F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis

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Simonen , P , Lehtonen , J , Kandolin , R , Schildt , J , Marjasuo , S , Miettinen , H , Airaksinen , J , Vihinen , T , Tuohinen , S , Haataja , P & Kupari , M 2015 , ' F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis ' , American Journal of Cardiology , vol. 116 , no. 10 , pp. 1581-1585 . https://doi.org/10.1016/j.amjcard.2015.08.025

Title: F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis
Author: Simonen, Piia; Lehtonen, Jukka; Kandolin, Riina; Schildt, Jukka; Marjasuo, Suvi; Miettinen, Heikki; Airaksinen, Juhani; Vihinen, Tapani; Tuohinen, Suvi; Haataja, Petri; Kupari, Markku
Contributor: University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Kardiologian yksikkö
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Clinicum
Date: 2015-11-15
Language: eng
Number of pages: 5
Belongs to series: American Journal of Cardiology
ISSN: 0002-9149
URI: http://hdl.handle.net/10138/159067
Abstract: Histologic proof of granulomatous inflammation is prerequisite for the diagnosis of cardiac sarcoidosis (CS). Because of the limited sensitivity of endomyocardial biopsy (EMB), confirmation of sarcoidosis often has to be acquired from extracardiac biopsies. We set out to review our experience of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) in guiding extracardiac tissue biopsies in suspected CS. We included in this work 68 consecutive patients with proved CS who had undergone cardiac F-18-FDG PET with (n = 57) or without whole-body imaging as part of initial diagnostic evaluation. Their hospital charts, imaging studies, and diagnostic biopsies were reviewed in retrospect. Whole-body PET images showed extracardiac foci of abnormally high F-18-FDG uptake in 39 of 57 patients, of whom 38 had involvement of mediastinal lymph nodes (MLN). Parallel F-18-FDG uptake was found in other lymph nodes (n = 10), lungs (n = 9), liver (n = 3), spleen (n = 2), and thyroid gland (n = 1). Adding the mediastinal findings at cardiac PET without whole-body imaging, abnormal F-18-FDG uptake in MLN was found in totally 43 of the 68 patients with CS (63%). Histology of systemic sarcoidosis was known at presentation of cardiac symptoms in 8 patients. Of the 60 patients with missing histology, 24 patients underwent mediastinoscopy for sampling of PET-positive MLN, most often (n = 20) after nondiagnostic EMB; microscopy revealed diagnostic noncaseating granulomatous inflammation in 24 of the 24 cases (sensitivity 100%). In the remaining 36 patients, sarcoidosis histology was confirmed by EMB (n = 30), by biopsy of lungs (n = 2) or peripheral lymph nodes (n = 2), or at autopsy (n = 1) or post-transplantation (n = 1). In conclusion, MLN accumulate F-18-FDG at PET in most patients with CS and provide a highly productive source for diagnostic biopsies either primarily or subsequent to nondiagnostic EMB. (C) 2015 Elsevier Inc. All rights reserved.
Subject: GIANT-CELL MYOCARDITIS
PET/CT
3121 General medicine, internal medicine and other clinical medicine
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