The role of positron emission tomography in the assessment of cardiac sarcoidosis

Abstract

The myocardium and the cardiovascular system are often involved in patients with sarcoidosis. As therapy should be started as early as possible to avoid complications such as left ventricular dysfunction, a prompt and reliable diagnosis by means of non-invasive tests would be highly warranted. Among other techniques, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as a high sensitive tool to detect sites of inflammation before morphological changes are visible to conventional imaging techniques. We therefore aim at summarizing the most relevant findings in the literature on the use of 18F-fluorodeoxyglucose PET in the diagnostic workup of cardiac sarcoidosis and to underline future perspectives.

BMIPP SPECT in cardiac sarcoidosis: A marker of risk?

“…The aforementioned concepts stem from references. 1,3,5,6,11,16,[18][19][20] Abbreviations: PET, positron emission tomography; 18 F-FDG, 18 F-Fluorodeoxyglucose; 123 I-BMIPP, 123 I-beta-methyl-piodophenylpentadecanoic; SPECT, single photon emission computed tomography; CMR, cardiac magnetic resonance.…”

“…Early diagnosis is a key factor because the anti-inflammatory treatment has the goal to slow fibrosis progression in the myocardial tissue. 18,19 BMIPP is also a predictor of recurrence and MACE in CS patients. 18 The combination of quantification of BMIPP defects with SUVderived quantitative measurements can be of help for therapeutical decisions.…”

“…In this regard, PET tracers like 68 Ga-DOTATOC/TATE/NOC, 18 F-FLT (fluorothymidine), and 8 F-FMISO, among others, are promising. 5,19 The possible advantages of these agents over FDG imaging in CS are under investigation. 5,19 Despite all the available diagnostic armamentarium, CS remains a challenging disease in daily practice.…”

“…5,19 The possible advantages of these agents over FDG imaging in CS are under investigation. 5,19 Despite all the available diagnostic armamentarium, CS remains a challenging disease in daily practice. Integrating clinical and surrogate cardiac imaging findings will likely enhance diagnostic and therapeutical strategies in CS patients.…”

Potential Applications of PET Scans, CT Scans, and MR Imaging in Inflammatory Diseases

“…Reported rates of isolated cardiac sarcoidosis among patients with cardiac sarcoidosis have similar ranges from 25 to 55% (82). Considering the importance of this clinical condition and limitations of traditional diagnostic methods, FDG-PET/CT has gained extensive attention in recent years to address this unmet need (83)(84)(85)(86)(87)(88)(89)(90).…”