Myocardial Positron Emission Tomography for Evaluation of Cardiac Sarcoidosis: Specialized Protocols for Better Diagnosis

Abstract

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology with various clinical presentations depending on the organs involved. Since cardiac sarcoidosis (CS) portends a higher risk of morbidity and mortality, early diagnosis and aggressive medical treatment are essential to improve the prognosis. 18 F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as an important tool with practical advantages in assessing disease activity and monitoring the treatment response in patients with CS. While it has high sensitivity, it also has great variability in specificity, probably due to normal physiologic myocardial FDG uptake, which interferes with the evaluation and follow-up of CS using FDG-PET. This review details the technical aspects of FDG-PET imaging for evaluating and diagnosing CS, assessing disease activity, and monitoring therapeutic response.

What cardiologists should know about cardiac sarcoidosis in 2022?

“…In our experience, prolonged fast (> 18 h) has also been successful to suppress myocardial uptake in patients with low compliance to HFLC diet. Finally, low-dose intravenous heparin administration at the time of PET/ CT could decrease cardiac physiologic uptake and consequently false positive result and should be considered a standard strategy when performing PET/CT [17].…”

Comparison of the Effect of Three Different Dietary Modifications on Myocardial Suppression in 18F-FDG PET/CT Evaluation of Patients for Suspected Cardiac Sarcoidosis

“…Therefore, non-invasive imaging methods, cardiac MRI and cardiac 18 F-FDGPET/CT (cPET/CT), are frequently used when screening or symptoms indicate cardiac involvement. While both modalities have limitations, they ultimately proved complementary as they measure different pathologic processes (3)(4)(5)(6)(7)(8).…”