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Identification of Cardiac Sarcoidosis with ¹³N-NH₃/¹⁸F-FDG PET

Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka City University, Osaka, Japan

To our knowledge, no study investigating the usefulness of cardiac PET for detection of myocardial involvement of sarcoidosis is available. We investigated whether ¹³N-NH₃/¹⁸F-FDG PET could identify cardiac involvement in patients with sarcoidosis. Methods: Seventeen patients with cardiac sarcoidosis underwent cardiac ¹³N-NH₃/¹⁸F-FDG PET under fasting condition. Systemic sarcoidosis was diagnosed by histologically proven noncaseating epithelioid granuloma, and cardiac sarcoidosis was diagnosed according to the Japanese Ministry of Health and Welfare guidelines for diagnosing cardiac sarcoidosis. Results: Only 6 patients exhibited myocardial ²⁰¹Tl defects and only 3 patients exhibited abnormal ⁶⁷Ga accumulation in the heart. Thirteen patients exhibited ¹³N-NH₃ defects, and 14 patients exhibited increased ¹⁸F-FDG uptake in the heart; 12 patients exhibited both ¹³N-NH₃ defects and increased ¹⁸F-FDG uptake, 2 patients exhibited increased ¹⁸F-FDG uptake but no ¹³N-NH₃ defect, and 1 patient exhibited ¹³N-NH₃ defects but no increased ¹⁸F-FDG uptake. ¹³N-NH₃ defects were observed frequently in the basal anteroseptal wall of the left ventricle, and increased ¹⁸F-FDG uptake was observed frequently in the basal and midanteroseptal-lateral wall of the left ventricle. Involvement of the apex was rare. Seven patients were treated with steroid hormone and underwent follow-up cardiac PET 1 mo after steroid therapy. ¹³N-NH₃ defects exhibited no significant change after steroid therapy, whereas increased ¹⁸F-FDG uptake was markedly diminished in size and intensity in 5 patients and disappeared completely in 2 patients. Conclusion: Our findings suggest that cardiac ¹³N-NH₃/¹⁸F-FDG PET is the most useful method both for the identification of cardiac involvement of sarcoidosis and for the assessment of cardiac sarcoidosis disease activity.

Key Words: ¹⁸F-FDG • PET • sarcoidosis

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