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Radionuclide Imaging of Cardiac Amyloidosis and Sarcoidosis: Roles and Characteristics of Various Tracers.
Hotta, M, Minamimoto, R, Awaya, T, Hiroe, M, Okazaki, O, Hiroi, Y
Radiographics : a review publication of the Radiological Society of North America, Inc. 2020;(7):2029-2041
Abstract
Amyloidosis and sarcoidosis are systemic diseases that affect multiple organ systems. Accurate diagnosis of cardiac amyloidosis and sarcoidosis is particularly important because cardiac involvement can be fatal. Amyloidosis is characterized by the deposition of amyloid fibrils, and cardiac amyloidosis is classified into amyloid immunoglobulin light chain (AL) and amyloid transthyretin (ATTR) types. Radionuclide tracers for amyloidosis include (a) bone tracers, (b) amyloid-directed molecules, and (c) PET amyloid agents. Bone tracers are particularly sensitive in detection of ATTR type amyloidosis, whereas PET amyloid agents show a higher affinity for the AL type. In sarcoidosis, gallium 67 (67Ga) citrate scintigraphy and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET are pivotal to diagnosis of cardiac sarcoidosis, and 18F-FDG PET/CT has particularly high efficacy in detection of sarcoidosis and monitoring of response to therapy. A major limitation of 18F-FDG is physiologic uptake in the myocardium, which can remain in approximately 20% of patients even after elaborate preparation (eg, prolonged fasting >12-18 hours, modification to a high-fat and low-carbohydrate diet, and injection of unfractionated heparin). This limitation has led to a search for potential new tracers. Recently introduced tracers that show promise include those used in somatostatin receptor imaging and cellular proliferation imaging, which provide detectability as high as that for 18F-FDG without requiring dietary restrictions and have potential for monitoring disease activity. ©RSNA, 2020.
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Rare case of parathyroid gland sarcoidosis presenting with hypercalcaemia.
Saha, BK, Burns, SL, Foulke, LA, Judson, MA
BMJ case reports. 2019;(7)
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Abstract
Sarcoidosis of the parathyroid gland is a rare occurrence. Parathyroid sarcoidosis is usually associated with parathyroid adenomas, and, therefore, hypercalcaemia is a common presentation of this entity. We present a case of parathyroid sarcoidosis and review the world literature regarding this rare condition. A woman with a history of diffuse large B cell lymphoma underwent a surveillance positron emission tomography scan that showed increased fluorodeoxyglucose uptake in multiple thoracic and abdominal lymph nodes and in a left upper extremity soft tissue mass. Biopsy of the soft tissue mass showed non-caseating granulomas consistent with sarcoidosis. Blood work showed a serum calcium of 11.1 mg/dL with an intact serum parathyroid hormone of 92 pg/dL. Primary hyperparathyroidism was suspected. A neck ultrasound and sestamibi parathyroid scintigraphy demonstrated a parathyroid nodule. She underwent surgical resection, and the histopathology revealed a parathyroid adenoma and non-caseating granulomata consistent with a diagnosis of sarcoidosis.
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PET/CT Evaluation of Cardiac Sarcoidosis.
Bois, JP, Muser, D, Chareonthaitawee, P
PET clinics. 2019;(2):223-232
Abstract
The increasing implementation of advanced cardiovascular imaging in the form of cardiac PET/CT has had a significant impact on the management of cardiac sarcoidosis, which continues to evolve. This review summarizes the role of PET/CT imaging in sarcoidosis with a specific focus on (1) indications, (2) patient preparation, (3) test performance, (4) study interpretation, (5) clinical relevance of findings, (6) comparison to alternative imaging modalities, and finally (7) introduction of areas of anticipated development and research.
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Advanced cardiovascular imaging for the evaluation of cardiac sarcoidosis.
