MRI and FDG PET/CT Imaging Manifestations of Cardiac Sarcoidosis

Abstract

A 52-year-old man had biopsy-proven sarcoidosis of mediastinal lymph nodes. Cardiac sarcoidosis was confirmed on cardiac MRI with typical imaging features as delayed gadolinium enhancement. Follow-up FDG PET/CT with a 3-day pretest diet modification showed suppression of overall myocardial uptake of FDG but with multifocal abnormal FDG uptake in the myocardium regions corresponding to the previous MRI findings. Additional noncardiac active sarcoidosis involving multiple organ and lymph nodes were also visualized on FDG PET/CT.

Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus

“…However, decreased perfusion at rest is not specific nor sensitive for CS diagnosis; many CS can have normal or even increased perfusion. Our experience also showed that, with optimal suppression of physiologic myocardial 18 F-FDG uptake, the rest myocardial perfusion study or reorientation/reconstruction of cardiac 18 F-FDG PET/CT images might not be needed (4,5). The authors recommended interpretation of concurrent myocardial perfusion and 18 F-FDG PET images mainly based on the data from Brigham and Women's Hospital, which included 118 patients over a 5-y period who underwent ,24-h HFHPVLC diet followed by a fast of at least 3 h before 18 F-FDG PET and 82 Rb myocardial perfusion PET (6).…”