Updates on the Role of Imaging in Cardiac Sarcoidosis

  • Yan Yatsynovich
  • Damian Valencia
  • Mikhail Petrov
  • Juan David Linares
  • Mufti M. Rahman
  • Nathaniel DittoeEmail author
Imaging (Q Truong, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Imaging


Purpose of review

The non-specific symptom profile and subclinical nature of disease along with variable region of cardiac involvement in systemic sarcoidosis make the diagnosis particularly challenging. The yield of endomyocardial biopsy, a gold standard for diagnosis, is not high unless coupled with additional imaging modalities to detect regional involvement. This review is focused on highlighting the major recent advances in imaging modalities and diagnosis of cardiac sarcoidosis.

Recent findings

There has been much interest and increasing research focused on developing newer and improved imaging modalities to establish diagnosis. CMR and 18F- FDG-PET are now considered imaging modalities of choice in most centers worldwide, but the data comparing both methodologies head-to-head is limited. Nevertheless, novel radiotracers (i.e. 68Ga-DOTANOC, 18F-Flurpiridaz, 13N-Ammonia) and hybrid combination PET/CMR imaging are coming to spotlight with improved sensitivity and specificity for earlier detection of myocardial sarcoid.


As CMR and PET are showing increased utilization in cardiac sarcoidosis, 201Th-SPECT, 99mTc MDP SPECT, 67Ga Scintigraphy, and 82Rb PET are falling out of favor. Newer imaging modalities, radionuclide tracers, and hybrid PET/CMR combinations have been promising in better detecting cardiac sarcoidosis and are currently being evaluated in larger trials.


Cardiac sarcoidosis Non-invasive imaging LGE CMR FDG-PET Hybrid PET-CMR 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Authorship Declaration

All authors listed meet the authorship criteria according to the latest guidelines the International Committee of Medical Journal Editors. All the authors have contributed equally and are in agreement with the manuscript.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Doughan AR, Williams BR. Cardiac Sarcoidosis. Heart. 2006;92(2):282–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Boeck C. Multiple benign sarcoid of the skin. The Journal of Cutaneous and Genito-Urinary Diseases 1899;17:543–50.Google Scholar
  3. 3.
    Bernstein M, Konzlemann FW, Sidlick DM. Boeck’s sarcoid: report of a case with visceral involvement. Arch Intern Med. 1929;44:721–34.CrossRefGoogle Scholar
  4. 4.
    Gentzen G. Über die Riesenzellen granulome bei zwei Fällen von Endokard-fibrose. Beitr. Path. Anat.. 1937;98:375–98.Google Scholar
  5. 5.
    Adickes GC, Zimmerman SL, Cardwell ES. Sarcoidosis with fatal cardiac involvement. Ann Intern Med. 1951;35:898–909.CrossRefPubMedGoogle Scholar
  6. 6.
    Silverman KJ, Hutchins GM, Bulkley BH. Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation. 1978;58:1204–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Sharma OP, Maheshwari A, Thaker K. Myocardial sarcoidosis. Chest. 1993;103:253–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Matsui Y, Iwai K, Tachibana T, Fruie T, Shigematsu N, Izumi T, et al. Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci. 1976;278:455–69.Google Scholar
  9. 9.
    Roberts WC, McAllister HA Jr, Ferrans VJ. Sarcoidosis of the heart: a clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977;63:86–108.CrossRefPubMedGoogle Scholar
  10. 10.
    Yigla M, Badarna-Abu-Ria N, Tov N, et al. Sarcoidosis in northern Israel; clinical characteristics of 120 patients. Sarcoidosis Vasc Diffuse Lung Dis. 2002;19:220.PubMedGoogle Scholar
  11. 11.
    Perry A, Vuitch F. Causes of death in patients with sarcoidosis: a morphologic study of 38 autopsies with clinicopathologic correlations. Arch Pathol Lab Med. 1995;119(2):167–72.PubMedGoogle Scholar
  12. 12.
    Bagwan IN, Hooper LV, Sheppard MN. Cardiac sarcoidosis and sudden death: the heart may look normal or mimic other cardiomyopathies. Virchows Arch. 2011;458(6):671–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Tavora F, Cresswell N, Li L, Ripple M, Solomon C, Burke A. Comparison of necropsy findings in patients with sarcoidosis dying suddenly from cardiac sarcoidosis versus dying suddenly from other causes. Am J Cardiol. 2009;104(4):571–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bradford JR, White A, Lopez A, Nelson WW. High-cost sarcoidosis patients in the United States: patient characteristics and patterns of health care resource utilization. J Manag Care Spec Pharm. 2017;23(12):1261–9.CrossRefGoogle Scholar
  15. 15.
