Sarcoid Pericarditis and Large Vessel Vasculitis Detected on FDG PET/CT

Abstract

A 65-year-old woman with history of sarcoidosis, hypertension, and peripheral vascular disease presented with lower extremity claudication and low left ventricular ejection fraction of 45% on echocardiogram. Further FDG PET/CT revealed hypermetabolic bilateral chest lymphadenopathy and pulmonary nodules in a butterfly-shaped distribution pattern, which was typically seen in patients with sarcoidosis. In addition, abnormal increased radiotracer uptake was present in pericardium, and along the walls of inferior vena cava, aorta, and pulmonary artery, which correlated with delayed enhancement on further cardiac MRI. These findings were suggestive of sarcoid-related pericarditis and great vessel vasculitis.

Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol

“…Over the years, our group has published our experiences of using a 72-hour ketogenic diet, that is, a high-fat, high-protein, very low-carbohydrate diet; the preparation protocol for sarcoidosis patients receiving FDG PET/CT evaluation, with a simple interpretation algorithm, avoided the complex and debatable interpretation, as well as the controversy "focalon-diffuse" pattern. [2][3][4][5][6][7] Our approach was also supported by other groups' findings. 8,9 As illustrated in this rare case of extensive biventricular CS, the 72-hour ketogenic diet preparation can satisfactorily suppress physiological myocardial uptake of FDG, and enable FDG PET/CT evaluation of CS.…”

“…Many preimaging preparation strategies have been developed to suppress physiological myocardial FDG uptake, including use of heparin, long fasting, overnight high-fat, low-carbohydrate diet modification, and combinations of these approaches. Over the years, our group has published our experiences of using a 72-hour ketogenic diet, that is, a high-fat, high-protein, very low-carbohydrate diet; the preparation protocol for sarcoidosis patients receiving FDG PET/CT evaluation, with a simple interpretation algorithm, avoided the complex and debatable interpretation, as well as the controversy "focalon-diffuse" pattern [2][3][4][5][6][7]. Our approach was also supported by other groups' findings 8,9.…”

Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation

“…Constrictive or effusive constrictive pericarditis, an uncommon complication of chemotherapy, can present with mild and diffuse pericardial FDG-uptake [94]. Additionally, pericarditis associated with increased metabolism of the wall of the large vessels like the thoracic or abdominal aorta can be caused by underlying vasculitis [98, 99]. …”