Clinical study
Diagnosis of cardiac sarcoidosis and evaluation of the effects of steroid therapy by gadolinium-DTPA–enhanced magnetic resonance imaging

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Abstract

BACKGROUND: Cardiac involvement is an important prognostic factor in patients with sarcoidosis. In this study, we evaluated the usefulness of gadolinium-DTPA (diethylene triamine pentaacetic acid)–enhanced magnetic resonance imaging (Gd-MRI) for diagnosing cardiac sarcoidosis and evaluating the effects of steroid therapy.

METHODS: Sixteen patients with sarcoidosis diagnosed by histology or by Japanese Ministry of Health and Welfare criteria for cardiac sarcoidosis underwent Gd-MRI with a 1.5-Tesla superconducting magnet system using a T1-weighted spin-echo sequence.

RESULTS: Gd-MRI showed localized enhancement of signal intensity, indicating interstitial edema, in the left ventricle in 8 of the 16 patients. Two patients with enhancement also had thinning of the left ventricular septal wall. After 1 month of prednisolone therapy (60 mg every other day or 30 to 40 mg every day), the localized high-intensity signals were markedly diminished in all 8 patients.

CONCLUSIONS: Images of the heart obtained by Gd-MRI may reflect active inflammation with interstitial edema in patients with sarcoidosis. Gd-MRI may be a useful noninvasive method for early detection of cardiac sarcoidosis and for evaluating the effects of steroid therapy.

Section snippets

Patients and methods

We studied 16 patients with systemic sarcoidosis and suspected cardiac involvement. Sarcoidosis was diagnosed histologically or according to Japanese Ministry of Health and Welfare guidelines for diagnosing cardiac sarcoidosis (Table 1)(11).

All 16 patients underwent electrocardiogram-gated Gd-MRI performed with a 1.5-Tesla superconducting magnet system (Gyroscan NT, Philips, The Netherlands) and a T1-weighted spin-echo sequence. A transaxial multilevel gradient-echo sequence was obtained, and

Results

Gd-MRI demonstrated localized enhancement of signal intensity, indicating interstitial edema, in the left ventricle of 8 of the 16 patients. Two patients with myocardial enhancement also had thinning of the left ventricular septal wall. The clinical, imaging, and histologic findings in the 8 patients with cardiac sarcoidosis are summarized in Table 2. Three representative cases are described in detail below.

Cardiac and extracardiac symptoms and signs were frequent in the 8 patients with cardiac

Discussion

Electrocardiography and echocardiography are widely used to detect cardiac involvement in patients with sarcoidosis. Electrocardiographic changes are found in as many as 50% of patients with systemic sarcoidosis without clinical evidence of cardiac involvement 12, 13, 14; the most common findings are repolarization changes, arrhythmias, and conduction disturbances (11). Evidence of transmural infarction is less common 15, 16. Echocardiography can detect features such as septal thinning, left

References (36)

  • S.J Ratner et al.

    Utility of endomyocardial biopsy in the diagnosis of cardiac sarcoidosis

    Chest

    (1986)
  • M Chandra et al.

    Diagnosis of cardiac sarcoidosis aided by MRI

    Chest

    (1996)
  • T Ishikawa et al.

    Steroid therapy in cardiac sarcoidosis. Increased left ventricular contractility concomitant with electrocardiographic improvement after prednisolone

    Chest

    (1984)
  • M Bernstein et al.

    Boeck’s sarcoidreport of a case with visceral involvement

    Arch Intern Med

    (1929)
  • K.J Silverman et al.

    Cardiac sarcoid

    Circulation

    (1978)
  • Y Matsui et al.

    Clinicopathological study on fatal myocardial sarcoidosis

    Ann NY Acad Sci

    (1976)
  • Tachibana T, Iwai K, Takemura T. Study on cause of death in the patients with sarcoidosis in Japan. XII World Congress...
  • H Sato et al.

    Detection of right ventricular infarction by gadolinium DTPA-enhanced magnetic resonance imaging

    Eur Heart J

    (1995)

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