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. 2017 Oct;27(10):4054-4063.
doi: 10.1007/s00330-017-4824-x. Epub 2017 Apr 5.

Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study

Tadao Aikawa  1 , Noriko Oyama-Manabe  2 , Masanao Naya  1 , Hiroshi Ohira  3 , Ayako Sugimoto  3 , Ichizo Tsujino  3 , Masahiko Obara  1 , Osamu Manabe  4 , Kohsuke Kudo  5 , Hiroyuki Tsutsui  6 , Nagara Tamaki  4
Affiliations
Free article

Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study

Tadao Aikawa et al. Eur Radiol. 2017 Oct.
Free article

Abstract

Objectives: To evaluate the diagnostic value of delayed contrast-enhanced computed tomography (DE-CT) for cardiac sarcoidosis (CS) in patients with or without implantable devices, including a quantitative comparison with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).

Methods: Twenty-four patients (mean age, 64 ± 9 years; 17 women) with known or suspected CS underwent retrospective electrocardiogram-gated DE-CT at 80 kV with knowledge-based iterative model reconstruction. Fourteen patients without implantable devices also underwent LGE-CMR, while ten with pacemakers or implantable cardioverter-defibrillators did not. The presence of hyperenhanced myocardium was assessed visually and quantitatively using a 5-standard deviation threshold above the mean of remote myocardium.

Results: Inter-observer agreement for visual detection of hyperenhanced segments on DE-CT was excellent in patients with implantable devices and in those without (κ = 0.91 and κ = 0.94, respectively). Comparisons of the percent area of hyperenhanced myocardium between DE-CT and LGE-CMR on both per-patient and per-segment analyses showed good correlations (r = 0.96 and r = 0.83, respectively; p < 0.001). The sensitivity and specificity of DE-CT for the diagnosis of CS were 94% and 33%.

Conclusions: The extent of hyperenhanced lesion with DE-CT showed good agreement with LGE-CMR results. DE-CT showed high sensitivity for detecting CS and may be useful particularly in patients with contraindications to CMR.

Key points: • Delayed contrast-enhanced CT (DE-CT) can be applied to patients with implantable devices. • DE-CT can detect cardiac sarcoidosis (CS) lesions similarly to cardiac MRI. • DE-CT shows high sensitivity for detecting CS. • DE-CT may be useful particularly in patients with contraindications to cardiac MRI.

Keywords: Cardiac CT; Cardiac sarcoidosis; Delayed enhancement; Iterative reconstruction; Myocardium.

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