Comparison of PET/CMR versus the Japanese Ministry of Health and Welfare (JMHW) Criteria for Evaluation of Patients with Suspected Cardiac Sarcoidosis

Objectives FDG-PET and cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and are both used to diagnose cardiac sarcoidosis (CS). However, the diagnostic concordance of these two tests, and their comparison against the JMHW criteria has not been reported

Methods 45 patients had PET and CMR for evaluation of CS. 30 (67%) had biopsy-proven extra-cardiac sarcoidosis. Cases were classified as: group 1, negatively concordant (no LGE/normal PET); group 2, positively concordant (abnormal LGE/FDG); group 3, partially discordant (abnormal LGE/PET perfusion but negative FDG); and group 4) discordant (abnormal LGE but normal PET). JMHW criteria were independently applied to all individuals

Results 9 patients had non-diagnostic scans, 6 due to poor FDG suppression, and 3 due to technical problems with LGE images. In the cases where PET/CMR were diagnostic (n=36), all patients with no-LGE (n=14) had normal PET (group 1), and all patients with abnormal FDG uptake (n=10) had LGE (group 2). The remaining 12 cases showed discordant findings: Each had abnormal LGE, but only 7/12 had abnormal PET perfusion but negative FDG (group 3) whereas PET was normal in 5/12 (group 4). Overall diagnostic concordance was 86% if only group 4 is considered discordant (Pearson’s r 0.68; P<0.0001). Clinically, 50%, 40%, 33% and 60% of patients from groups 1, 2, 3 and 4, respectively, met JMHW criteria for CS (Pearson’s r 0.005; P=0.9)

Conclusions Diagnostic concordance between PET and CMR was good in the evaluation of patients with suspected CS. No correlation was found between the combination of PET-CMR findings and JMHW criteria