Technetium-99m Sestamibi/Tetrofosmin Myocardial Perfusion Scanning in Cardiac and Noncardiac Sarcoidosis

Abstract

Left ventricular (LV) and right ventricular (RV) involvement in sarcoidosis must be firmly confirmed to determine patients’ prognosis. We examined whether myocardial perfusion images using technetium-99m single photon emission computed tomography (SPECT) have a diagnostic benefit in the evaluation of biventricular involvement. Sixteen patients with sarcoidosis, aged 21–78 (54 ± 12) years old, 5 males and 11 females, complicated with cardiac disease (cardiac sarcoidosis, n = 6) including tachyarrhythmias of ventricular origin (n = 5), atrioventricular block (n = 4), and congestive heart failure (NYHA ≧ II, n = 1), were enrolled in this study. Myocardial SPECT using technetium-99m sestamibi or tetrofosmin was performed and semiquantitatively scored for comparison with 25 control subjects. Perfusion abnormalities were more frequently recognized in sarcoidosis (LV 5/16, 31% and RV 14/16, 88% vs. LV 0/25, 0% and RV 8/25, 32% in controls). LV involvement had a close correlation with atrioventricular block and with congestive heart failure, and multiple sites of RV involvement correlated with ventricular tachyarrhythmia of RV origin. Total number of defect segments were highest in cardiac sarcoidosis (18/30, 60% vs. 19/60, 32% in noncardiac sarcoidosis, and 11/150, 7% in controls, p = 0.0001), and semiquantitatively evaluated total LV and RV scores (ranging from 0 to 18) were higher than those of controls (15.1 ± 1.8 vs. 11.4 ± 3.0 in noncardiac sarcoidosis, and 9.0 ± 5.0 in cardiac sarcoidosis) and exhibited a significant positive linear correlation with the RV ejection fraction (y = 19.8 + 1.83x, r = 0.786, p = 0.001). Biventricular SPECT using technetium-99m is clinically useful for the noninvasive evaluation of both ventricular involvements in sarcoidosis.

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

“…35, 7, 410-415 (2012) 31 In comparing sestamibi SPECT to gallium scintigraphy, Eguchi et al found a greater prevalence of perfusion defects with 99m Tc-sestamibi in patients with CS (21 of 36; 60%) compared with systemic sarcoidosis (19 of 60; 32%) and healthy controls (11 of 150; 7%). 32 Also, 99m Tc-sestamibi detected defects in 4 of 6 patients with known CS, whereas gallium only detected defects in 1 of 6 patients. 32 To assess the activity of the disease and its potential response to systemic steroid therapy, a dual ( 99m Tcsestamibi + 67-gallium) approach might be beneficial.…”

“…32 Also, 99m Tc-sestamibi detected defects in 4 of 6 patients with known CS, whereas gallium only detected defects in 1 of 6 patients. 32 To assess the activity of the disease and its potential response to systemic steroid therapy, a dual ( 99m Tcsestamibi + 67-gallium) approach might be beneficial. In a study by Nakazawa et al, 33 14 patients with systemic sarcoidosis received a dual scan.…”

Advanced Imaging of Cardiac Sarcoidosis

“…It is believed that reverse redistribution in CS is caused by focal reversible microvascular constriction in coronary arterioles around the granulomas (69). According to the results of a few studies, 99m Tc-sestamibi seems to be superior to 201 Tl in detecting reverse distribution (67,70). 67 Ga scintigraphy detects CS during its inflammatory phase, because of accumulation in inflamed areas.…”

ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging—Executive Summary

“…Perfusion defects are more common in the RV than the in LV and correlate with atrioventricular block, heart failure, and ventricular tachycardia of RV origin. 55 These defects are frequently reversible, which makes it unlikely that they represent deposition of granulomata or fibrosis. 67 Ga was formerly used in sarcoidosis as a marker of the activity and extent of the disease and for predicting the efficacy of corticosteroids, but it has been largely superseded by serial chest CT and pulmonary function tests.…”