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Bravo PE, Singh A, Di Carli MF, Blankstein R. Advanced cardiovascular imaging for the evaluation of cardiac sarcoidosis. J Nucl Cardiol 2019; 26:188-199. [PMID: 30390241 PMCID: PMC6374180 DOI: 10.1007/s12350-018-01488-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis (CS) remains an intriguing infiltrating disorder and one of the most important forms of inflammatory cardiomyopathy. Identification of patients with CS is of extreme importance because they are at higher risk of sudden death, and heart-failure progression. And while it remains a diagnostic conundrum, a great amount of experience has been accumulated over the last decade with the advent of fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance with late gadolinium enhancement imaging. They have both proven to be advanced imaging techniques that provide important, and often complementary, diagnostic and prognostic information for the management of CS. However, they have also shown to have limitations, and, thus, there is a continued need for developing more specific imaging probes for identifying cardiac inflammation. The aim of the present manuscript is to provide the reader with a better understanding of the histopathology of the disease, how this potentially relates to noninvasive imaging detection, and the best strategies available for the diagnosis and management of patients with CS.
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Affiliation(s)
- Paco E Bravo
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amitoj Singh
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Vitola JV, Dondi M, Prado P, Shaw L, Paez D. Worldwide Availability and Utilization of PET/CT from IAEA Survey. ACTA ACUST UNITED AC 2019. [DOI: 10.17996/anc.19-00103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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103
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Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias. HeartRhythm Case Rep 2018; 4:584-588. [PMID: 30581738 PMCID: PMC6301890 DOI: 10.1016/j.hrcr.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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104
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Ganeshan D, Menias CO, Lubner MG, Pickhardt PJ, Sandrasegaran K, Bhalla S. Sarcoidosis from Head to Toe: What the Radiologist Needs to Know. Radiographics 2018; 38:1180-1200. [PMID: 29995619 DOI: 10.1148/rg.2018170157] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disorder characterized by development of noncaseating granulomas in various organs. Although the etiology of this condition is unclear, environmental and genetic factors may be substantial in its pathogenesis. Clinical features are often nonspecific, and imaging is essential to diagnosis. Abnormalities may be seen on chest radiographs in more than 90% of patients with thoracic sarcoidosis. Symmetric hilar and mediastinal adenopathy and pulmonary micronodules in a perilymphatic distribution are characteristic features of sarcoidosis. Irreversible pulmonary fibrosis may be seen in 25% of patients with the disease. Although sarcoidosis commonly involves the lungs, it can affect virtually any organ in the body. Computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT are useful in the diagnosis of extrapulmonary sarcoidosis, but imaging features may overlap with those of other conditions. Familiarity with the spectrum of multimodality imaging findings of sarcoidosis can help to suggest the diagnosis and guide appropriate management. ©RSNA, 2018.
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Affiliation(s)
- Dhakshinamoorthy Ganeshan
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Meghan G Lubner
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Perry J Pickhardt
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Kumaresan Sandrasegaran
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Sanjeev Bhalla
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
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105
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Manabe O, Ohira H, Hirata K, Hayashi S, Naya M, Tsujino I, Aikawa T, Koyanagawa K, Oyama-Manabe N, Tomiyama Y, Magota K, Yoshinaga K, Tamaki N. Use of 18F-FDG PET/CT texture analysis to diagnose cardiac sarcoidosis. Eur J Nucl Med Mol Imaging 2018; 46:1240-1247. [PMID: 30327855 DOI: 10.1007/s00259-018-4195-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE 18F-fluorodeoxyglocose positron emission tomography (FDG PET) plays a significant role in the diagnosis of cardiac sarcoidosis (CS). Texture analysis is a group of computational methods for evaluating the inhomogeneity among adjacent pixels or voxels. We investigated whether texture analysis applied to myocardial FDG uptake has diagnostic value in patients with CS. METHODS Thirty-seven CS patients (CS group), and 52 patients who underwent FDG PET/CT to detect malignant tumors with any FDG cardiac uptake (non-CS group) were studied. A total of 36 texture features from the histogram, gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), gray-level zone size matrix (GLZSM) and neighborhood gray-level difference matrix (NGLDM), were computed using polar map images. First, the inter-operator and inter-scan reproducibility of the texture features of the CS group were evaluated. Then, texture features of the patients with CS were compared to those without CS lesions. RESULTS Twenty-eight of the 36 texture features showed high inter-operator reproducibility with intraclass correlation coefficients (ICCs) over 0.80. In addition, 17 of the 36 showed high inter-scan reproducibility with ICCs over 0.80. The SUVmax showed no difference between the CS and non-CS group [7.36 ± 2.77 vs. 8.78 ± 4.65, p = 0.45, area under the curve (AUC) = 0.60]. By contrast, 16 of the 36 texture features could distinguish CS from non-CS grsoup with AUC > 0.80. Multivariate logistic regression analysis after hierarchical clustering concluded that long-run emphasis (LRE; P = 0.0004) and short-run low gray-level emphasis (SRLGE; P = 0.016) were significant independent factors that could distinguish between the CS and non-CS groups. Specifically, LRE was significantly higher in CS than in non-CS (30.1 ± 25.4 vs. 11.4 ± 4.6, P < 0.0001), with high diagnostic ability (AUC = 0.91), and had high inter-operator reproducibility (ICC = 0.98). CONCLUSIONS The texture analysis had high inter-operator and high inter-scan reproducibility. Some of texture features showed higher diagnostic value than SUVmax for CS diagnosis. Therefore, texture analysis may have a role in semi-automated systems for diagnosing CS.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Souichiro Hayashi
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Yuuki Tomiyama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Keiichi Magota
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, Hokkaido, 0608638, Japan
| | - Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Science, Chiba, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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106
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Zeppenfeld K. Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy. JACC Clin Electrophysiol 2018; 4:1123-1140. [PMID: 30236385 DOI: 10.1016/j.jacep.2018.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/06/2023]
Abstract
Catheter ablation is being increasingly performed as adjunctive treatment to prevent recurrent implantable cardioverter-defibrillator therapies in patients with nonischemic cardiomyopathy and ventricular tachycardia (VT). In the context of VT ablation, nonischemic cardiomyopathy usually refers to dilated cardiomyopathy (DCM) as one morphological phenotype. Over the past decades, progress has been made to better characterize distinct subtypes and to differentiate between causes of DCM, which has important practical and prognostic implications. The goal of this review is to summarize available data on VT ablation in patients with DCM and, more specifically, review procedural and outcome data in specific etiologies and substrate location. It will focus on our current understanding of nonischemic scars, as well as the value of multimodal imaging, image integration, and electroanatomic mapping for substrate identification, procedural planning, and ablation. In addition, recent findings from whole human heart histology of patients with DCM and VT and their potential implications for imaging and mapping will be discussed.
