CT chest may show mediastinal lymphadenopathy and lung changes in systemic sarcoidosis. Pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. CT Coronary Calcium There is no relevant literature to support the use of CT coronary calcium for the evaluation of restrictive cardiomyopathy. Incidental pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. CT Heart Function and Morphology Abnormal first-pass perfusion, delayed iodine enhancement, and high ECV values have been shown with CT in cardiac amyloidosis [57,58]. Subepicardial or mid myocardial delayed iodine enhancement has also been shown to identify cardiac sarcoidosis [59]. Pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. Nonischemic Myocardial Disease CTA Coronary There is no relevant literature to support the use of coronary CTA for the evaluation of restrictive cardiomyopathy when ischemic cardiomyopathy has already been excluded. Nuclear Medicine Tc-DPD and Tc-PYP have high specificity in the diagnosis of cardiac amyloidosis. Ga-67 scintigraphy shows high uptake in cardiac sarcoidosis, with the intensity correlating with degree of inflammation [55]; however, it has low sensitivity [55]. Perfusion defects seen in thallium-201 and Tc-99m myocardial scintigraphy, as well as Rb- 82, can be distinguished from ischemia by using PET/CT [55]. FDG-PET/CT Heart FDG-PET performed after suppressing normal glucose metabolism shows high uptake in cardiac sarcoidosis, with reverse distribution in thallium-201 scans. FDG-PET had an 82% to 100% specificity and 39% to 91% specificity in the diagnosis of cardiac sarcoidosis [54]. FDG has higher sensitivity than Ga-67 scintigraphy, although Ga-67 scintigraphy is included in the imaging criteria [54].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . CT chest may show mediastinal lymphadenopathy and lung changes in systemic sarcoidosis. Pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. CT Coronary Calcium There is no relevant literature to support the use of CT coronary calcium for the evaluation of restrictive cardiomyopathy. Incidental pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. CT Heart Function and Morphology Abnormal first-pass perfusion, delayed iodine enhancement, and high ECV values have been shown with CT in cardiac amyloidosis [57,58]. Subepicardial or mid myocardial delayed iodine enhancement has also been shown to identify cardiac sarcoidosis [59]. Pericardial calcification points toward a pericardial constriction rather than restrictive cardiomyopathy. Nonischemic Myocardial Disease CTA Coronary There is no relevant literature to support the use of coronary CTA for the evaluation of restrictive cardiomyopathy when ischemic cardiomyopathy has already been excluded. Nuclear Medicine Tc-DPD and Tc-PYP have high specificity in the diagnosis of cardiac amyloidosis. Ga-67 scintigraphy shows high uptake in cardiac sarcoidosis, with the intensity correlating with degree of inflammation [55]; however, it has low sensitivity [55]. Perfusion defects seen in thallium-201 and Tc-99m myocardial scintigraphy, as well as Rb- 82, can be distinguished from ischemia by using PET/CT [55]. FDG-PET/CT Heart FDG-PET performed after suppressing normal glucose metabolism shows high uptake in cardiac sarcoidosis, with reverse distribution in thallium-201 scans. FDG-PET had an 82% to 100% specificity and 39% to 91% specificity in the diagnosis of cardiac sarcoidosis [54]. FDG has higher sensitivity than Ga-67 scintigraphy, although Ga-67 scintigraphy is included in the imaging criteria [54].