Rapid Fire Abstracts
Mohanad Ghonim, MD
Postdoctoral Research Fellow
Hospital of the University of Pennsylvania
Mohanad Ghonim, MD
Postdoctoral Research Fellow
Hospital of the University of Pennsylvania
Mohamed Ghonim, MD
Postdoctoral Reasearch Fellow
Hospital of the University of Pennsylvania
William Ohley, MD, MA
Resident
Hospital of the University of Pennsylvania
Ahmad S Alhamshari, MD
Post-doctoral Research Fellow
University of Pennsylvania
Mahesh K. Vidula, MD
Assistant Professor of Cardiovascular Medicine
Hospital of the University of Pennsylvania
Jui Hu, MD
Assistant Professor
Hospital of the University of Pennsylvania
Harold I. Litt, MD, PhD
Division Chief, Cardiothoracic Imaging
Hospital of the University of Pennsylvania
Walter R. Witschey, PhD
Associate Professor of Radiology
Perelman School of Medicine, University of Pennsylvania
Paco E. Bravo, MD
Director of Nuclear Cardiology and Cardiovascular Molecular Imaging
Hospital of the University of Pennsylvania
Combined contrast-enhanced cardiac magnetic resonance (CMR) followed or preceded by fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging are complementary techniques and an emerging standard of care for evaluation of individuals with suspected cardiac sarcoidosis. We hypothesized that T2 mapping values may correlate positively with areas of FDG-PET activity. We aimed to investigate whether CMR T2 mapping can serve as a marker of myocardial disease activity, using FDG-PET as the reference.
Methods:
We retrospectively identified 106 patients with suspected cardiac sarcoidosis (mean age 59.8 ± 12 years, Male 63%, White 55%, Black 37%, diabetes 28%, heart failure 50%, biopsy-proven sarcoidosis 30%) who underwent both FDG-PET and CMR at 1.5T within 1 month. We excluded individuals with 1) FDG uptake patterns suggestive of incomplete suppression, 2) recent acute coronary syndrome, 3) immunosuppression treatment in between exams, and 4) T2 mapping abnormalities not matching the location of FDG activity. Cardiac T2 mapping was quantitatively assessed by measuring ROIs in six different regions based on the myocardial polar map on both base- and mid- LV short axis slices with values >55 ms considered positive. Cardiac FDG uptake was visually characterized as either negative or positive.
Results:
The majority of patients had negative FDG and T2 (n=74; 70%). Three cases were FDG and T2 positive (2.8%). The remaining cases (n=29) showed discordance between T2 mapping (T2 positive & FDG negative; n=20) and FDG (T2 negative & FDG positive; n=9 [Figure 1]). Diagnostic agreement was 73%; however, this was driven by the large number of negative cases. T2 mapping showed 25% sensitivity to rule out FDG-defined inflammation and 79% specificity to rule in cases with a positive predictive value of only 13%.
Conclusion:
In patients with suspected cardiac sarcoidosis, CMR T2 mapping has limited predictive value in detecting disease activity in comparison to FDG PET imaging as the reference standard. This is likely because elevations in T2 may be caused by processes other than granulomatous inflammation.