    Lynch JP. III, Baughman RP, Deng JC. Cardiac involvement in sarcoidosis: evolving concepts in diagnosis and treatment. Semin Respir Crit Care Med. 2002;23(6).Google Scholar
  16. 16.
    Judson M, Costabel U, Drent M, et al. The WASOG sarcoidosis organ assessment instrument: an update of a previous clinical tool. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31:19–27.PubMedGoogle Scholar
  17. 17.
    •• Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11(7):1304–23. The HRS Expert Consensus Statement recommends 2D-Echocardiography as the initial imaging study of choice for cardiac sarcoidosis as it provides structural and functional data.
  18. 18.
    Burstow DJ, Tajik A, Bailey KR, Deremee RA, Taliercio CP. Two-dimensional echocardiographic findings in systemic sarcoidosis. Am J Cardiol. 1989;63(7):478–82. Scholar
  19. 19.
    Fahy GJ, Marwick T, Mccreery CJ, Quigley PJ, Maurer BJ. Doppler echocardiographic detection of left ventricular diastolic dysfunction in patients with pulmonary sarcoidosis. Chest. 1996;109(1):62–6. Scholar
  20. 20.
    Gregor P, Widimsky P, Sladkova T, Petrikova J, Cervenka V, Visek V. Echocardiography in sarcoidosis. Jpn Heart J. 1984;25(4):499–508. Scholar
  21. 21.
    Yazaki Y, Isobe M, Hiramitsu S, Morimoto SI, Hiroe M, Omichi C, et al. Comparison of clinical features and prognosis of cardiac sarcoidosis and idiopathic dilated cardiomyopathy. Am J Cardiol. 1998;82(4):537–40.
  22. 22.
    Kinney EL, Jackson GL, Reeves WC, Zelis R. Thallium-scan myocardial defects and echocardiographic abnormalities in patients with sarcoidosis without clinical cardiac dysfunction. Am J Med. 1980;68(4):497–503. Scholar
  23. 23.
    Chapelon-Abric C, Zuttere DD, Duhaut P, et al. Cardiac sarcoidosis. Medicine. 2004;83(6):315–34. Scholar
  24. 24.
    Kaderli AA, Gullulu S, Coskun F, Yilmaz D, Uzaslan E. Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis. Eur J Echocardiogr. 2010;11(10):809–13. Scholar
  25. 25.
    Elikowski W, Małek-Elikowska M, Świerkocki K, Wróblewski D, Bolewski A, Janus M. Utility of left ventricular longitudinal strain in the diagnosis and treatment monitoring of cardiac sarcoidosis. Pol Arch Intern Med. 2018;128(2):126–8.
  26. 26.
    Felekos I, Aggeli C, Gialafos E, et al. Global longitudinal strain and long-term outcomes in asymptomatic extracardiac sarcoid patients with no apparent cardiovascular disease. Echocardiography. 2018.
  27. 27.
    Handa T, Nagai S, Miki S, Fushimi Y, Ohta K, Mishima M, et al. Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest. 2006;129(5):1246–52.
  28. 28.
    Kinney E, Murthy R, Ascunce G, Donohoe R, Zelts R. Pericardial effusions in sarcoidosis. Chest. 1979;76(4):476–8. Scholar
  29. 29.
    Garrett J, Oneill H, Blake S. Constrictive pericarditis associated with sarcoidosis. Am Heart J. 1984;107(2):394. Scholar
  30. 30.
    Fleming HA, Bailey SM. Sarcoid heart disease. J R Coll Physicians Lond. 1981;15(4):245–6. 9-53PubMedGoogle Scholar
  31. 31.
    Angomachalelis I, Kyriazis G, Angomachalelis N. Pericardial involvement frequently complicating pulmonary and/or systemic sarcoid granulomatosis: a lifelong, multistage disease, periodical study in 278 biopsy-proven patients. Chest. 2012;142(4):449A. CrossRefGoogle Scholar
  32. 32.