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Affiliation(s)
- Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Abstract
OBJECTIVE The purpose of this article is to provide an update on clinical PET/MRI, including current and developing clinical indications and technical developments. CONCLUSION PET/MRI is evolving rapidly, transitioning from a predominant research focus to exciting clinical practice. Key technical obstacles have been overcome, and further technical advances promise to herald significant advancements in image quality. Further optimization of protocols to address challenges posed by this hybrid modality will ensure the long-term success of PET/MRI.
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108
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FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018; 45:1250-1269. [PMID: 29637252 PMCID: PMC5954002 DOI: 10.1007/s00259-018-3973-8] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
Large vessel vasculitis (LVV) is defined as a disease mainly affecting the large arteries, with two major variants, Takayasu arteritis (TA) and giant cell arteritis (GCA). GCA often coexists with polymyalgia rheumatica (PMR) in the same patient, since both belong to the same disease spectrum. FDG-PET/CT is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases. Functional FDG-PET combined with anatomical CT angiography, FDG-PET/CT(A), may be of synergistic value for optimal diagnosis, monitoring of disease activity, and evaluating damage progression in LVV. There are currently no guidelines regarding PET imaging acquisition for LVV and PMR, even though standardization is of the utmost importance in order to facilitate clinical studies and for daily clinical practice. This work constitutes a joint procedural recommendation on FDG-PET/CT(A) imaging in large vessel vasculitis (LVV) and PMR from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine (EANM), the Cardiovascular Council of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the PET Interest Group (PIG), and endorsed by the American Society of Nuclear Cardiology (ASNC). The aim of this joint paper is to provide recommendations and statements, based on the available evidence in the literature and consensus of experts in the field, for patient preparation, and FDG-PET/CT(A) acquisition and interpretation for the diagnosis and follow-up of patients with suspected or diagnosed LVV and/or PMR. This position paper aims to set an internationally accepted standard for FDG-PET/CT(A) imaging and reporting of LVV and PMR.
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109
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Beller GA. Future growth and success of nuclear cardiology. J Nucl Cardiol 2018; 25:375-378. [PMID: 29417418 DOI: 10.1007/s12350-018-1211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- George A Beller
- Division of Cardiovascular Medicine, University of Virginia Health System, Box 800158, Charlottesville, VA, 22903, USA.
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Saab R, Bhambhvani P, Iskandrian AE, Hage FG. A case of longitudinal care of a patient with cardiac sarcoidosis. J Nucl Cardiol 2018; 25:443-456. [PMID: 29423905 DOI: 10.1007/s12350-018-1217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
Cardiac sarcoidosis has long been an evasive diagnosis with a spectrum of clinical presentations that extend from asymptomatic to ventricular arrhythmias and sudden cardiac death. The diagnosis has traditionally relied on histology which suffers from the low sensitivity of endomyocardial biopsy due to the patchy nature of the disease in addition to its invasive nature. Due to significant advancements in imaging, it is now possible to accurately identify cardiac sarcoidosis using non-invasive imaging modalities even without histological confirmation. Emerging guidelines are highlighting the role of multimodality imaging in the diagnosis and management of this challenging entity. We present the case of a 36-year-old man known to have sarcoidosis in which a variety of imaging modalities not only assisted in the diagnosis of cardiac sarcoidosis, but also played a key role in the monitoring of disease activity and response to therapy.
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Affiliation(s)
- Rayan Saab
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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111
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Jouni H, Chareonthaitawee P. Unraveling Inflammation and Oxidative Stress in Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.007287. [DOI: 10.1161/circimaging.117.007287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hayan Jouni
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Fluorine-18 fluorodeoxyglucose positron emission tomography for cardiac sarcoidosis-is it time to consider a new radiotracer? EJNMMI Res 2017; 7:70. [PMID: 28853012 PMCID: PMC5574831 DOI: 10.1186/s13550-017-0322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 11/17/2022] Open
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