DIAGNOSTIC AND PROGNOSTIC VALUE OF MYOCARDIAL SCINTIGRAPHY WITH TL-201 AND GA-67 IN CARDIAC SARCOIDOSIS

Study Objective: To examine the diagnostic and prognostic value of myo cardial scintigraphy using thallium-201 and gallium-67 in cardiac sarc oidosis. Patients: Twenty-five patients with sarcoidosis. Methods: All patients underwent myocardial thallium-201 scintigraphy. Six patients with myocardial thallium-201 defects were classified into group A and another 19 without defects were classified into group B. Between grou p A and B, we compared the results of other noninvasive examinations, including standard 12-lead EGG, 24 h ambulatory EGG, chest radiography , measurements of serum angiotensin-converting enzyme (ACE) and lysozy me levels, and gallium-67 scintigraphy. Results: Proportions of subjec ts who had varying degrees of heart block, severe ventricular arrhythm ias (more than or equal to third grade of Lown's classification), and high levels of serum ACE and lysozyme levels were not different betwee n these two groups (p > 0.05). Although an enlarged cardiothoracic rat io was more frequent in group A (p < 0.05), bilateral hilar lymphadeno pathy was more frequent in group B (p < 0.01). Four patients of group A and 15 of group B underwent gallium-67 scintigraphy. Although no sub jects of group B had myocardial uptake of gallium-67, two of four grou p A patients showed cardiac uptake. These four group A patients were t reated with corticosteroids, The therapy provided clinical and scintig raphic improvement in two patients with myocardial gallium-67 uptake, although it did no improvement in the other two patients without galli um-67 uptake. Conclusions: When cardiac sarcoidosis was diagnosed acco rding to myocardial thallium-201 defects, other noninvasive examinatio ns were not useful to detect this disease, However, gallium-67 uptake may predict the efficacy of corticosteroids. Thus, the combination of thallium-201 and gallium-67 scintigraphy may be useful not only in dia gnosis of cardiac sarcoidosis but also in prediction of effects of cor ticosteroids.