    Joyce E, Ninaber MK, Katsanos S, Debonnaire P, Kamperidis V, Bax JJ, et al. Subclinical left ventricular dysfunction by echocardiographic speckle-tracking strain analysis relates to outcome in sarcoidosis. Eur J Heart Fail. 2014;17(1):51–62.
  33. 33.
    Pizarro C, Kluenker F, Hammerstingl C, Skowasch D. Diagnostic value of speckle-tracking echocardiography in confirmed cardiac sarcoidosis. Clin Res Cardiol. 2016;105(10):884–6. Scholar
  34. 34.
    Schouver E-D, Moceri P, Doyen D, Tieulie N, Queyrel V, Baudouy D, et al. Early detection of cardiac involvement in sarcoidosis with 2-dimensional speckle-tracking echocardiography. Int J Cardiol. 2017;227:711–6.
  35. 35.
    Smedema J. Tissue Doppler imaging in cardiac sarcoidosis. Eur J Echocardiogr. 2008;9(4):579–80. Scholar
  36. 36.
    Hyodo E. Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterization. Heart. 2004;90(11):1275–80. Scholar
  37. 37.
    Perez IE, Garcia MJ, Taub CC. Multimodality imaging in cardiac sarcoidosis: is there a winner? Curr Cardiol Rev. 2016;12(1):3–11. Scholar
  38. 38.
    Yufu K, Kondo H, Shinohara T, et al. Outcome of patients with cardiac sarcoidosis who received cardiac resynchronization therapy: comparison with dilated cardiomyopathy patients. J Cardiovasc Electrophysiol. 2016;28(2):177–81. Scholar
  39. 39.
    •• Slart RHJA, Glaudemans AWJM, Lancellotti P, Hyafil F, Blankstein R, Schwartz RG, et al. The joint procedural position statement from the cardiovascular, inflammation and infection committees of the European association of nuclear medicine, as well as the European association of cardiovascular imaging and the American society of nuclear cardiology, recommend imaging with FDG-PET or CMR after initial evaluation with echocardiography. J Nucl Cardiol. 2018;25(1):298–319 22 p. CMR is a very sensitive (100%) modality with relatively high specificity (78%) for cardiac involvement in sarcoidosis. Echocardiography in contrast has a sensitivity of 10% to 47% and a specificity of 82%-99% CMR can be used for both diagnosis and risk assessment of CS. The high-sensitivity of CMR makes it especially useful to exclude CS.Google Scholar
  40. 40.
    Smedema J, Snoep G, Kroonenburgh MPV, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45(10):1683–90. Scholar
  41. 41.
    Ghanizada M, Rossing K, Bundgaard H, Gustafsson F. Clinical presentation, management and prognosis of patients with cardiac sarcoidosis. Dan Med J. 2018;65(4).Google Scholar
  42. 42.
    Bruder O, Schneider S, Pilz G, van Rossum AC, Schwitter J, Nothnagel D, et al. 2015 update on acute adverse reactions to gadolinium based contrast agents in cardiovascular MR. large multi-national and multi-ethnical population experience with 37788 patients from the EuroCMR registry. J Cardiovasc Magn Reson. 2015;17(1):58.
  43. 43.
    Reiter T, Ritter O, Prince MR, Nordbeck P, Wanner C, Nagel E, et al. Minimizing risk of nephrogenic systemic fibrosis in cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14(1):31.
  44. 44.
    Ward EV, Nazari J, Edelman RR. Coronary artery vasculitis as a presentation of cardiac sarcoidosis. Circulation. 2012;125(6):e344–6. CrossRefPubMedGoogle Scholar
  45. 45.
    Blankstein R, Waller AH. Evaluation of known or suspected cardiac sarcoidosis. Circ Cardiovasc Imaging. 2016;9(3):e000867. Scholar
  46. 46.
    Okabe T, Yakushiji T, Hiroe M, Oyama Y, Igawa W, Ono M, et al. Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction. ESC Heart Fail. 2016;3(4):288–92.
  47. 47.
    Hulten E, Aslam S, Osborne M, Abbasi S, Bittencourt MS, Blankstein R. Cardiac sarcoidosis—state of the art review. Cardiovasc Diagn Ther. 2016;6(1):50–63. Scholar
  48. 48.
    Crawford T, Mueller G, Sarsam S, Prasitdumrong H, Chaiyen N, Gu X, et al. Magnetic resonance imaging for identifying patients with cardiac sarcoidosis and preserved or mildly reduced left ventricular function at risk of ventricular arrhythmias. Circ Arrhythm Electrophysiol. 2014;7:1109–15.Google Scholar
  49. 49.
