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Sarcoidosis Recognition of Early Cardiac Involvement in Systemic Sarcoid
Another recent study (2017) that was using cardiac MRI to detect Sarcoidosis.

So it sounds VPT will offer a very interesting alternative to MRI in terms of technology, cost and accuracy.

Original Research
Cardiac Imaging

T1 and T2 Mapping in Recognition of Early Cardiac Involvement in Systemic Sarcoidosis


Valentina O. Puntmann , Alexander Isted, Rocio Hinojar, Lucy Foote, Gerald Carr-White, Eike Nagel

Author Affiliations

From the Department of Cardiology, Guy’s and St Thomas’ NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King’s College London, St. Thomas’ Hospital, London, England (V.O.P.); Ramn y Cajal University Hospital, University of Alcal, Madrid, Spain (R.H.); and King’s College Hospital NHS Trust, Denmark Hill, London, England (G.C.).

Address correspondence to V.O.P. (email: [e-mail]).

Published Online: Apr 27, 2017

https://doi.org/10.1148/radiol.2017162732

Abstract
Purpose

To determine whether quantitative tissue characterization with T1 and T2 mapping supports recognition of myocardial involvement in patients with systemic sarcoidosis.
Materials and Methods

Fifty-three consecutive patients with a biopsy-proven extracardiac diagnosis of systemic sarcoidosis (21 men; median age, 45 years; interquartile range, 22 years) and 36 normotensive previously healthy control subjects (14 men; median age, 43 years; interquartile range, 18 years) underwent cardiovascular magnetic resonance imaging, which was performed to assess cardiac function and late gadolinium enhancement, and T1 and T2 mapping. A follow-up substudy was performed in 40 patients (mean follow-up interval, 144 days ± 35 [standard deviation]); of these 40 patients, 18 underwent anti-inflammatory treatment for systemic symptoms. Binary logistic regression and receiver operating characteristic curve analyses were used to assess discrimination between health and disease; Wilcoxon signed rank test was used to assess the effect of treatment.
Results

When compared with control subjects, patients had higher ventricular volume, higher myocardial native T1 and T2, and lower longitudinal strain and ejection fraction (P < .05 for all). Myocardial native T1 and T2 had higher discriminatory accuracy (area under the receiver operating characteristic curve [AUC]: 0.96 and 0.89, respectively) for separation between control subjects and patients when compared with the standard diagnostic criteria (AUC < 0.67). Native T1 was the independent discriminator between health and disease (specificity, 90%; sensitivity, 96%; accuracy, 94%). There was a significant reduction of native T1 and T2 in the patients who underwent treatment (z score: -3.72 and -2.88; P < .01) but not in the patients who did not (z score, -1.42 and -1.38; P > .15).
Conclusion

Quantitative myocardial tissue characterization with T1 and T2 mapping may enable noninvasive recognition of cardiac involvement and activity of myocardial inflammation in patients with systemic sarcoidosis. Future studies will be performed to confirm their role in risk stratification and guidance of clinical management.

Introduction

Systemic sarcoidosis is a chronic systemic inflammatory condition that is histologically characterized by noncaseating granulomatous tissue infiltration (1,2). Most patients present with systemic symptoms and signs of disease due to involvement of the pulmonary system or skin. Clinical symptoms due to cardiac involvement are rare and manifest in only those patients with advanced disease in the form of heart failure and arrhythmia (3,4). The predominantly subclinical inflammatory myocardial involvement poses an overall challenge to disease recognition and treatment (5,6).

Two sets of diagnostic criteria have evolved to provide a pathway for recognition of cardiac involvement in the presence of known systemic disease (7). The 1993 Japanese Ministry of Health and Welfare (JMHW) guidelines (summarized in Appendix E1 [online]) (7–9) integrated findings of multiple cardiac diagnostic tests, including electrocardiography and a dedicated cardiac imaging study (echocardiography, radionuclide scintigraphy, or cardiac catheterization). These later evolved into 2014 Heart Rhythm Society (HRS) expert consensus criteria by including cardiovascular magnetic resonance (MR) imaging based on the visualization of regional myocardial scarring at late gadolinium enhancement (LGE) (Figs 1,2) (8,10–12). These cardiac diagnostic tests rely on detection of gross and advanced abnormalities of structure and function. As such, they are insensitive to the myocardial inflammatory tissue process, precluding early recognition of disease and disease activity. Quantitative tissue characterization imaging with T1 and T2 mapping enables detection of myocardial inflammation by directly relating to the altered magnetization properties (reviewed by Puntmann et al [13]). We and others have shown that T1 and T2 mapping values correlate with histologic evidence of myocardial inflammation, severity of left ventricular (LV) remodeling and longitudinal strain, and activity of myocardial inflammation in patients with other systemic inflammatory conditions (14–18). Quantitative tissue characterization with T1 and T2 mapping may support recognition of myocardial involvement in patients with systemic sarcoidosis.
A total of 13 patients underwent endomyocardial biopsy independently of the cardiovascular MR imaging findings by using the right ventricular approach; 11 subjects showed nonspecific chronic inflammatory infiltrate, and eight had evidence of chronic inflammation with noncaseating granulomas (4). All 13 patients with endomyocardial biopsy had abnormal native T1 (22) and evidence of LGE.