Advertisement

Annals of Nuclear Medicine

, Volume 7, Issue 2, pp 97–103 | Cite as

Thallium-201 myocardial SPECT findings at rest in sarcoidosis

  • Noritaka Yamamoto
  • Kohshi Gotoh
  • Yasuo Yagi
  • Yasushi Terashima
  • Kenshi Nagashima
  • Toshiyuki Sawa
  • Fumiko Deguchi
  • Masumi Nawada
  • Haruhito Tanaka
  • Tatsuo Tsukamoto
  • Senri Hirakawa
Original Article

Abstract

In 41 patients with sarcoidosis (diagnosed according to criteria recommended by the Committee on Diffuse Pulmonary Disease, Ministry of Health and Welfare, Japan 1988), thallium-201 (201Tl) myocardial SPECT was performed to investigate: (1) the ability of201Tl SPECT to detect cardiac involvement of sarcoidosis with images recorded at rest and 2 hours later, and (2) the relationships between201Tl myocardial SPECT findings and the activity of sarcoidosis or endomyocardial biopsy findings. As to the abnormal findings in201Tl myocardial SPECT, (1) a low density area was seen in 13 of 41 cases (31.7%) and non-uniform uptake was found in 17 cases (41.5%), (2) the mean washout ratio (n=39) was 16.5±7.4%, which is significantly (p < 0.05) lower than that found in normal subjects, 23.9±7.5 % (n=10). Of the 19 patients judged visually to be normal, 5 patients had a reduced mean washout ratio less than 12%. Thus, the incidence of abnormal findings including all types of abnormality, on201Tl myocardial SPECT in sarcoidosis was 63.4% (26/41 cases). In studying the relationship between201Tl myocardial SPECT findings and the activity of sarcoidosis (as measured by the serum ACE (angiotensin converting enzyme) or lysozyme level, or the presence of more than 30% symphocyte fraction in BALF (broncho-alveolar lavage fluid)), 20 (80%) of 25 cases with201Tl abnormality were judged to be active sarcoidosis, while only 6 (37.5%) of 16 cases with normal findings on201Tl SPECT were judged to be active. This suggests that there is a significant (p < 0.01) relationship between the presence or absence of an abnormal finding on201Tl myocardial SPECT and the activity of sarcoidosis. Among 13 patients examined by endomyocardial biopsy, 10 patients had abnormal findings on201Tl myocardial SPECT and 7 of these 10 patients had no histological evidence of cardiac sarcoidosis. In all of these 7 patients, however, sarcoidosis was judged to be active. This suggest that endomyocardial biopsy is of limited value in the diagnosis of cardiac sarcoidosis.