    • Patel MR, Cawley PJ, Heitner JF, Klem I, Parker MA, Jaroudi WA, et al. Detection of myocardial damage in patients with sarcoidosis. Circulation. 2009;120:1969–77. DE-CMR is more than twice as sensitive for cardiac sarcoidosis when compared to current consensus criteria and DE-CMR myocardial damage is associated with cardiac death.Google Scholar
  50. 50.
    • Smedema J, van Geuns R, Ainslie G, Ector J, Heidbuchel H, Crijns HJGM. Right ventricular involvement in cardiac sarcoidosis demonstrated with cardiac magnetic resonance. Esc Heart Fail. 2017;4(4):535–44. Right ventricular enhancement was detected in 16% of patients diagnosed pulmonary sarcoidosis and in 48% of patients with left ventricular enhancement and was directly linked with pulmonary arterial hypertension, right ventricular systolic dysfunction, hypertrophy and dilation.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Philips B, Madhavan S, James CA, te Riele ASJM, Murray B, Tichnell C, et al. Arrhythmogenic right ventricular dysplasia/cardiomyopathy and cardiac sarcoidosis. Distinguishing features when the diagnosis is unclear. Circ Arrhythm Electrophysiol. 2014;7:230–6.Google Scholar
  52. 52.
    Crouser ED, Ono C, Tran T, He X, Raman SV. Improved detection of cardiac sarcoidosis using magnetic resonance with myocardial T2 mapping. Am J Respir Crit Care Med. 2014;189(1):109–12. Scholar
  53. 53.
    Coleman GC, Shaw PW, Balfour PC, et al. Prognostic value of myocardial scarring on CMR in patients with cardiac sarcoidosis: a systematic review and meta-analysis. JACC Cardiovasc Imaging. 2017;10(4):411–20. Scholar
  54. 54.
    • Greulich S, Deluigi CC, Gloekler S, Wahl A, Zürn C, Kramer U, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. J Am Coll Cardiol Img. 2013;6(4):501–11. The presence of myocardial scarring identified via LGE on CMR is the best independent risk factor for lethal events and adverse events, suggesting the need for future studies to establish LGE as an independent predictor of cardiac death in sarcoidosis patients.
  55. 55.
    Schuller JL, Zipse M, Crawford T, Bogun F, Beshai J, Patel AR, et al. Implantable cardioverter defibrillator therapy in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2012;23:925–9.Google Scholar
  56. 56.
    Muser D, Santangeli P, Patahk RK, et al. Long-term outcomes of catheter ablation of ventricular tachycardia in patients with cardiac sarcoidosis. Circ Arrhythm Electrophysiol. 2016;9:e004333.CrossRefPubMedGoogle Scholar
  57. 57.
    Watanabe Y, Nishii T, Shimoyama S, et al. Focal myocardial damage in cardiac sarcoidosis characterized by strain analysis on magnetic resonance tagged imaging in comparison with fluorodeoxyglucose positron emission tomography accumulation and magnetic resonance late gadolinium enhancement. J Comput Assist Tomogr. 2018.
  58. 58.
    Rao DA, Dellaripa PF. Extrapulmonary manifestations of sarcoidosis. Rheum Dis Clin N Am. 2013;39(2):277–97. Scholar
  59. 59.
    Skali H, Schulman AR, Dorbala S. 18F-FDG PET/CT for the assessment of myocardial sarcoidosis. Curr Cardiol Rep. 2013;15(4):352. Scholar
  60. 60.
    Skali H, Schulman A, Dorbala S. 18F-FDG PET/CT for the assessment of myocardial sarcoidosis. Eur Heart J. 2005;26:1538–43.Google Scholar
  61. 61.
    Skali H, Schulman A, Dorbala S. 18F-FDG PET/CT for the assessment of myocardial sarcoidosis. Eur Heart J. 2005;26:1538–43.CrossRefGoogle Scholar
  62. 62.
    Manabe O, Yoshinaga K, Ohira H, Masuda A, Sato T, Tsujino I, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial 18F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol. 2015;23(2):244–52.
  63. 63.
    Pereira NL, Grogan M, Dec GW. Spectrum of restrictive and infiltrative cardiomyopathies: part 2 of a 2-part series. J Am Coll Cardiol. 2018;71(10):1149–66. ReviewCrossRefPubMedGoogle Scholar
  64. 64.
