Advanced Imaging of Cardiac Sarcoidosis

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

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Cardiac Procedures: 1.00

Outline

1. Introduction
2. Clinical Manifestation
3. The Need for Reliable Diagnosis
   1. The Missing Gold Standard
   2. Clinical Evaluation
4. Advanced Imaging
   1. CMR
   2. PET
   3. Comparing PET and CMR
   4. Other Radionuclide Imaging Tests
5. Therapeutic Options and Prognosis
6. Summary

Objectives

Upon completion of this course, students will:

1. be familiar with factors that have been linked with sarcoidosis
2. identify the organs that are most frequently involved with sarcoidosis
3. identify the area of the world where cardiac sarcoidosis is the leading cause of death
4. understand the parts of the heart that are most frequently affected by cardiac sarcoidosis
5. be familiar with the effects of corticosteroid treatment when provided during the inflammatory phase of cardiac sarcoidosis
6. know the conditions for which patients should be considered to possibly also have cardiac sarcoidosis
7. understand the four characteristics that integrate the heart’s electrical and mechanical activity
8. be familiar with how some of the most frequent non-sinus arrhythmias are visualized on ECG
9. be familiar with how some of the most frequent cardiac conduction problems are visualized on ECG
10. be familiar with the aspects of the JMHWG guidelines for clinical diagnosis of cardiac sarcoidosis
11. identify the indications for screening a patient for cardiac sarcoidosis
12. be familiar with possible screening findings that can lead to further cardiac sarcoidosis work-up
13. recognize endomyocardial biopsy’s role in the detection of cardiac sarcoidosis, as well as the challenges that can be present which limit its usefulness
14. be familiar with how cardiac sarcoidosis presents on CMR in both the inflammatory phase and the chronic phase
15. understand the implications of CMR delayed gadolinium enhancement to cardiac sarcoidosis patients
16. understand the causes of increased glucose metabolism in inflammation
17. understand the importance of suppression of cardiac myocyte glucose uptake for a PET-based diagnostic workup for cardiac sarcoidosis
18. know the strategies currently used to suppress myocardial glucose uptake
19. understand the effect of heparin on the body to suppress myocardial glucose uptake
20. know the information provided from FDG PET cardiac imaging relevant to cardiac sarcoidosis management
21. be familiar with the pitfalls that should be considered when observing a diffuse cardiac FDG uptake pattern
22. know the condition that can be signified by diffuse or focal FDG uptake of the lateral wall
23. be familiar with the various combinations of perfusion and uptake patterns when combining FDG PET with gated perfusion imaging
24. be familiar with the procedures included in the cardiac sarcoidosis PET protocol described in the article
25. be familiar with the terms which use probability to measure the outcomes for diagnostic examinations
26. know how CMR and FDG PET compare using the JMHWG
27. know the limitations of CMR in comparison to FDG PET for cardiac sarcoidosis imaging
28. know the advantages of FDG PET for cardiac sarcoidosis imaging
29. know the disadvantages of FDG PET for cardiac sarcoidosis imaging
30. understand PET standardized uptake value, how it is calculated as well as its usefulness and its potential shortcomings
31. be familiar with the radiopharmaceuticals used to detect and monitor cardiac involvement in sarcoidosis prior to the advent of clinical PET imaging
32. understand how ⁶⁷Ga detects cardiac sarcoidosis during its inflammatory phase
33. be familiar with the basic medical treatment options for cardiac sarcoidosis
34. understand the reported effects of early corticosteroid therapy on LV function
35. understand why antiarrhythmic agents are often required for cardiac sarcoidosis patients