) had abnormal F18-fluorodeoxyglucose uptake on PET, suggesting active inflammation. Among the 91 patients with positive late gadolinium enhancement, 60 (66%) had abnormal F18-fluorodeoxyglucose uptake. When PET data were added to CMR, 48 (45%) patients were reclassified as having a higher or lower likelihood of CS, most of them (80%) being correctly reclassified when compared with the final diagnosis. Changes in immunosuppressive therapies were significantly more likely among patients with highly probable CS. Conclusions-Among patients with suspected CS, combining CMR and PET provides complementary value for estimating the likelihood of CS and guiding patient management. (Circ Cardiovasc Imaging. 2018;11:e007030.

Pulmonary hemorrhage after TTLB is common but rarely requires intervention. An enlarged mPAD at CT may not be a risk factor for higher-grade hemorrhage.

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Stability or improvement in pulmonary function or severity of ILD on CT was seen in most patients. Use of RTX was well tolerated in the majority of patients. RTX may play a therapeutic role in patients with AS-ILD, and further clinical investigation is warranted.

While cardiac disease is responsible for a majority of RA-related deaths, pulmonary disease is also a major contributor, accounting for approximately 10-20% of all mortality. Pulmonary complications occur in 60-80% of RA patients, many of whom are asymptomatic. 7-10 RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly the vasculature (Box 1). 11,12 In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents utilized for the treatment of RA can occur. RA-associated lung disease typically occurs within 5 years of RA diagnosis and may even precede joint disease in up to 20% of patients. 13-16 Respiratory symptoms may be masked by the patient's poor functional status from chronic joint and systemic inflammation, which may lead to delays in diagnosis. 17 It is therefore imperative for clinicians to regularly assess RA patients for signs and symptoms of pulmonary disease and, reciprocally, to consider CTD, including RA, when evaluating a patient with pulmonary disease of unknown etiology.