    Lebasnier A, Legallois D, Bienvenu B, Bergot E, Desmonts C, Zalcman G, et al. Diagnostic value of quantitative assessment of cardiac 18F-fluoro-2-deoxyglucose uptake in suspected cardiac sarcoidosis. Ann Nucl Med. 2018;32:319–27.
  65. 65.
    • Ohira H, Tsujino I, Ishimaru S, Oyama N, Takei T, Tsukamoto E, et al. Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis. Eur J Nucl Med Mol Imaging. 2007;35(5):933–41. This 21-patient study found that FDG-PET was superior to CMR for ruling out cardiac sarcoidosis with a sensitivity of 87.5% and specificity of 38.5%, compared to CMR with sensitivity of 75% and specificity of 76.9%. Specificity of FDG-PET was lower in this study compared to previous data.
  66. 66.
    Okumura W, Iwasaki T, Toyama T, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med. 2004;45:1986–98.Google Scholar
  67. 67.
    Ishimaru S, Tsujino I, Takei T, Tsukamoto E, Sakaue S, Kamigaki M, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J. 2005;26(15):1538–43.
  68. 68.
    • Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M, et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest. 2008;133(6):1426–35. This was a review of 62 patients with sarcoidosis; prevalence of cardiac involvement of 39%. The review concluded that sarcoid lesions in myocardial tissue as seen on CMR or PET did not predict arrhythmia in ambulatory patients who had preserved cardiac function. Additionally, as CS is common among patients with sarcoidosis, incorporating advanced cardiac imaging with FDG PET or CMR is recommended as it is more sensitive than established clinical criteria.
  69. 69.
    Matoh F, Satoh H, Shiraki K, Odagiri K, Saitoh T, Urushida T, et al. The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis. J Cardiol. 2008;51(3):179–88.
  70. 70.
    Langah R, Spicer K, Gebregziabher M, Gordon L. Effectiveness of prolonged fasting 18f-FDG PET-CT in the detection of cardiac sarcoidosis. J Nucl Cardiol. 2009;16(5):801–10. Scholar
  71. 71.
    Tahara N, Tahara A, Nitta Y, Kodama N, Mizoguchi M, Kaida H, et al. Heterogeneous myocardial FDG uptake and the disease activity in cardiac sarcoidosis. JACC Cardiovasc Imaging. 2010;3(12):1219–28.
  72. 72.
    Youssef G, Leung E, Mylonas I, Nery P, Williams K, Wisenberg G, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and meta-analysis including the Ontario experience. J Nucl Med. 2012;53(2):241–8.
  73. 73.
    Manabe O, Ohira H, Yoshinaga K, Sato T, Klaipetch A, Oyama-Manabe N, et al. Elevated 18F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis. European Journal of Nuclear Medicine and Molecular Imaging. 2013;40(10):1558–66.
  74. 74.
    McArdle BA, Birnie DH, Klein R, et al. Is there an association between clinical presentation and the location and extent of myocardial involvement of cardiac sarcoidosis as assessed by 18F-fluorodoexyglucose positron emission tomography? Circ Cardiovasc Imaging. 2013;6(5):617–26. Scholar
  75. 75.
    Soussan M, Brillet PY, Nunes H, Pop G, Ouvrier MJ, Naggara N, et al. Clinical value of a high-fat and low-carbohydrate diet before FDG-PET/CT for evaluation of patients with suspected cardiac sarcoidosis. J Nucl Cardiol. 2013;20(1):120–7.
  76. 76.
    Ahmadian A, Brogan A, Berman J, Sverdlov AL, Mercier G, Mazzini M, et al. Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis. J Nucl Cardiol. 2014;21(5):925–39.
  77. 77.
    Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol. 2014;63(4):329–36.
  78. 78.
    Manabe O, Yoshinaga K, Ohira H, Sato T, Tsujino I, Yamada A, et al. Right ventricular 18F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis. Ann Nucl Med. 2014;28(7):656–63.
  79. 79.
    Wicks E, Menezes L, Pantazis A, Mohiddin S, Porter J, Booth H, et al. 135 novel hybrid positron emission tomography - magnetic resonance (PET-MR) multi-modality inflammatory imaging has improved diagnostic accuracy for detecting cardiac sarcoidosis. Heart. 2014;100(Suppl 3):A80–LP-A80.
