Fig. 28.1
Coronal image from a contrast-enhanced chest CT scan shows calcified lymph nodes along the mediastinum (A) with chronic bilateral lung disease in a patient with known sarcoidosis. Note the course interstitial thickening (B)
28.2.4 MRI Findings
T2-weighted and short-T1 inversion recovery (STIR)
Sarcoidosis may demonstrate focal or diffuse myocardial hyperintensity due to edema with thinning of the ventricle wall
Sensitive in detecting iron deposition within the myocardium in siderotic cardiomyopathy
SSFP cine MR
Assess ventricular filling dysfunction
Decreased E/A ratio—a measurement of transmitral flow, comparing peak early diastole flow (E measurement) with the flow during atrial contraction (A)
Most ventricular filling occurs in late diastole because of impaired ventricular relaxation during early diastole
Septal convexity is preserved through all respiratory phases. By comparison, septal flattening occurs during early inspiration in constrictive pericarditis.
Decreased systolic contraction may be seen in regions with granulomatous infiltration by sarcoid
Delayed gadolinium enhancement
May represent areas of fibrosis
Amyloidosis demonstrates a specific diffuse, heterogeneous subendocardial pattern of enhancement that correlates with regions of systolic hypokinesis or akinesis
Sarcoid has a typical enhancement pattern involving the basal interventricular septum and lateral left ventricle wall with sparing of the subendocardium. Enhancement may be diffuse and transmural in advanced disease
In scleroderma, late enhancement characteristics show a linear pattern, mostly involving basal and midwall segments of the left ventricle (Fig. 28.2)
Fig. 28.2
Immediate (left) and delayed (right) short-axis cardiac MR perfusion images in a patient with sarcoidosis show delayed uptake of contrast material (arrow) on the image on the left. The delayed image (right) shows hyperenhancement of the interventricular septum consistent with sarcoid infiltration of the myocardium. The function of the left ventricle was globally decreased with no coronary artery disease
28.2.5 Cardiac Catheterization
Subendomyocardial biopsy can be performed to help differentiate etiology.
28.2.6 Imaging Recommendations
Echocardiography can be used to evaluate ventricular dysfunction
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