Features and clinical impact of extra-cardiac lesions with 18F-fluorodeoxyglucose positron emission tomography in patients with suspected cardiac sarcoidosis
Features and clinical impact of extra-cardiac lesions with 18F-fluorodeoxyglucose positron emission tomography in patients with suspected cardiac sarcoidosis
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DOI：
10.1016/j.ijcha.2020.100587
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发表时间：
2020-10-01
影响因子：
2.9
通讯作者：
Yamaguchi, Osamu
中科院分区：
文献类型：
--
作者：
Higashi, Haruhiko;Inaba, Shinji;Yamaguchi, Osamu
背景：结节病是一种全身性炎症性疾病，常累及心脏以外的其他器官。全身F-18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）不仅用于检测心脏，而且用于检测结节病的心外受累。然而，心外病变的特征和临床影响尚未完全阐明。因此，本研究旨在使用FDG-PET来阐明这些问题。方法和结果：我们连续招募了120名临床上提示心脏结节病的异常发现患者，并接受了全身FDG-PET检查。在本研究中，疑似心脏结节病患者定义为临床疑似结果和FDG-PET阳性心脏摄取。随后，共发现并分析了36例疑似心脏结节病患者。在14例患者的35处病变中检测到心外受累（每例患者39%）。特别是，心外病变广泛分布于全身，最常见的是纵隔/肺门淋巴结受累。在大多数患者中（93%/患者，13/14），心外病变位于与肌内膜活检（EMB）相比更容易接近且并发症风险更低的区域。根据FDG-PET结果，8例患者接受了心外活检，无并发症，其对组织学结节病的诊断敏感性较高（75%，6/8）。此外，FDG-PET引导下的心外活检可以确认组织学结节病在4个病灶，EMB未能证实。结论：心外受累的可疑心脏结节病患者是相对较高的。FDG-PET引导下心外穿刺活检对心脏结节病的影像学诊断是安全有效的。(C)2020年，任作家。由爱思唯尔公司出版
Background: Sarcoidosis is a systemic inflammatory disorder and can often affect any other organs beyond the heart. Whole-body F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is used to detect not only cardiac but also extra-cardiac involvement of sarcoidosis. However, the features and clinical impact of extra-cardiac lesions have not yet been fully elucidated. Therefore, this study aimed to clarify these using FDG-PET.Methods and results: We enrolled 120 consecutive patients with abnormal findings clinically suggesting cardiac sarcoidosis who underwent whole-body FDG-PET. In this study, a patient with suspected cardiac sarcoidosis was defined as one having both clinically suspected findings and FDG-PET positive cardiac uptake. Subsequently, a total of 36 patients with suspected cardiac sarcoidosis were found and analyzed. Extra-cardiac involvement was detected in 35 lesions of 14 patients (39% per patient). In particular, the extra-cardiac lesions were widely distributed throughout the body, and mediastinal/hilar lymph node involvement was most commonly observed. In most of the patients (93% per patient, 13/14), the extra-cardiac lesions were localized in the regions that were considered more accessible with less risk of complication compared with endomyocardial biopsy (EMB). Based on the FDG-PET findings, 8 patients underwent extra-cardiac biopsy without complication, and its diagnostic sensitivity for histological sarcoidosis was high (75%, 6/8). Moreover, FDG-PET-guided extra-cardiac biopsy could confirm histological sarcoidosis in 4 lesions that EMB failed to prove.Conclusions: Extra-cardiac involvement in patients with suspected cardiac sarcoidosis was relatively high. FDG-PET-guided extra-cardiac biopsy may be safe and useful for the imaging based diagnosis of cardiac sarcoidosis. (C) 2020 The Authors. Published by Elsevier B.V.