  80. 80.
    Yokoyama R, Miyagawa M, Okayama H, Inoue T, Miki H, Ogimoto A, et al. Quantitative analysis of myocardial 18F-fluorodeoxyglucose uptake by PET/CT for detection of cardiac sarcoidosis. Int J Cardiol. 2015;195(2015):180–7.
  81. 81.
    Gormsen LC, Haraldsen A, Kramer S, Dias AH, Kim WY, Borghammer P. A dual tracer 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT pilot study for detection of cardiac sarcoidosis. EJNMMI Res. 2016;6(1):52. CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Lapa C, Reiter T, Kircher M, Schirbel A, Werner RA, Pelzer T, et al. Somatostatin receptor based PET/CT in patients with the suspicion of cardiac sarcoidosis: an initial comparison to cardiac MRI. Oncotarget. 2016;7(47):77807–14.
  83. 83.
    Ohira H, Birnie DH, Pena E, Bernick J, Mc Ardle B, Leung E, et al. Comparison of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2016;43(2):259–69.
  84. 84.
    Aikawa T, Oyama-Manabe N, Naya M, Ohira H, Sugimoto A, Tsujino I, et al. Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: a feasibility study. Eur Radiol. 2017;27(10):4054–63.
  85. 85.
    Norikane T, Yamamoto Y, Maeda Y, Noma T, Dobashi H, Nishiyama Y. Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis. EJNMMI Res. 2017;7:1–7. CrossRefGoogle Scholar
  86. 86.
    • Kouranos V, Tzelepis GE, Rapti A, et al. Complementary role of CMR to conventional screening in the diagnosis and prognosis of cardiac sarcoidosis. JACC Cardiovasc Imaging. 2017;10(12):1437–47. Although 2D-Electrocardiography holds a high positive predictive value (83.9%) and relative low risk to benefit margins, CMR is the most valuable diagnostic and prognostic imaging study for evaluation of myocardial tissue in patients with diagnosed sarcoidosis 2D-Electrocardiography has low sensitivity (27.1%). This study has the largest CMR cohort size (N=321) and was able to identify silent CS at a rate of nearly 10%, sensitivity 96.9% and specificity 100%.CrossRefPubMedGoogle Scholar
  87. 87.
    Dweck MR, Abgral R, Trivieri MG, Robson PM, Karakatsanis N, Mani V, et al. Hybrid magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose to diagnose active cardiac sarcoidosis.Google Scholar
  88. 88.
    • Wicks EC, Menezes LJ, Barnes A, et al. Diagnostic accuracy and prognostic value of simultaneous hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in cardiac sarcoidosis. Eur Heart J Cardiovasc Imaging. 2018. doi: This review of literature compares combined 18F-FDG PET and LGE on CMR against 18F-FDG PET alone and CMR alone. The study found hybrid imaging to be superior with sensitivity 94%, specificity 44%, positive predictive value 76%, negative predictive value 80%. Sensitivity for 18F-FDG PET alone is 85% and LGE on CMR alone is 82%. This review suggests combined imaging techniques for increased diagnostic accuracy of cardiac sarcoidosis.
  89. 89.
    Smedema JP, van Geus RJ, Truter R, Mayosi BM, Crijns H. Contrast-enhanced cardiac magnetic resonance: distinction between cardiac sarcoidosis and infarction scar. Sarcoidosis Vasculitis and Diffuse Lung Disease. 2018;34(4):307–14.Google Scholar
  90. 90.
    Bremer W, Sweiss NJ, Lu Y. Serial FDG-PET/CT imaging in the management of cardiac sarcoidosis. Clin Nucl Med. 2018;43(2):e50–2.PubMedGoogle Scholar
  91. 91.
    • Muser D, Santangeli P, Castro SA, et al. Prognostic role of serial quantitative evaluation of 18F-fluorodeoxyglucose uptake by PET/CT in patients with cardiac sarcoidosis presenting with ventricular tachycardia. Eur J Nucl Med Mol Imaging. 2018. Ventricular arrhythmia response to ablation using lesion metabolic activity (LMA) correlated with a 20-fold higher risk of MACE in non-responders (p=0.007) as well as parallels systolic function (p=0.003). This study suggests that a reduction in FDG uptake is strongly associated with decreased MACE at long term follow up.
  92. 92.
