CTICasesCardiac Sarcoidosis on FDG-PET and Cardiac MRI
Imaging findings
FDG-PET with special dietary preparation (high fat, low carbohydrate diet for 2-3 days to suppress myocardial glucose uptake) demonstrates focal FDG avidity in the interventricular septum and right ventricle in a patient with sarcoidosis. Serial PET studies over multiple time points show reduction in FDG uptake following treatment with steroids, consistent with response. Corresponding cardiac MRI with delayed gadolinium enhancement shows mid-myocardial enhancement in the interventricular septum and left ventricular wall in a non-coronary distribution, in typical locations for cardiac sarcoidosis. MIP CT images show peribronchial nodules in the lungs consistent with mild pulmonary sarcoid.
Key takeaways
Cardiac sarcoidosis can be imaged with FDG-PET (requiring specialized dietary suppression of myocardial glucose uptake) to detect active granulomatous inflammation, and with cardiac MRI delayed enhancement to identify areas of fibrosis or infiltration. Both modalities are complementary: PET assesses disease activity and treatment response, while MRI characterizes fibrosis independent of metabolic activity. The mid-myocardial or subepicardial pattern of delayed enhancement in a non-coronary distribution is characteristic of cardiac sarcoid. Cardiac sarcoidosis can present as a primary cardiac manifestation with very subtle lung involvement.
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