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18F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis

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Abstract

Cardiac sarcoidosis (CS) is a rare and potentially life-threatening disease that causes conduction disturbance, systolic dysfunction, and most notably sudden cardiac death. Accurate diagnosis of CS is thus mandatory; however, a reliable approach that enables diagnosis of CS with high sensitivity and specificity has yet to be established. Recent studies have demonstrated the promising potential of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) in the diagnosis and assessment of CS. Indeed, 18F-FDG PET provides a wide variety of advantages over previous imaging modalities; however, there are pitfalls and limitations that should be recognized. In this review article, (1) the rationale for 18F-FDG PET application in CS, (2) suitable pretest preparations, and (3) evaluation protocols for the 18F-FDG PET images obtained will be addressed. In particular, sufficient suppression of physiological 18F-FDG uptake in the heart is essential for accurate assessment of CS. Also, (4) recent studies addressing the diagnostic role of 18F-FDG PET and (5) the clinically important differences between 18F-FDG PET and other imaging technologies will be reviewed. For example, active sarcoid lesions and their response to steroid treatment will be better detected by 18F-FDG PET, whereas fibrotic lesions might be shown more clearly by magnetic resonance imaging or other nuclear myocardial perfusion imaging. In the last decade, 18F-FDG PET has substantially enhanced detection of CS; however, CS would be better evaluated by a combination of multiple modalities. In the future, advances in 18F-FDG PET and other emerging imaging modalities are expected to enable better management of patients with sarcoidosis.

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Acknowledgments

The authors acknowledge Dr. Masaharu Nishimura, Professor of the first Department of Medicine of the Hokkaido University School of Medicine, and Dr. Nagara Tamaki, Professor of the Department of Nuclear Medicine of the Hokkaido University School of Medicine, for critical reading of the manuscript. We also thank Ms. Yuka Yoshida, a nutritionist at the Hokkaido University Hospital, for her cooperation in the preparation of the low-carbohydrate meals.

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  1. First Department of Medicine, Hokkaido University School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Hiroshi Ohira & Ichizo Tsujino

  2. Department of Photobiology, Division of Molecular Cellular Imaging, Hokkaido University School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Keiichiro Yoshinaga

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  1. Hiroshi Ohira
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Ohira, H., Tsujino, I. & Yoshinaga, K. 18F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging 38, 1773–1783 (2011). https://doi.org/10.1007/s00259-011-1832-y

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