Wicks, Eleanor Catherine; (2021) The technical development, diagnostic accuracy and prognostic value of multimodality imaging in cardiac sarcoidosis and myocarditis. Doctoral thesis (Ph.D), UCL (University College London).

Abstract

Cardiac sarcoidosis (CS) and myocarditis are potentially fatal inflammatory heart muscle conditions that are under-diagnosed in everyday clinical practice. A scarcity of data and lack of consensus on the most appropriate methods for detecting, monitoring and treating these inflammatory cardiomyopathies presents a significant diagnostic and therapeutic challenge. Moreover, whether inflammation plays a role in arrhythmogenic cardiomyopathy (AC) in-vivo remains unknown. This thesis describes the novel technical development of the hybrid imaging technique positron emission tomography and magnetic resonance imaging (PET/MRI) in cardiovascular imaging. It validates the use of this technique in imaging CS and explores its wider utility within routine clinical practice. It confirms that novel hybrid PET/MRI multimodality imaging improves the diagnostic accuracy for detecting CS and suggests that each imaging component provides complimentary information on disease pathophysiology. Furthermore, it establishes that abnormalities detected on PET/MRI provide additive clinical value in predicting adverse disease-related outcomes. Given the demonstrated value of PET/MRI in CS, the diagnostic and prognostic utility of multimodality imaging using PET and MRI is sequentially evaluated in myocarditis and elucidates similar findings to those found in CS, highlighting the critical clinical role of PET and MRI in the evaluation of myocarditis. Extrapolating the concept of imaging inflammation even further to those with AC, a retrospective analysis of those who underwent a PET scan confirms the in-vivo hypothesis that inflammation is involved in the pathophysiology of AC. Consequently, a standardised, systematic diagnostic pathway is defined for use in the diagnostic and prognostic evaluation of patients with inflammatory heart muscle disease. Translated directly into clinical practice, these data offer enormous opportunities for cardiomyopathy services and patients by enabling earlier diagnoses and the institution of therapies to reduce morbidity and mortality. Finally, illustrative case studies demonstrate the wider utility and clinical application of multiparametric, multimodality imaging offered by PET and MRI across cardiovascular disease and future translational and innovative opportunities are proposed.

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