Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis†

Abstract

Focal uptake of the heart on (18)F-FDG PET images is a characteristic feature of patients with sarcoidosis. Furthermore, (18)F-FDG PET has the potential to detect cardiac sarcoidosis that cannot be diagnosed by (67)Ga or (99m)Tc-MIBI scintigraphy.

A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology

“…[54][55][56] The potential additional value of myocardial blood flow quantification by PET in the diagnosis and evaluation of cardiac sarcoidosis remains to be investigated. Due to the limited sensitivity and specificity of MPI alone, and due to the fact that abnormal MPI alone cannot distinguish scar from active sarcoidosis, MPI is currently used for the evaluation of cardiac sarcoidosis only in conjunction with FDG-PET.…”

“…[53][54][55]57,69,70 A recent meta-analysis of seven studies demonstrated an overall sensitivity of 89% and a specificity of 78% for FDG-PET. 70 However, these estimates are biased as the lower specificity of PET in some studies may reflect the fact that this test is more sensitive for identifying cardiac sarcoidosis than the JMHW criteria.…”

Joint SNMMI–ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring

“…30,35,37,[46][47][48][49][50] In the absence of tissue confirmation of CS, there is agreement that the diagnosis of cardiac involvement requires integrating multiple sources of data, including 18 F-FDG PET in some cases. Consequently, the diagnosis of CS should not be based on 18 F-FDG PET alone.…”

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

“…28 Ishimaru et al echoed the findings of previous studies. 29 They used 18F-FDG PET, 99m Tc-sestamibi, and gallium scintigraphy to identify abnormalities suggestive of CS in a cohort of 32 patients with systemic sarcoidosis, and found a respective prevalence of 31%, 12.5%, and 0% for each. 29 Furthermore, in a retrospective examination of 76 patients with suspected CS who underwent 18F-FDG PET and/or gallium scintigraphy for evaluation of CS, Langah et al found that 18F-FDG PET had a sensitivity and specificity of 85% and 90%, respectively, vs 15% and 80%, respectively, for gallium scintigraphy.…”

“…29 They used 18F-FDG PET, 99m Tc-sestamibi, and gallium scintigraphy to identify abnormalities suggestive of CS in a cohort of 32 patients with systemic sarcoidosis, and found a respective prevalence of 31%, 12.5%, and 0% for each. 29 Furthermore, in a retrospective examination of 76 patients with suspected CS who underwent 18F-FDG PET and/or gallium scintigraphy for evaluation of CS, Langah et al found that 18F-FDG PET had a sensitivity and specificity of 85% and 90%, respectively, vs 15% and 80%, respectively, for gallium scintigraphy. 30 Overall it can be concluded that 18F-FDG PET has the potential to detect subtle sarcoid-induced changes in myocardium missed by other radionuclide studies, but the test is commonly limited to large tertiary referral centers (Table 1).…”