A meta-analysis showed 89% sensitivity, 78% specificity, and area under the receiver operator characteristic curve of 93% for diagnosis of cardiac sarcoidosis [60]. The FDG activity can be quantified to improve the diagnostic accuracy, assess disease activity, and evaluate prognosis [60]. Simultaneous PET/MRI has been shown to be feasible with diagnostic image quality to evaluate cardiac sarcoidosis [61]. MRI Chest There is no relevant literature to support the use of MRI chest for the evaluation of restrictive cardiomyopathy. MRI chest may show mediastinal lymphadenopathy and lung changes in systemic sarcoidosis. MRI Heart Function and Morphology MRI has distinctive appearances in several infiltrative disorders and restrictive cardiomyopathies. Cardiac amyloidosis produces concentric thickening of ventricles, atria, interatrial septum, and valves, with low signal in T2-weighted images [62]. Diffuse subendocardial LGE is seen in early stages, which progresses to transmural LGE. Abnormal LGE has a pooled specificity of 92% and sensitivity of 85% in the diagnosis of cardiac amyloidosis [63]. Dark blood pool and earlier nulling of myocardium is also seen in cardiac amyloidosis. High native T1 and ECV values are more sensitive than LGE and reliably distinguish amyloidosis from HCM [64]. MRI can distinguish AL and ATTR types, with ATTR amyloidosis showing more LV thickening and mass, lower left ventricular ejection fraction (LVEF), greater LGE, more transmural LGE, and lower T1 values than the AL type [64]. An LGE-based scoring system was shown to have 87% sensitivity and 96% specificity in distinguishing AL and ATTR amyloidosis [64]. LGE, T1, and ECV abnormalities all correlate with prognosis in cardiac amyloidosis [65]. Transmural LGE is a predictor of adverse events including death [66]. Postcontrast difference in T1 between subepicardium and subendocardium of >23 ms predicts mortality with high accuracy [67].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . A meta-analysis showed 89% sensitivity, 78% specificity, and area under the receiver operator characteristic curve of 93% for diagnosis of cardiac sarcoidosis [60]. The FDG activity can be quantified to improve the diagnostic accuracy, assess disease activity, and evaluate prognosis [60]. Simultaneous PET/MRI has been shown to be feasible with diagnostic image quality to evaluate cardiac sarcoidosis [61]. MRI Chest There is no relevant literature to support the use of MRI chest for the evaluation of restrictive cardiomyopathy. MRI chest may show mediastinal lymphadenopathy and lung changes in systemic sarcoidosis. MRI Heart Function and Morphology MRI has distinctive appearances in several infiltrative disorders and restrictive cardiomyopathies. Cardiac amyloidosis produces concentric thickening of ventricles, atria, interatrial septum, and valves, with low signal in T2-weighted images [62]. Diffuse subendocardial LGE is seen in early stages, which progresses to transmural LGE. Abnormal LGE has a pooled specificity of 92% and sensitivity of 85% in the diagnosis of cardiac amyloidosis [63]. Dark blood pool and earlier nulling of myocardium is also seen in cardiac amyloidosis. High native T1 and ECV values are more sensitive than LGE and reliably distinguish amyloidosis from HCM [64]. MRI can distinguish AL and ATTR types, with ATTR amyloidosis showing more LV thickening and mass, lower left ventricular ejection fraction (LVEF), greater LGE, more transmural LGE, and lower T1 values than the AL type [64]. An LGE-based scoring system was shown to have 87% sensitivity and 96% specificity in distinguishing AL and ATTR amyloidosis [64]. LGE, T1, and ECV abnormalities all correlate with prognosis in cardiac amyloidosis [65]. Transmural LGE is a predictor of adverse events including death [66]. Postcontrast difference in T1 between subepicardium and subendocardium of >23 ms predicts mortality with high accuracy [67].