Research ArticleContinuing Education

Assessment of Cardiac Sarcoidosis with PET/CT

Alexander Liu, Lionel T. Munemo, Nuno Martins, Vasileios Kouranos, Athol U. Wells, Rakesh K. Sharma and Kshama Wechalekar
Journal of Nuclear Medicine Technology February 2025, jnmt.124.268142; DOI: https://doi.org/10.2967/jnmt.124.268142

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    18F-FDG PET/CT images in transaxial, sagittal, and coronal planes and maximum-intensity projection images. (A) Intense 18F-FDG uptake in LV myocardium due to inadequate preparation. (B) No uptake in myocardium in same patient after appropriate preparation.

  • FIGURE 2.
    FIGURE 2.

    Column with resting 82Rb perfusion images shows patchy perfusion in septum and in part of anterior and apical anterolateral walls. Column with 18F-FDG images shows active inflammation in septum, anterior wall, and apical anterolateral wall indicative of perfusion and metabolism mismatch. Additional active inflammation demonstrated in right ventricle and papillary muscles is suggestive of biventricular involvement. Polar plots show mismatch between areas of perfusion and inflammation defects.

  • FIGURE 3.
    FIGURE 3.

    Column with 82Rb perfusion images shows areas of patchy myocardial scarring in basal anteroseptum (white arrow), mid to basal lateral wall (yellow arrow), and apical inferior wall (green arrow). Column with 18F-FDG shows no inflammation in myocardium but only blood-pool activity. These findings suggest that disease has left some scarring but inflammation has died out in patient with CS.

Tables

  • TABLE 1.

    Indications for 18F-FDG PET/CT in Patients with Suspected CS

    IndicationSpecifics
    Histologic diagnosis of extra-CS and abnormal screening tests for CSECG: complete left or right BBB or unexplained pathologic Q waves in ≥2 leads
    Echo: RWMA, LV aneurysm, basal LV septal thinning, or LV systolic dysfunction (LVEF < 50%)
    CMR: features consistent with CS
    Holter monitoring: sustained or nonsustained VT
    Unexplained palpitations or syncope
    Younger than 60 y and presenting with unexplained new-onset high-grade AV block (second- or third-degree)
    Suspected CS with idiopathic sustained VT, excluding typical outflow tract VT, fascicular VT, or VT secondary to other structural heart disease

    • ECG = electrocardiogram; BBB = bundle branch block; echo = echocardiography; RWMA = regional wall motion abnormalities; AV = atrioventricular.

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