Comparison of routine contrast‑enhanced computed tomography with late gadolinium enhancement cardiac magnetic resonance imaging in the detection of myocardial pathology

Bacground: Cardiac magnetic resonance imaging (MRI) represents the gold standard in noninvasive evaluation of myocardial tissue. However, some patients are unable to undergo cardiac MRI due to a variety of reasons. Aims: We sought to determine the diagnostic accuracy of routinely performed contrast‑enhanced computed tomography (CECT) compared with cardiac MRI in the evaluation of myocardial tissue. Methods: We retrospectively evaluated 96 consecutive patients (mean [SD] age, 51 [15] years; 41 women) who underwent both CECT and cardiac MRI within 30 days. All CECT scans that visualized the entire heart were analyzed, regardless of the indication for and protocol of the procedure. The presence of late gadolinium enhancement on cardiac MRI was compared with the finding of myocardial hypoattenuation on computed tomography scans. Results: With cardiac MRI as the gold standard, CECT revealed a per‑patient sensitivity of 66%, specificity of 89%, positive predictive value of 75%, negative predictive value of 84%, and accuracy of 81%. Per‑segment sensitivity was 54%; specificity, 98%; positive predictive value, 76%; negative predictive value, 94%; and accuracy, 92%. Conclusions: Our study suggests that routinely performed CECT has high specificity, but only moderate sensitivity, compared with cardiac MRI in the evaluation of myocardial tissue. This result supports the recommendation that all CECT scans that visualize the entire heart should be analyzed for myocardial tissue pathology

Role of magnetic resonance in the detection of cardiac involvement in patients with newly diagnosed extracardiac sarcoidosis: Single center experience

BACKGROUND: Sarcoidosis is a systemic inflammatory disease of unknown etiology, which can affect almost any organ. Cardiac involvement determines the prognosis of the affected individuals. Its prevalence in patients with extracardiac sarcoidosis with the absence of cardiac symptoms remains unclear. Cardiac magnetic resonance (CMR) provides an excellent diagnostic accuracy in the detection of the heart involvement by sarcoidosis. AIM: We sought to determine the prevalence of cardiac sarcoidosis in asymptomatic individuals with newly diagnoses extracardiac sarcoidosis using CMR. METHODS: We prospectively evaluated 55 consecutive patients mean (SD) aged 43 (11) years, including 23 women with newly diagnosed extracardiac sarcoidosis who underwent contrast-enhanced CMR and had no symptoms of heart disease. The presence of myocardial late gadolinium enhancement (LGE) of non-ischemic etiology on CMR examination was considered diagnostic for the presence of cardiac sarcoidosis. RESULTS: In 3 (6%) patients LGE pattern consistent with cardiac sarcoidosis was detected. In all these patients, preserved left ventricular systolic regional a well as global function was present and in none of them the elevation of blood biomarkers of myocardial injury or overload was found. CONCLUSIONS: Our study suggests that the prevalence of cardiac involvement in patients with newly diagnosed extracardiac sarcoidosis and no symptoms of heart disease is very low as assesed by CMR.  However, CMR may be considered as a part of routine evaluation of patients with extracardiac sarcoidosis due its higher diagnostic yield in comparison with echocardiography and ECG, respectively