TL-201-SCINTIGRAPHY USING THE SPECT TECHN IQUE IN THE DIAGNOSIS OF CARDIAC SARCOIDOSIS AND COMPLETE HEART-BLOCK

Cardiac sarcoidosis is difficult to diagnose even with invasive method s and definite diagnosis is often only made by post-mortem analysis, C onduction abnormalities are among the most frequent complications of c ardiac sarcoidosis and due to their frequent lethal course require ear ly diagnosis to introduce specific therapy as early as possible, Here we report about a 32-year old man with a syncope due to complete heart block, After implantation of a pacemacer a cutaneous sarcoidosis and later on pulmonary manifestations were diagnosed, Apart from the compl ete heart block progressive left ventricular dilatation and decreased left ventricular function were observed to indicate cardiac involvemen t, By endomyocardial biopsy the diagnosis of a cardiac sarcoidosis cou ld not be established, Thus, a Tl-201-SPECT analysis was performed, Th e Tl-201 Scan in ECT-technic immediately post stress and 3 hours post stress revealed the following picture: perfusion defects of the septum , especially in the basal and middle part with extension to the antero basal anterior wall, In the delayed study persistent anterobasal defec ts and in the septum could be detected, In the case presented the perf usion defects in the Tl-scintigraphy using the SPECT-technique correla te well with the anatomic region of the expected granulomata in a pati ent with a complete heart block, However, prospective studies would be necessary to investigate, whether the higher spatial resolution of th e ECT-technic in comparison with the planar technic allows an early di agnosis and monitoring of specific therapy.