Late Gadolinium Enhancement in Cardiac Sarcoidosis

PURPOSE: Cardiac involvement is an important prognostic factor in sarcoidosis, and cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) can facilitate the identification of cardiac sarcoidosis (CS). In patients with CS, we investigated LGE characteristics and their relationship with left ventricular (LV) function to identify those characteristics unique to severely reduced LV function. We also investigated the relationship between LGE and duration of sarcoidosis. MATERIALS AND METHODS: We retrospectively evaluated 19 patients with CS diagnosed according to the 2006 revised guidelines of the Japanese Ministry of Health and Welfare who underwent CMR imaging. We analyzed LGE location using 17-segment and subsegment (subepicardial, midwall, subendocardial, and transmural) models and evaluated the relationship between the characteristics of LGE and LV ejection fraction (LVEF) and duration of sarcoidosis. RESULTS: Images of 17 of the 19 patients showed LGE most frequently in the subepicardial layer. The total number of affected segments with LGE correlated significantly with LVEF (r=-0.84, P<0.0001) and LV-diastolic volumes (r=0.88, P<0.0001). Transmural lesions were significantly more common in patients with LVEF of 35% or lower than in those with LVEF exceeding 35% (P=0.0004). All patients with LVEF of 35% or lower had both subepicardial and transmural lesions. The total number of affected segments with LGE correlated with the duration of sarcoidosis in patients with onset in an extracardiac organ (r=0.76, P=0.005). CONCLUSIONS: Demonstration of a characteristic LGE pattern and location allows diagnosis of CS, and CMR imaging with LGE aids in prediction of LV function.