Key words

cardiac sarcoidosis 201Tl myocardial SPECT activity of sarcoidosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bulkley BH, Rouleau JR, Whitaker JQ, et al: The use of201Thallium for myocardial perfusion imaging in sarcoid heart disease.Chest 72: 27–32, 1977PubMedCrossRefGoogle Scholar
  2. 2.
    Sharma OP, Siegel M, Haywood LJ: Role of Thallium-201 scanning in the management of myocardial sarcoidosis.Arch Monaldi 36: 79–86, 1981PubMedGoogle Scholar
  3. 3.
    Tsukamoto T, Gotoh K, Yagi Y, et al: Usefulness of resting Thallium-201 delayed imaging for detecting myocardial viability in patients with previous myocardial infarction.Ann Nucl Med 7 (2): 79–86, 1993PubMedCrossRefGoogle Scholar
  4. 4.
    Chretien J, Venet A, Danel C, et al: Bronchoalveolar lavage in sarcoidosis.Respiration 48: 222–230, 1985PubMedCrossRefGoogle Scholar
  5. 5.
    Fleming HA, Bailey SM: The prognosis of sarcoid heart disease in the United Kingdom.Ann NY Acad Sci 465: 543–550, 1986PubMedCrossRefGoogle Scholar
  6. 6.
    Matsui Y, Iwai K, Tachibana T, et al: Clinicopathological study on fatal myocardial sarcoidosis.Ann NY Acad Sci 278: 455–469, 1975CrossRefGoogle Scholar
  7. 7.
    Ogawa H, Kinoshita N, Omori F, et al: A case of fetal myocardial sarcoidosis.Jap J Med 73: 1656–1664, 1984 (in Japanese)Google Scholar
  8. 8.
    Roberts WC, McAllister HA, Ferrans VJ: Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 2).Am J Med 63: 86–108, 1977PubMedCrossRefGoogle Scholar
  9. 9.
    Wynne J, Braunward E: The cardiomyopathies and myocarditis. Braunward E, eds. Heart disease;A textbook of cardiovascular medicine, 2nd ed, Saunders Philadelphia, pp. 1426–1427, 1984Google Scholar
  10. 10.
    Sekiguchi M, Nomao Y, Imai M, et al: Clinical and histopathological profile of sarcoidosis of the heart and acute idiopathic myocarditis. Concepts through a study employing endomyocardial biopsy. I. Sarcoidosis.Jpn Circ J 44: 249–263, 1980PubMedGoogle Scholar
  11. 11.
    Silverman KJ, Hutchins GM, Bulkley BH: Cardiac sarcoid. A clinicopathologic study of 84 unselected patients with systemic sarcoidosis.Circulation 58: 1204–1211, 1978PubMedGoogle Scholar
  12. 12.
    Tachibana A, Iwai K, Matsui Y, et al: Cause of death in Japanese sarcoidosis.Committee report of Japanese sarcoidosis research report: 76, 1979 (in Japanese)Google Scholar
  13. 13.
    Abdulmassih S, Iskandrian MD, A-Hamid Hakki MD: Thallium-201 myocardial Scintigraphy.Am Heart J 109: 113–129, 1985CrossRefGoogle Scholar
  14. 14.
    Kinney EL, Jackson GL, Reeves WC, et al: Thalliumscan myocardial defect and echocardiographic abnormalities in patients with sarcoidosis without clinical cardiac dysfunction. An analysis of 44 patients.Am J Med 68: 497–503, 1980PubMedCrossRefGoogle Scholar
  15. 15.
    Haywood LJ, Sharma OP, Siegel ME, et al: Detection of myocardial sarcoidosis by Thallium 201 imaging.J Nat Med Assoc 74: 959–964, 1982Google Scholar
  16. 16.
    Mikami R, Sekiguchi M, Ryuzin Y, et al: Changes in the peripheral vasculature of various organs in patients with sarcoidosis-Possible role of microangiopathy.Heart & Vessels 2: 129–139, 1986CrossRefGoogle Scholar
  17. 17.
    Fanburg BL, Pitt EA: Sarcoidosis. Murray JF & Nadel JA, eds.Textbook of respiratory Medicine, Saunders Philadelphia, pp. 1486–1500, 1988Google Scholar
  18. 18.
    Baarsuma GS, La-Hay E, Glasius E, et al: The predictive value of serum angiotensin converting enzyme and lysozyme levels in the diagnosis of ocular sarcoidosis.Am J Ophthalmol 104 (3): 211–217, 1987Google Scholar
  19. 19.
    Nakata Y, Ejiri T, Kishi T, et al: Alveolar lymphocyte proliferation induced by Propionibacterium acnes in sarcoidosis patients.Acta Med Okayama 40 (5): 257–264, 1986PubMedGoogle Scholar
  20. 20.
    Alberts C, Schoot JB, Broen AS:67Ga scintigraphy as an indicator of disease activity in pulmonary sarcoidosis.Eur J Nucl Med 6: 205–212, 1981PubMedCrossRefGoogle Scholar
  21. 21.
    Ratner SJ, Fenoglio JJ, Ursell PC, et al: Utility of endomyocardial biopsy in the diagnosis of cardiac sarcoidosis.Chest 90: 528–533, 1986PubMedCrossRefGoogle Scholar
  22. 22.
    Lemery R, McGoon MD, Edwards WD: Cardiac sarcoidosis: A potentially treatable form of myocarditis.Myo Clin Proc 60: 549–554, 1985Google Scholar
  23. 23.
    Fujita M, Sasayama S, Hoshino T, et al: Myocardial sarcoidosis with congestive heart failure.Jpn Circ J 51: 436–438, 1987PubMedGoogle Scholar
  24. 24.
    Kinney EL, Caldwell JW: Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patients without cardiac symptoms?Angiology 41 (7): 573–576, 1990PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Noritaka Yamamoto
    • 1
  • Kohshi Gotoh
    • 1
  • Yasuo Yagi
    • 1
  • Yasushi Terashima
    • 1
  • Kenshi Nagashima
    • 1
  • Toshiyuki Sawa
    • 1
  • Fumiko Deguchi
    • 1
  • Masumi Nawada
    • 1
  • Haruhito Tanaka
    • 1
  • Tatsuo Tsukamoto
    • 2
  • Senri Hirakawa
    • 1
  1. 1.The Second Department of Internal MedicineGifu University School of MedicineGifuJapan
  2. 2.The Ibi General HospitalJapan

Personalised recommendations