Sensitivity and specificity of chest imaging for sarcoidosis screening in patients with cardiac presentations

Juan J Russo; Pablo B Nery; Andrew C Ha; Jeff S Healey; Daniel Juneau; Lena Rivard; Matthias G Friedrich; Lorne Gula; Gerald Wisenberg; Robert deKemp; Santabhanu Chakrabarti; Tomasz W Hruczkowski; Russell Quinn; F. Daniel Ramirez; Girish Dwivedi; Rob SB Beanlands; David H Birnie

doi:10.36141/svdld.v36i1.6865

Sensitivity and specificity of chest imaging for sarcoidosis screening in patients with cardiac presentations

Authors

Juan J Russo Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
Pablo B Nery Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
Andrew C Ha Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, ON
Jeff S Healey Population Health Research Institute, Mc- Master University, Hamilton, ON
Daniel Juneau
Lena Rivard Montreal Heart Institute, Montreal, QC
Matthias G Friedrich Cardiovascular Imaging, McGill University Health Centre, Montreal, QC
Lorne Gula Department of Medicine, Western University, London, ON
Gerald Wisenberg Department of Medicine, Western University, London, ON and Division of Imaging, Lawson Research Institute, London, ON
Robert deKemp Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
Santabhanu Chakrabarti Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC
Tomasz W Hruczkowski University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, AB
Russell Quinn Libin Cardiovascular Institute of Alberta, Calgary, AB
F. Daniel Ramirez Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
Girish Dwivedi Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
Rob SB Beanlands Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
David H Birnie Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON

Keywords:

Cardiac sarcoidosis, Sarcoidosis, Screening, Imaging, Cardiomyopathy

Abstract

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: 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: 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.