Usefulness of late gadolinium enhancement combined with MRI and 67-Ga scintigraphy in the diagnosis of cardiac sarcoidosis and disease activity evaluation

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.

Left ventricular apical aneurysm due to unrecognized sarcoidosis

“…In the previous study including a relatively larger number of patients, LV systolic dysfunction were observed in 14% of 88 patients with systemic sarcoidosis, and wall motion abnormalities were generalized or localized to the base and mid level of the LV [4]. To our knowledge, there have been two case reports investigating the LV apical aneurysm in patients suffering from systemic sarcoidosis [5,6]. It would be clinically worthy to show a case with the LV apical aneurysm in cardiac sarcoidosis without obvious involvement of other organs.…”

Cardiac sarcoidosis evaluated by multimodality imaging

“…67-Gallium-citrate accumulates only in areas of active inflammation, T2-weighted MRI reveals edema with inflammation, and fasting 18F-FDG accumulation in PET indicates active inflammation. Positive findings in a 67-gallium-citrate scintigram and 18F-FDG PET indicate good response to steroid therapy [18,19]. Whether T2-weighted MRI can be used for evaluating response to steroid therapy requires further clinical study.…”

Diagnostic and Therapeutic Management of Cardiac Sarcoidosis -Application of High Resolution Electrocardiography

“…Thus, Gallium-67 uptake is highly specific to inflammatory disease and a useful for detection of disease activity of cardiac sarcoidosis. Meanwhile, the main disadvantage is lack of sensitivity (20%, 36%) (Okayama et al, 1995;Kiuchi et al, 2007).…”