Purpose: To assess the follow-up of patients with sarcoidosis and myocardial MRI abnormalities.

Materials and methods: Twelve patients with histologically proven sarcoidosis and highly suspected cardiac involvement underwent initial and 12-month follow-up cardiac assessment including cardiac MRI (T2-weighted, functional gradient resound and T1-weighted gadolinium-diethylenetriamine penta-acetic acid-enhanced sequences) MRI abnormalities and clinical and MRI progression were scored by way of two observers.

Results: Six patients receiving corticosteroid therapy (including three patients with clinical cardiac involvement) were scored as having cleared or improved at MRI follow-up while others were seen to have worsened or remained stable. The stability, improvement, or clearing of MRI findings were correlated with clinically stable, improved or cleared sarcoidosis, while a worsening at MRI follow-up was correlated with a worsening of sarcoidosis and, in the same patient, was predictive of clinical cardiac involvement.

Conclusion: Cardiac MRI is a useful noninvasive mode for the early diagnosis and follow-up of cardiac sarcoidosis.

clew words: heart, diseases; heart, MRI; sarcoidosis

Abbreviations: DTPA = diethylenetriamine penta-acetic acid; HRCT = high-resolution CT

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Cardiac involvement is symptomatic in solitary 5% of patients with sarcoidosis, (12) although it is evident in the myocardium at autopsy in 20 to 50% (23) greatest in number patients with subclinical, myocardial, histologic lesions will remain asymptomatic, still sudden death due to ventricular tachyarrhythmia or conduction shut up accounts for 30 to 65% of fatalities. (45) The early initiation of corticosteroid therapy in patients with cardiac sarcoidosis improves left ventricular function and obviate malignant arrhythmia. (6) Noninvasive imaging systems such as echocardiography and thallium scan, which might allow the identification of patients at risk requiring corticosteroids, put up with from low sensitivity or specificity, while an endomyocardial biopsy finding may be negative because of the patchy distribution of lesions.

Experience in applying MRI to the diagnosis of sarcoidal heart disease has been limited to a hardly any case reports. (7-12) Shimata et al (13) lately emphasized the usefulness of gadolinium-diethylenetriamine penta-acetic acid (DTPA)-enhanced MRI in a series of eight patients with histologically proven cardiac sarcoidosis. The aim of the existing study was to prospectively assess the clinical and MRI follow-up of 12 patients with active sarcoidosis and initial cardiac MRI abnormalities, in the same manner as to clarify the significance of myocardial MRI abnormalities and investigate the character of cardiac MRI in the management of patients with sarcoidosis.

MATERIALS AND METHODS

research Population

Between October 1999 and September 2000 20 patients with histologically proven active sarcoidosis were referr for cardiac assessment. A diagnosis of sarcoidosis was confirmed if the clinical presentation and chest radiographic findings were supported by means of histologic evidence of noncaseous epithelioid granulomas by the agency of bronchial or salivary gland biopsy, and one time the possibility of infection, environmental factors or medical treatment causing the granuloma had been eliminated. Other data consider probableed included gender, age at the diagnosis of sarcoidosis, duration, chest radiography, and extrathoracic sarcoidosis based forward clinical, biological, radiologic, and histologic findings. Radiologic chest stage through high-resolution CT (HRCT), angiotensin-converting enzyme concentrations, and treatment were recorded. Cardiac evaluation included a physical examination, surface ECG and 24-h Holter monitoring, echocardiography, [sup201]Tl myocardial scintigraphy, and cardiac MRI; coronary angiography was also performed in patients with suspected coronary artery disease or those > 40 years old

Inclusion criteria were patients with highly suspected cardiac involvement based onward perfusion defects that regressed after nicardipine therapy in succession the thallium scan. Exclusion criteria were cardiac MRI findings not consistent with myocardial involvement (n = 3) or port of other cardiac conditions, as evidenced through clinical, echocardiographic, or angiographic data (ischemia, n = 2; valve disease, n = 1; hypertension, n = 2) Twelve patients were included (3 male, 9 female; mean [+ or -] SD age, 382 [+ or -] 73 years), and they underwent a follow-up MRI examination at 12 month using the same protocol as the initial MRI procedure

The data argueed during the 12-month follow-up assessment included physical examination, the visceral distribution of sarcoidosis, surface ECG and 24-h Holter monitoring, echocardiography, chest HRCT staging, angiotensin-converting enzyme concentrations, and treatment. The studious mood was approved by the Institutional Review Board, and informed consensus was obtained from all subjects

Clinical Progression Score

At the 12-month follow-up assessment, brace clinicians (R.D., P.B.) reached a consensus as to the clinical score for disease activity: cleared was defined as a recur to normal of chest HRCT findings and angiotensin-converting enzyme concentrations, and a ended clearing of extrathoracic involvement; improvement was defined as a downgrading of the chest HRCT stage, a reduction in angiotensin-converting enzyme concentrations, and a reduction in visceral involvement; worsening was defined as an increase in at least single in kind of these parameters, and stability was defined no changes from the initial evaluation.

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