Sensitivity and specificity of chest imaging for sarcoidosis screening in patients with cardiac presentations.
cardiac sarcoidosis
cardiomyopathy
imaging
sarcoidosis
screening
Journal
Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG
ISSN: 2532-179X
Titre abrégé: Sarcoidosis Vasc Diffuse Lung Dis
Pays: Italy
ID NLM: 9610928
Informations de publication
Date de publication:
2019
2019
Historique:
received:
12
03
2018
accepted:
19
09
2018
entrez:
2
6
2020
pubmed:
1
1
2019
medline:
1
7
2020
Statut:
ppublish
Résumé
Patients with sarcoidosis can present with cardiac symptoms as the first manifestation of disease in any organ. In these patients, the use of chest imaging modalities may serve as an initial screening tool towards the diagnosis of sarcoidosis through identification of pulmonary/mediastinal involvement; however, the use of chest imaging for this purpose has not been well studied. We assessed the utility of different chest imaging modalities for initial screening for cardiac sarcoidosis (CS). All patients were investigated with chest x-ray, chest computed tomography (CT) and/or cardiac/thorax magnetic resonance imaging (MRI). We then used the final diagnosis (CS versus no CS) and adjudicated imaging reports (normal versus abnormal) to calculate the sensitivity and specificity of individual and combinations of chest imaging modalities. We identified 44 patients (mean age 54 (±8) years, 35.4% female) and a diagnosis of CS was made in 18/44 patients (41%). The sensitivity and specificity for screening for sarcoidosis were 35% and 85% for chest x-ray, respectively (AUC 0.60; 95%CI 0.42-0.78; p value=0.27); 94% and 86% for chest CT (AUC 0.90; 95%CI 0.80-1.00; p value <0.001); 100% and 50% for cardiac/thorax MRI (AUC 0.75; 95%CI 0.56-0.94; p value=0.04). During the initial diagnostic workup of patients with suspected CS, chest x-ray was suboptimal as a screening test. In contrast CT chest and cardiac/thorax MRI had excellent sensitivity. Chest CT has the highest specificity among imaging modalities. Cardiac/thorax MRI or chest CT could be used as an initial screening test, depending on local availability.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with sarcoidosis can present with cardiac symptoms as the first manifestation of disease in any organ. In these patients, the use of chest imaging modalities may serve as an initial screening tool towards the diagnosis of sarcoidosis through identification of pulmonary/mediastinal involvement; however, the use of chest imaging for this purpose has not been well studied. We assessed the utility of different chest imaging modalities for initial screening for cardiac sarcoidosis (CS).
METHODS AND RESULTS
RESULTS
All patients were investigated with chest x-ray, chest computed tomography (CT) and/or cardiac/thorax magnetic resonance imaging (MRI). We then used the final diagnosis (CS versus no CS) and adjudicated imaging reports (normal versus abnormal) to calculate the sensitivity and specificity of individual and combinations of chest imaging modalities. We identified 44 patients (mean age 54 (±8) years, 35.4% female) and a diagnosis of CS was made in 18/44 patients (41%). The sensitivity and specificity for screening for sarcoidosis were 35% and 85% for chest x-ray, respectively (AUC 0.60; 95%CI 0.42-0.78; p value=0.27); 94% and 86% for chest CT (AUC 0.90; 95%CI 0.80-1.00; p value <0.001); 100% and 50% for cardiac/thorax MRI (AUC 0.75; 95%CI 0.56-0.94; p value=0.04).
CONCLUSIONS
CONCLUSIONS
During the initial diagnostic workup of patients with suspected CS, chest x-ray was suboptimal as a screening test. In contrast CT chest and cardiac/thorax MRI had excellent sensitivity. Chest CT has the highest specificity among imaging modalities. Cardiac/thorax MRI or chest CT could be used as an initial screening test, depending on local availability.
Identifiants
pubmed: 32476932
doi: 10.36141/svdld.v36i1.6865
pii: SVDLD-36-18
pmc: PMC7247116
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Pagination
18-24Informations de copyright
Copyright: © 2019.
Références
Circ J. 2007 Dec;71(12):1937-41
pubmed: 18037750
Circ Arrhythm Electrophysiol. 2014 Apr;7(2):230-6
pubmed: 24585727
J Cardiovasc Electrophysiol. 2014 Aug;25(8):875-881
pubmed: 24602015
Can J Cardiol. 2013 Mar;29(3):260-5
pubmed: 23010085
Proc (Bayl Univ Med Cent). 2009 Jul;22(3):236-8
pubmed: 19633746
Heart Rhythm. 2014 Jul;11(7):1305-23
pubmed: 24819193
Pacing Clin Electrophysiol. 2014 Mar;37(3):364-74
pubmed: 24102263
J Am Coll Cardiol. 2016 Jul 26;68(4):411-21
pubmed: 27443438
Circulation. 2015 Oct 27;132(17):e211
pubmed: 26503753
J Chin Med Assoc. 2007 Nov;70(11):492-6
pubmed: 18063503
J Intern Med. 2011 Nov;270(5):461-8
pubmed: 21535250
Circ Arrhythm Electrophysiol. 2011 Jun;4(3):303-9
pubmed: 21427276
Ann Intern Med. 2011 Oct 18;155(8):529-36
pubmed: 22007046
Heart Rhythm. 2015 Dec;12(12):2488-98
pubmed: 26272522
Circulation. 2015 Feb 17;131(7):624-32
pubmed: 25527698
Cardiovasc Pathol. 2014 Jan-Feb;23(1):17-20
pubmed: 23928368
Clin Anat. 2011 Sep;24(6):684-91
pubmed: 21387415