ABSTRACT
BACKGROUNDS: High-degree atrioventricular block (AVB) recovery in CS has been shown to be highly variable despite immunosuppressive treatment, with no reliable tool available to predict odds of reversibility. This study sought to evaluate the potential of combined fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and resting myocardial perfusion imaging (rMPI) to predict reversibility of newly diagnosed high-grade AVB in cardiac sarcoidosis (CS). METHODS: We performed a single-center, retrospective analysis of patients with CS presenting with high-grade AVB who underwent combined FDG-PET/CT and rMPI. The 2016 JCS and the 2014 HRS diagnostic criteria were used for the diagnosis of CS. Patients with a history of coronary artery disease or prior immunosuppressive treatment were excluded. Patients were divided into AVB recovery and non-recovery subgroups. CS disease staging was based on FDG-PET and rMPI findings: (Stage 0) normal FDG-PET and rMPI (Stage 1) positive FDG-PET and normal rMPI (Stage 2) positive FDG-PET with perfusion deficits on rMPI (Stage 3) normal FDG-PET with perfusion deficits on rMPI. RESULTS: Twenty-seven patients, including 13 demonstrating AVB recovery, were identified. Eleven out of fourteen (78.6%) patients presenting with stage 1 CS demonstrated AVB recovery. Stage 1 CS was significantly more present in the recovery group compared to the non-recovery group (84.6% vs 21.4%, P = .002). Eleven presented with stage 2 CS, with only 2 (18.2%) recovering AV nodal conduction. Stage 2 CS presented more frequently in the non-recovery group (64.3% vs 15.4%, P = .020). CONCLUSIONS: Combined FDG-PET and rMPI employed to stage CS disease presenting with high-degree AVB appears to have good performance for predicting likelihood of recovery.
Subject(s)
Atrioventricular Block , Cardiomyopathies , Myocardial Perfusion Imaging , Myocarditis , Sarcoidosis , Humans , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Atrioventricular Block/diagnostic imaging , Retrospective Studies , Cardiomyopathies/diagnosis , Myocardial Perfusion Imaging/methods , Radiopharmaceuticals , Positron-Emission Tomography , Sarcoidosis/complications , Sarcoidosis/diagnostic imaging , Immunosuppressive AgentsABSTRACT
This is the case of a 68-year-old man with known cardiac sarcoidosis undergoing treatment with methotrexate who presented with new onset of dyspnea and lipothymia. FDG-PET/CT revealed pathological uptake within lung parenchyma which resolved following discontinuation of methotrexate, compatible with methotrexate-induced pneumonitis. This is the first case of methotrexate-induced pneumonitis documented by FDG-PET/CT.
ABSTRACT
We present the case of a 65-year-old woman with known pulmonary and muscular sarcoidosis who presented with dyspnea. FDG-PET/CT revealed unsuspected active myositis of multiple muscle groups, including the neck, and was useful in monitoring treatment response.