Higashi Haruhiko, Inaba Shinji, Iio Chiharuko, Inoue Katsuji, Ogimoto Akiyoshi, Miyagawa Masao, Mochizuki Teruhito, Ikeda Shuntaro, Yamaguchi Osamu
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
Division of Cardiology, Uwajima City Hospital, Uwajima, Japan.
Int J Cardiol Heart Vasc. 2020 Jul 24;30:100587. doi: 10.1016/j.ijcha.2020.100587. eCollection 2020 Oct.
Sarcoidosis is a systemic inflammatory disorder and can often affect any other organs beyond the heart. Whole-body F-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.
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.
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.
结节病是一种全身性炎症性疾病，常常会累及心脏以外的其他器官。全身F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）不仅用于检测结节病的心脏受累情况，还可检测心脏外受累情况。然而，心脏外病变的特征及其临床影响尚未完全阐明。因此，本研究旨在通过FDG-PET来阐明这些情况。
我们纳入了120例临床上有异常表现提示心脏结节病且接受了全身FDG-PET检查的连续患者。在本研究中，疑似心脏结节病的患者定义为既有临床疑似表现又有FDG-PET显示心脏摄取阳性的患者。随后，共发现并分析了36例疑似心脏结节病的患者。14例患者（每位患者39%）的35个病变中检测到心脏外受累。特别是，心脏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（每位患者93%，13/14），心脏外病变位于与心内膜心肌活检（EMB）相比被认为更容易到达且并发症风险较低的区域。基于FDG-PET检查结果，8例患者接受了心脏外活检且无并发症，其对组织学结节病的诊断敏感性较高（75%，6/8）。此外，FDG-PET引导下的心脏外活检能够在4个EMB未能证实的病变中确诊组织学结节病。
疑似心脏结节病患者的心脏外受累情况相对较高。FDG-PET引导下的心脏外活检对于基于影像学的心脏结节病诊断可能是安全且有用的。
