Cardiac Sarcoidosis and the Role of Advanced Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 1.25
Procedures: 1.25
Diagnostic and Electrophysiology Procedures: 1.25

Nuclear Medicine Technology: 1.25
Procedures: 1.25
Cardiac Procedures: 1.25

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Thoracic Section: 1.25

Outline

1. Introduction
2. Pathology Relevant for Cardiac Imaging
3. Diagnosis
   1. Echocardiography
   2. SPECT
   3. ¹⁸F-FDG PET
   4. CMR
4. Therapeutic and Prognostic Considerations of Cardiac PET and CMR
   1. ¹⁸F-FDG PET
   2. CMR
   3. ¹⁸F-FDG PET Versus CMR
   4. Hybrid CMR/PET
5. Clinical use of Advanced Cardiac Imaging in CS
   1. Diagnostic Tool in Patients with Established Extracardiac Sarcoidosis
   2. Diagnostic Tool in Patients Without Established Extracardiac Sarcoidosis
   3. Therapeutic Response Monitoring in Patients with Established Inflammatory CS
   4. Prognostication in Patients with Established CS Considered for Device Therapy
6. Conclusion

Objectives

Upon completion of this course, students will:

1. describe the reasons associated with the importance of effectively diagnosing CS
2. list the patient population who should be considered for CS evaluation
3. identify the organization that provides current criteria that are key for a CS diagnosis
4. understand the various histological stages associated with CS
5. recognize which imaging modality is best suited for identifying edema and inflammation
6. identify which left ventricular cardiac walls are commonly affected by CS
7. identify which imaging modality is best at evaluating basal septal thinning
8. isolate which initial imaging modality is utilized in patients with suspected CS
9. explain what speckle tracking echocardiography can offer in patients with possible CS
10. describe the physiology behind “reverse distribution” with SPECT imaging
11. differentiate between PET and SPECT cardiac perfusion as it relates to spatial resolution
12. describe why PET inflammatory imaging is combined with another imaging procedure to aid in the diagnosis of CS
13. explain why ¹⁸F-FDG PET can be non-specific for CS
14. list advantages and disadvantages as they relate to ¹⁸F-FDG PET imaging
15. understand which imaging modality is affected by diet, fasting and heparin intervention
16. describe how ⁶⁸GA-DOTANOC PET imaging can aid in the diagnosis of CS
17. know what role CMR plays in diagnosing CS
18. list the common cardiac ventricular sarcoidosis sites for LGE
19. know the annual rate of ventricular tachycardia and death when myocardial perfusion defects and abnormal ¹⁸F-FDG uptake are discovered
20. identify the preferred imaging procedure for evaluating immunosuppressive therapy response
21. isolate which imaging procedure is thought to be a strong prognosticator for future cardiac events in patients with CS
22. explain the clinical implications when LGE is observed
23. explain what is meant by a “gold standard” when it comes to diagnosing CS
24. label the imaging modality that is thought to have higher specificity
25. explain how the study by Ju Lee related CMR with LGE to ¹⁸F-FDG PET
26. list and understand the various imaging patterns associated with CMR/PET imaging
27. identify what image pattern may relate to a false positive on CMR/PET imaging
28. describe the relationship between LGE and ¹⁸F-FDG uptake based on the study conducted by Vita et al
29. describe the parameters and findings listed to detect active CS in the study by Dweck et al
30. list the findings on CMR/PET hybrid imaging that provide complementary value in patients with suspected CS
31. list the suggested initial screening approaches for patients positive for extracardiac sarcoidosis and suspected of CS
32. identify which initial imaging approach is best suited for evaluating CS in patients with established extracardiac sarcoidosis
33. name the imaging modality that can occasionally be used when CMR is negative
34. explain what clinical context should be considered to diagnose CS in patients without established extracardiac sarcoidosis
35. identify what general consensus has been established for identifying CS in patients without known extra cardiac sarcoidosis
36. explain what imaging procedures could be utilized for evaluating possible CS in the absence of extracardiac sarcoidosis
37. list the caveats associated with cardiac imaging findings in patients without extracardiac sarcoidosis
38. identify which imaging procedure has gained value with initial therapy planning
39. list the criteria needed for an implantable cardioverter-defibrillator device
40. identify the challenges and recommendations needed for diagnosing CS