Abstract:FDG PET has been proposed to play a role in the diagnosis and therapy monitoring of sarcoidosis including cardiac involvement. However, assessing inflammatory lesions in cardiac sarcoidosis using FDG can be challenging because the FDG accumulates in normal myocardium. We report a case of sarcoidosis with cardiac involvement that underwent 3'-deoxy-3'-F-fluorothymidine (FLT) PET. FLT PET images demonstrated increased uptake in the lymph nodes and left ventricle. After immunosuppressive therapy, a follow-up PET … Show more
“…Along with the important role of CMR and cardiac PET in the detection of ICS, radio-tracers targeting inflammatory cells such as F-18 fluorothymidine (FLT) 45 and Ga-68 DOTATOC 46 may provide additional and complementary information. Improved detection and diagnosis may facilitate a deeper understanding of the pathobiology, epidemiology, clinical characteristics, and prognosis of ICS.…”
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
“…Along with the important role of CMR and cardiac PET in the detection of ICS, radio-tracers targeting inflammatory cells such as F-18 fluorothymidine (FLT) 45 and Ga-68 DOTATOC 46 may provide additional and complementary information. Improved detection and diagnosis may facilitate a deeper understanding of the pathobiology, epidemiology, clinical characteristics, and prognosis of ICS.…”
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
“…6; [117–119]). Though very preliminary in nature, other alternatives include hypoxia displaying agents like [ 18 F]-fluoromisonidazole (FMISO) [120] or proliferation markers like 3′-deoxy-3′-[ 18 F]-fluorothymidine (FLT) [121]. Fig.…”
Purpose of ReviewInflammation is a key player in a wide range of cardiovascular and myocardial diseases. Given the numerous implications of inflammatory processes in disease initiation and progression, functional imaging modalities including positron emission tomography (PET) represent valuable diagnostic, prognostic, and monitoring tools in patient management. Since increased glucose metabolism is a hallmark of inflammation, PET using the radiolabeled glucose analog [18F]-2-deoxy-2-fluoro-d-glucose (FDG) is the mainstay diagnostic test for nuclear imaging of (cardiac) inflammation. Recently, new approaches using more specific tracers to overcome the limited specificity of FDG have emerged.Recent FindingsPET imaging has proven its value in a number of inflammatory conditions of the heart including myocarditis, endocarditis, sarcoidosis, or reactive changes after myocardial infarction. In infection-related endocarditis, FDG-PET and white blood cell scintigraphy have been implemented in current guidelines. FDG-PET is considered as nuclear medical gold standard in myocarditis, pericarditis, or sarcoidosis. Novel strategies, including targeting of somatostatin receptors or C-X-C motif chemokine receptor CXCR4, have shown promising results in first studies.SummaryNuclear medicine techniques offer valuable information in the assessment of myocardial inflammation. Given the possibility to directly visualize inflammatory activity, they represent useful tools for diagnosis, risk stratification, and therapy monitoring.
“…68 In preclinical studies, FLT uptake has been shown to be comparable to that of FDG in rat models of granulomatous disease, 69 and in recent studies FLT has been shown to accumulate in both extracardiac 70 and CS. 71,72 Additional studies are required to further evaluate the clinical utility of these novel probes for myocardial inflammation detection.…”
Section: Future Nuclear Techniques For Imaging Inflammationmentioning
Cardiac sarcoidosis (CS) remains an intriguing infiltrating disorder and one of the most important forms of inflammatory cardiomyopathy. Identification of patients with CS is of extreme importance because they are at higher risk of sudden death, and heart-failure progression. And while it remains a diagnostic conundrum, a great amount of experience has been accumulated over the last decade with the advent of fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance with late gadolinium enhancement imaging. They have both proven to be advanced imaging techniques that provide important, and often complementary, diagnostic and prognostic information for the management of CS. However, they have also shown to have limitations, and, thus, there is a continued need for developing more specific imaging probes for identifying cardiac inflammation. The aim of the present manuscript is to provide the reader with a better understanding of the histopathology of the disease, how this potentially relates to noninvasive imaging detection, and the best strategies available for the diagnosis and management of patients with CS.
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