    Danwade TA, Devidutta S, Shelke AB, Saggu DK, Yalagudri SD, Sridevi C, et al. Prognostic value of Fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography in patients with unexplained atrioventricular block. Heart Rhythm. 2017;15:234–9.
  93. 93.
    Sipilä K, Tuominen H, Haarala A, Tikkakoski A, Kähönen M, Nikus K. Novel ECG parameters are strongly associated with inflammatory 18F-FDG PET findings in patients with suspected cardiac sarcoidosis. Int J Cardiol. 2017 Dec 15;249:454–60. Scholar
  94. 94.
    Travin MI, Bergmann SR. Assessment of myocardial viability. Semin Nucl Med. 2005;35:2–16.CrossRefPubMedGoogle Scholar
  95. 95.
    • Krumm P, Mangold S, Gatidis S, et al. Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Jpn J Radiol. 2018. This study suggests that FDG-PET negative imaging in the setting of positive LGE in CMR may be suggestive of inactive cardiac sarcoidosis and scarring while FDG-PET positive imaging may be suggestive of an active inflammatory process and active cardiac sarcoidosis.
  96. 96.
    Wada K, Niitsuma T, Yamaki T, Masuda A, Ito H, Kubo H, et al. Simultaneous cardiac imaging to detect inflammation and scar tissue with (18)F-fluorodeoxyglucose PET/MRI in cardiac sarcoidosis. J Nucl Cardiol. 2016;23:1180–2.Google Scholar
  97. 97.
    White JA, Rajchl M, Butler J, Thompson RT, Prato FS, Wisen- berg G. Active cardiac sarcoidosis: first clinical experience of simultaneous positron emission tomography–magnetic resonance imaging for the diagnosis of cardiac disease. Circulation. 2013;127:e639–41.CrossRefPubMedGoogle Scholar
  98. 98.
    • Ohira H, Yoshinaga K, Manabe O, Oyama-Manabe N, Tsujino I, Nishimura M, et al. Clinical application of 18F-fluorodeoxyglucose PET and LGE CMR in cardiac sarcoidosis. Ann of Nuclear Cardiology. 2017;3(1):125–30. Volume intensity detection (cardiac metabolic activity) has been independently associated with adverse cardiac events; FDG-PET and CMR may be used independently or in combination to better improve detection and to reduce adverse cardiac events.
  99. 99.
    Haywood J, Sharma O, Siegel M, Siegal R, Gottlieb S, Caldwell J, et al. Detection of myocardial sarcoidosis by thallium 201 imaging. J Natl Med Assoc. 1982;74:959–64.Google Scholar
  100. 100.
    Kandolin R, Lehtonen J, Graner M, Schildt J, Salmenkivi K, Kivistö SM, et al. Diagnosing isolated cardiac sarcoidosis. J Intern Med. 2011;270:461–8.Google Scholar
  101. 101.
    Tellier P, Paycha F, Antony I, Nitenberg A, Valeyre FD, Foult JM, et al. Reversibility by dipyridamole of thallium-201 myocardial scan defects in patients with sarcoidosis. Am J Med. 1988;85(2):189–93.
  102. 102.
    Lee PI, Cheng G, Alavi A. The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis. J Nucl Cardiol. 2016;24(1):19–28. Scholar
  103. 103.
    Le Guludec D, Menad F, Faraggi M, Weinmann P, Battesti J, Myocardial Sarcoidosis VD. Clinical value of technetium-99m Sestamibi tomoscintigraphy. Chest. 1994;106:1675–82.CrossRefPubMedGoogle Scholar
  104. 104.
    Schatka I, Bengel FM. Advanced imaging of cardiac sarcoidosis. J Nucl Med. 2013;55(1):99–106. Scholar
  105. 105.
    Chatal JF, Rouzet F, Haddad F, Bourdeau C, Mathieu C, Guludec DL. Story of rubidium-82 and advantages for myocardial perfusion PET imaging. Front Med. 2015;2.
  106. 106.
    Senthamizhchelvan S, Bravo PE, Esaias C, Lodge MA, Merrill J, Hobbs RF, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med. 2010;51(10):1592–9.
  107. 107.
    Bateman T, Heller G, Mcghie A, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol. 2006;13(1):24–33. Scholar
  108. 108.
    Fakhri GE, Kardan A, Sitek A, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with 82Rb PET: comparison with 13N-ammonia PET. J Nucl Med. 2009;50(7):1062–71. Scholar
  109. 109.