Bravo, PE, Singh, A, Di Carli, MF, Blankstein, R
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2019;(1):188-199
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Abstract
Cardiac sarcoidosis (CS) remains an intriguing infiltrating disorder and one of the most important forms of inflammatory cardiomyopathy. Identification of patients with CS is of extreme importance because they are at higher risk of sudden death, and heart-failure progression. And while it remains a diagnostic conundrum, a great amount of experience has been accumulated over the last decade with the advent of fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance with late gadolinium enhancement imaging. They have both proven to be advanced imaging techniques that provide important, and often complementary, diagnostic and prognostic information for the management of CS. However, they have also shown to have limitations, and, thus, there is a continued need for developing more specific imaging probes for identifying cardiac inflammation. The aim of the present manuscript is to provide the reader with a better understanding of the histopathology of the disease, how this potentially relates to noninvasive imaging detection, and the best strategies available for the diagnosis and management of patients with CS.
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Patient page-sarcoidosis imaging.
Bois, JP, Chareonthaitawee, P
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2019;(1):222-226
Abstract
Optimizing our imaging capabilities for patients with cardiac sarcoidosis is critical as it has diagnostic, prognostic, and therapeutic implications. 18FDG PET/CT has the highest sensitivity for the detection of CS but requires specific dietary preparation that is difficult for patients to follow which may lead to ineffective suppression of physiologic 18FDG uptake. This may result in inconclusive scan results in up to 30% of patients undergoing 18FDG PET/CT imaging for CS. Therefore, it is imperative that we relay to our patients the importance of dietary preparation for CS PET imaging and then provide simple, easy to follow instructions for them. The current patient protocol is designed to achieve these two objectives.
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Nutrition and corticosteroids in the treatment of sarcoidosis.
Bast, A, Semen, KO, Drent, M
Current opinion in pulmonary medicine. 2018;(5):479-486
Abstract
PURPOSE OF REVIEW Sarcoidosis is a chronic disease, which is routinely treated with corticosteroids. Steroid resistance or steroid-induced adverse effects require alternatives. Other immune-modulating pharmacological treatments have been developed, and therefore expanded tremendously. Until now, the role of nutrition in the overall management of sarcoidosis has been neglected although anti-inflammatory properties of nutritional components have been known for many years now. New nutritional possibilities emerge from already existing data and offer new therapeutic avenues in the treatment of sarcoidosis. RECENT FINDINGS Various dietary components have been shown to reduce pulmonary inflammatory processes. It is increasingly recognized, however, that the specificity and magnitude of the effect of nutrition differs from pharmacological interventions. Conventional randomized clinical trials are less suitable to test the effect of nutrition in comparison with testing drugs. Mechanistic knowledge on the action of dietary components in conjunction with an increasing understanding of the molecular processes underlying steroid resistance (as investigated in asthma and COPD and unfortunately hardly in sarcoidosis) lead to exciting suggestions on combinations of nutrition/nutritional bioactive compounds and corticosteroids that may benefit sarcoidosis patients. SUMMARY In order to understand the effects of nutrition in chronic disease, it is important to elucidate mechanisms and pathways of effects. Several complementing lines of evidence should be integrated in order to be able to advise sarcoidosis patients on a healthy diet as such or in combination with prescribed anti-inflammatory therapy.
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Sarcoid Myopathy Mimicking Polymyositis: A Case Report and Pool Analysis of the Literature Reviews.
Sazliyana Shaharir, S, Jamil, A, Kosasih, S, Soo Fin, L, Sridharan, R, Hayati Md Pauzi, S
Acta medica Iranica. 2017;(12):800-806
Abstract
A 59-year-old man presented with proximal myopathy, myalgia, and weight loss, with the initial markedly elevated serum creatine kinase at 11,000 U/L. Due to his refusal for muscle biopsy, he was initially treated as inflammatory myositis and responded well with the corticosteroids. However, he subsequently had a relapse of the symptoms with more extensive systemic involvement, i.e., hypercalcemia, lymphadenopathy and subcutaneous nodules. Finally, a biopsy of the thigh and subcutaneous nodule revealed non-caseating granulomatous inflammation, consistent with sarcoidosis. He responded well to the corticosteroids, and finally, azathioprine was added as a steroid-sparing agent. Including our series, there are 103 cases of symptomatic muscle involvement in sarcoidosis patients published in the English literature to date. Further pool analysis of the cases will be reported in this review.
