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A clinical case on the use of cardiac MRI for identification of cardiac inflammation
Poster Title: A clinical case on the use of cardiac MRI for identification of cardiac inflammation
Submitted on 30 Oct 2020
Author(s): Munaib Din; Ansab Fazili; Vardah Alam; Eliana Reyes
Affiliations: Guy's and St Thomas' NHS Foundation Trust; King's College London
Poster Views: 418
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Poster Information
A 55-year-old woman with type II diabetes presented with non-specific constitutional symptoms. Physical examination revealed cervical masses. A CT scan showed extensive lymphadenopathy and lung nodules. Differential diagnoses included lymphoma and sarcoidosis.

A cardiac MRI was performed to investigate cardiac involvement. The overall impression was of a recent myocardial ischaemic event. A subsequent fine-needle aspiration of the parotid gland revealed non-caseating granuloma, confirming the diagnosis of sarcoidosis.

Two years later, she represented with significant weight loss raising the suspicion of malignancy, leading to a PET-CT. A half-body PET-CT study was consistent with widespread active sarcoid. Inspection of the heart revealed focal high-grade FDG uptake in the interventricular septum. Subsequent Cardiac MRI studies confirmed cardiac involvement with progression to myocardial fibrosis and impaired contractile function.

It highlights the current challenges for detecting and characterising cardiac sarcoidosis using contemporary imaging, and the importance of a multi-modality, multi-disciplinary approach in preventing misinterpretation, and the potential delay in diagnosis and management.
The case shows the importance of image quality, careful review of STIR, and the added value of T2 mapping by providing a quantitative assessment of myocardial tissue
PET Imaging has a high sensitivity for the detection of cardiac inflammation, suggesting its use should be further incorporated for review of the heart on half-body acquisitions
Summary: This poster details a clinical case study that highlights the challenges faced when characterising cardiac sarcoidosis using current imaging techniques, and the importance of a multi-modality approach.Report abuse »
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