18F-FDG PET/CT for the Assessment of Myocardial Sarcoidosis
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Cardiac involvement portends a poor prognosis in patients with sarcoidosis. However, due to the nonspecific clinical manifestations of the disease, patchy myocardial involvement, and the limited diagnostic yield of diagnostic tests, early diagnosis of cardiac sarcoidosis has been exceedingly difficult. As a result, there is no standardized approach for the early diagnosis of cardiac sarcoidosis. Imaging modalities that can both identify disease and predict response to therapy are paramount to improve management of cardiac sarcoidosis. 18F-FDG PET has many practical advantages in assessing disease activity and monitoring treatment response in patients with cardiac sarcoidosis. Accumulating data support the growing role of 18F-fluorodeoxyglucose (18F-FDG) PET in the diagnosis and risk stratification of patients with cardiac sarcoidosis.
KeywordsCardiac sarcoidosis 18F-FDG PET Myocardial sarcoidosis
Conflicts of Interest
Hicham Skali declares that he has no conflict of interest.
Allison R. Schulman declares that she has no conflict of interest.
Sharmila Dorbala has received salary support from a research grant from the National Institutes of Health (5K23HL092299-03); has received grant support from Astellas Global Pharma Development, Bracco Diagnostics; has received travel/accommodations expenses covered or reimbursed from RSNA, ASNC.
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- 6.•• Youssef G, Leung E, Mylonas I, Nery P, Williams K, Wisenberg G, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 2012;53:241–8. Meta-analysis of 7 studies comparing the accuracy of 18F-FDG PET for the diagnosis of cardiac sarcoidosis.PubMedCrossRefGoogle Scholar
- 8.Hiraga H, Hiroe M, Iwai K, et al. Guideline for the diagnosis of cardiac sarcoidosis: study report on Diffuse Pulmonary Diseases (in Japanese). 1993:23–4.Google Scholar
- 9.•• Tahara N, Tahara A, Nitta Y, Kodama N, Mizoguchi M, Kaida H, et al. Heterogeneous myocardial FDG uptake and the disease activity in cardiac sarcoidosis. JACC Cardiovasc Imaging. 2010;3:1219–28. First study to use quantitative assessment of FDG uptake in patients with cardiac sarcoidosis compared with normal and dilated cardiomyopathy patients.PubMedCrossRefGoogle Scholar
- 10.Diagnostic standard and guidelines for sarcoidosis. Jpn J Sarcoidosis and Granulomatous Disorders (in Japanese). 2007;27:89–102.Google Scholar
- 28.Wykrzykowska J, Lehman S, Williams G, Parker JA, Palmer MR, Varkey S, et al. Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation. J Nucl Med. 2009;50:563–8.PubMedCrossRefGoogle Scholar
- 32.Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Gropler RJ, et al. PET Myocardial Perfusion and Metabolism Clinical Imaging. J Nucl Cardiol 2009;16. doi: 10.1007/s12350-009-9094-9. Available at: http://www.asnc.org/imageuploads/ImagingGuidelinesPETJuly2009.pdf. Accessed 24 Jan 2013.
- 40.•• Mantini N, Williams Jr B, Stewart J, Rubinsztain L, Kacharava A. Cardiac sarcoid: a clinician's review on how to approach the patient with cardiac sarcoid. Clin Cardiol. 2012;35:410–5. Recent review paper summarizing several current concepts in the diagnosis and managements of patients with cardiac sarcoidosis.PubMedCrossRefGoogle Scholar
- 43.••Matthews R, Bench T, Meng H, Franceschi D, Relan N, Brown DL. Diagnosis and monitoring of cardiac sarcoidosis with delayed-enhanced MRI and 18F-FDG PET-CT. J Nucl Cardiol. 2012;19:807–10. Interesting case-report illustrating the differential information provided by 18F-FDG PET and cardiac MRI.PubMedCrossRefGoogle Scholar