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Physical activity and training in sarcoidosis: review and experience-based recommendations.
Strookappe, B, Saketkoo, LA, Elfferich, M, Holland, A, De Vries, J, Knevel, T, Drent, M
Expert review of respiratory medicine. 2016;(10):1057-68
Abstract
INTRODUCTION Sarcoidosis is a multisystemic inflammatory disorder with a great variety of symptoms, including fatigue, dyspnea, pain, reduced exercise tolerance and muscle strength. Physical training has the potential to improve exercise capacity and muscle strength, and reduce fatigue. The aim of this review and survey was to present information about the role of physical training in sarcoidosis and offer practical guidelines. AREAS COVERED A systematic literature review guided an international consensus effort among sarcoidosis experts to establish practice-basic recommendations for the implementation of exercise as treatment for patients with various manifestations of sarcoidosis. International sarcoidosis experts suggested considering physical training in symptomatic patients with sarcoidosis. Expert commentary: There is promising evidence of a positive effect of physical training. Recommendations were based on available data and expert consensus. However, the heterogeneity of these patients will require modification and program adjustment of the standard rehabilitation format for e.g. COPD or interstitial lung diseases. An optimal training program (types of exercise, intensities, frequency, duration) still needs to be defined to optimize training adjustments, especially reduction of fatigue. Further randomized controlled trials are needed to consolidate these findings and optimize the comprehensive care of sarcoidosis patients.
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Advances in radionuclide imaging of cardiac sarcoidosis.
Kouranos, V, Wells, AU, Sharma, R, Underwood, SR, Wechalekar, K
British medical bulletin. 2015;(1):151-63
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Abstract
INTRODUCTION Radionuclide imaging for the diagnosis and monitoring of cardiac involvement in sarcoidosis has advanced significantly in recent years. SOURCES OF DATA This article is based on published clinical guidelines, literature review and our collective clinical experience. AREAS OF AGREEMENT Gallium-67 scintigraphy is among the diagnostic criteria for cardiac involvement in systemic sarcoidosis, and it is strongly associated with response to treatment. However, fluorine-18, 2-fluoro-deoxyglucose (FDG) positron emission tomography (PET) is now preferred both for diagnosis and for assessing prognosis. AREAS OF CONTROVERSY Most data are from small observational studies that are potentially biased. GROWING POINTS Quantitative imaging to assess changes in disease activity in response to treatment may lead to FDG-PET having an important routine role in managing cardiac sarcoidosis. AREAS TIMELY FOR DEVELOPING RESEARCH Larger prospective studies are required, particularly to assess the effectiveness of radionuclide imaging in improving clinical management and outcome.
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Particulate matter granulomas masquerading as sarcoidosis: a diagnostic dilemma.
Nair, N, Patrick, H, Narula, J
Biomolecular concepts. 2015;(3):229-33
Abstract
Sarcoidosis is a multiorgan disease with no single etiology. Evidence over the years points to complex interactions between environmental and genetic factors and a hypersensitive immune response to these insults. This brief overview discusses the uncertainty in the diagnosis of sarcoidosis versus other granulomatous diseases masquerading as sarcoidosis. The diagnostic dilemma is highlighted by a brief case review. The development of newer techniques in molecular biology and the identification of a panel of biomarkers in the future with appreciable specificity and sensitivity would help in the process. Future studies to determine receiver operating curves (ROC) using multiple biomarker combinations would help develop robust testing. More in-depth studies are also needed for defining the immunological basis of sarcoidosis because recent studies implicate Th17 cells in addition to the Th1 cell pathway. It is very likely that direct exposure to environmental agents and systemic distribution of these agents can elicit an exaggerated immune response leading to multiorgan granuloma formation mimicking sarcoidosis. A genetically susceptible host may be necessary to complete the granulomatous response to the particulate matter.