    Ben-Haim S, Murthy VL, Breault C, Allie R, Sitek A, Roth N, et al. Quantification of myocardial perfusion reserve using dynamic SPECT imaging in humans: a feasibility study. J Nucl Med. 2013;54(6):873–9.
  110. 110.
    Yalamanchili P, Wexler E, Hayes M, Yu M, Bozek J, Kagan M, et al. Mechanism of uptake and retention of F-18 BMS-747158-02 in cardiomyocytes: a novel PET myocardial imaging agent. J Nucl Cardiol. 2007;14(6):782–8.
  111. 111.
    Berman DS, Maddahi J, Tamarappoo B, et al. Phase II safety and clinical comparison with single-photon emission computed tomography myocardial perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol. 2013;61(4):469–77. Scholar
  112. 112.
    Maddahi J, Huang S, Truong D, Lazewatsky JL, Ehlgen A, Schelbert H, et al. Preliminary results of absolute quantification of rest and stress myocardial blood flow with flurpiridaz F-18 PET in normal and coronary artery disease patients in a single-center study. J Nucl Cardiol. 2010;17:743.CrossRefGoogle Scholar
  113. 113.
    Gormsen LC, Haraldsen A, Kramer S, Dias AH, Kim WY, Borghammer P. A dual tracer 68 Ga-DOTANOC PET/CT and 18F-FDG PET/CT pilot study for detection of cardiac sarcoidosis. EJNMMI Res. 2016;6(1):52.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Pizarro C, Kluenker F, Dabir D, Thomas D, Gaertner FC, Essler M, et al. Cardiovascular magnetic resonance imaging and clinical performance of somatostatin receptor positron emission tomography in cardiac sarcoidosis. ESC Heart Fail. 2018;5(2):249–61.
  115. 115.
    Bailey DL, Pichler BJ, Gückel B, Barthel H, Beer AJ, Botnar R, et al. Combined PET/MRI: from status quo to status go. Summary report of the fifth international workshop on PET/MR imaging; February 15–19, 2016; Tübingen, Germany. Mol Imaging Biol. 2016;18(5):637–50.
  116. 116.
    Sobic-Saranovic D, Grozdic I, Videnovic-Ivanov J, Vucinic-Mihailovic V, Artiko V, Saranovic D, et al. The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis. J Nucl Med. 2012;53(10):1543–9.
  117. 117.
    Kim JS, Judson MA, Donnino R, Gold M, Cooper LT Jr, Prystowsky EN, et al. Cardiac sarcoidosis. Am Heart J. 2009;157(1):9–21.
  118. 118.
    •• Vita T, Okada DR, Veillet-Chowdhury M, et al. Complementary value of cardiac magnetic resonance imaging and positron emission tomography/computed tomography in the assessment of cardiac sarcoidosis. Circ Cardiovasc Imaging. 2018;11:e007030. This was a retrospective study on 107 patients referred for evaluation of cardiac sarcoidosis. The study found 85% had LGE on CMR and 76% had positive FDG PET scans, among the 85% of patients with LGE findings, 66% had abnormal FDG PET scans as well. When analyzing probability of cardiac sarcoidosis with combined imaging, 45% of patients would be re-classified. Amongst the 45% re-classified, 80% were correctly classified when compared to final diagnosis. This study suggest combined imaging is critical in increasing the accuracy of diagnosis and disease classification.CrossRefPubMedGoogle Scholar
  119. 119.
    Miller EJ, Culver DA. Establishing an evidence-based method to diagnose cardiac sarcoidosis: the complementary use of cardiac magnetic resonance imaging and FDG-PET. Circulation: Cardiovascular Imaging. 2018;11(1):e007408. EditorialGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yan Yatsynovich
    • 1
  • Damian Valencia
    • 1
  • Mikhail Petrov
    • 2
  • Juan David Linares
    • 1
  • Mufti M. Rahman
    • 2
  • Nathaniel Dittoe
    • 1
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Internal MedicineKettering Medical CenterDaytonUSA
  2. 2.Department of Internal MedicineNorwalk HospitalNorwalkUSA
  3. 3.Division of Cardiovascular MedicineDepartment of Internal Medicine, Kettering Medical CenterDaytonUSA
  4. 4.Boonshoft School of Medicine, Department of Internal MedicineWright State UniversityDaytonUSA
  5. 5.Kettering Medical CenterDaytonUSA

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