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Aitken M, Chan MV, Urzua Fresno C, Farrell A, Islam N, McInnes MDF, Iwanochko M, Balter M, Moayedi Y, Thavendiranathan P, Metser U, Veit-Haibach P, Hanneman K. Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2022; 304:566-579. [PMID: 35579526 DOI: 10.1148/radiol.213170] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is limited consensus regarding the relative diagnostic performance of cardiac MRI and fluorodeoxyglucose (FDG) PET for cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis to compare the diagnostic accuracy of cardiac MRI and FDG PET for cardiac sarcoidosis. Materials and Methods Medline, Ovid Epub, Cochrane Central Register of Controlled Trials, Embase, Emcare, and Scopus were searched from inception until January 2022. Inclusion criteria included studies that evaluated the diagnostic accuracy of cardiac MRI or FDG PET for cardiac sarcoidosis in adults. Data were independently extracted by two investigators. Summary accuracy metrics were obtained by using bivariate random-effects meta-analysis. Meta-regression was used to assess the effect of different covariates. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The study protocol was registered a priori in the International Prospective Register of Systematic Reviews (Prospero protocol CRD42021214776). Results Thirty-three studies were included (1997 patients, 687 with cardiac sarcoidosis); 17 studies evaluated cardiac MRI (1031 patients) and 26 evaluated FDG PET (1363 patients). Six studies directly compared cardiac MRI and PET in the same patients (303 patients). Cardiac MRI had higher sensitivity than FDG PET (95% vs 84%; P = .002), with no difference in specificity (85% vs 82%; P = .85). In a sensitivity analysis restricted to studies with direct comparison, point estimates were similar to those from the overall analysis: cardiac MRI and FDG PET had sensitivities of 92% and 81% and specificities of 72% and 82%, respectively. Covariate analysis demonstrated that sensitivity for FDG PET was highest with quantitative versus qualitative evaluation (93% vs 76%; P = .01), whereas sensitivity for MRI was highest with inclusion of T2 imaging (99% vs 88%; P = .001). Thirty studies were at risk of bias. Conclusion Cardiac MRI had higher sensitivity than fluorodeoxyglucose PET for diagnosis of cardiac sarcoidosis but similar specificity. Limitations, including risk of bias and few studies with direct comparison, necessitate additional study. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Michael Vinchill Chan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ashley Farrell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Nayaar Islam
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Mark Iwanochko
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Meyer Balter
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ur Metser
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Patrick Veit-Haibach
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
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11
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Mathijssen H, Tjoeng TWH, Keijsers RGM, Bakker ALM, Akdim F, van Es HW, van Beek FT, Veltkamp MV, Grutters JC, Post MC. The usefulness of repeated CMR and FDG PET/CT in the diagnosis of patients with initial possible cardiac sarcoidosis. EJNMMI Res 2021; 11:129. [PMID: 34928457 PMCID: PMC8688603 DOI: 10.1186/s13550-021-00870-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis (CS) diagnosis is usually based on advanced imaging techniques and multidisciplinary evaluation. Diagnosis is classified as definite, probable, possible or unlikely. If diagnostic confidence remains uncertain, cardiac imaging can be repeated. The objective is to evaluate the usefulness of repeated cardiac magnetic resonance imaging (CMR) and fluorodeoxyglucose positron emission tomography (FDG PET/CT) for CS diagnosis in patients with an initial "possible" CS diagnosis. METHODS We performed a retrospective cohort study in 35 patients diagnosed with possible CS by our multidisciplinary team (MDT), who received repeated CMR and FDG PET/CT within 12 months after diagnosis. Imaging modalities were scored on abnormalities suggestive for CS and classified as CMR+/PET+, CMR+/PET-, CMR-/PET+ and CMR-/PET-. Primary endpoint was final MDT diagnosis of CS. RESULTS After re-evaluation, nine patients (25.7%) were reclassified as probable CS and 16 patients (45.7%) as unlikely CS. Two patients started immunosuppressive treatment after re-evaluation. At baseline, eleven patients (31.4%) showed late gadolinium enhancement (LGE) on CMR (CMR+) and 26 (74.3%) patients showed myocardial FDG-uptake (PET+). At re-evaluation, nine patients (25.7%) showed LGE (CMR+), while 16 patients (45.7%) showed myocardial FDG-uptake (PET+). When considering both imaging modalities together, 82.6% of patients with CMR-/PET+ at baseline were reclassified as possible or unlikely CS, while 36.4% of patients with CMR+ at baseline were reclassified as probable CS. Three patients with initial CMR-/PET+ showed LGE at re-evaluation. CONCLUSION Repeated CMR and FDG PET/CT may be useful in establishing or rejecting CS diagnosis, when initial diagnosis is uncertain. However, clinical relevance has to be further determined.
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Affiliation(s)
- H Mathijssen
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435CM, Nieuwegein, Utrecht, The Netherlands.
| | - T W H Tjoeng
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435CM, Nieuwegein, Utrecht, The Netherlands
| | - R G M Keijsers
- Department of Nuclear Medicine, St. Antonius Hospital Nieuwegein, Nieuwegein, Utrecht, The Netherlands
| | - A L M Bakker
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435CM, Nieuwegein, Utrecht, The Netherlands
| | - F Akdim
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435CM, Nieuwegein, Utrecht, The Netherlands
| | - H W van Es
- Department of Radiology, St. Antonius Hospital Nieuwegein, Nieuwegein, Utrecht, The Netherlands
| | - F T van Beek
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Nieuwegein, Utrecht, The Netherlands
| | - M V Veltkamp
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Nieuwegein, Utrecht, The Netherlands.,Department of Pulmonology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J C Grutters
- Department of Pulmonology, St. Antonius Hospital Nieuwegein, Nieuwegein, Utrecht, The Netherlands.,Department of Pulmonology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435CM, Nieuwegein, Utrecht, The Netherlands.,Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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